Prevalence of high‐risk HPV and atypia in liquid‐based cytology of cervical and intra‐anal specimens from kidney‐transplanted women

Abstract

Background: There is a high frequency of human papillomavirus (HPV)-induced lesions in cervix and anus of immunosuppressed patients. However, few studies have evaluated these lesions in kidney-transplanted women.Methods: This cross-sectional study examined 31 kidney-transplanted women receiving immunosuppressive therapy at the General Hospital of Fortaleza in Brazil. Cervical and anal samples were collected and preserved in order to perform liquid-based cytology and a real-time polymerase chain reaction assay detecting high-risk HPV. Results: The patients' ages ranged from 31 to 70 years (mean: 42.6 ± 10.4). The age of sexual debut varied from 14 to 30 years (mean: 19.7 ± 3.8). Cervical cytology was diagnosed as atypical in 25.8% of cases (atypical squamous cells of undetermined significance [ASC-US] in 2 [6.2%], atypical squamous cells, but unable to exclude a high-grade squamous intraepithelial lesion in 1 [3.1%], low-grade squamous intraepithelial lesion [LSIL] in 4 [12.4%], and squamous cell carcinoma in 1 [3.1%]). Anal cytology was atypical in 35.4% of cases (ASC-US in 1 [3.2%]and LSIL in 7 [21.7%]). The presence of cervical HPV was confirmed in 22.5% of patients, and anal HPV was found in 48.8% of the cases. The relative risk of atypical anal cytology in cases of atypical cervical cytology was 4.37 (1. 35-14.20). High-risk cervical HPV did not significantly increase the risk of having atypical anal cytology. However, for HPV in the anus, this was associated with a relative risk of 10.18 (1.45-71.54).Conclusion: High-risk HPV and atypical cytology are very common in the cervix and anus of kidney-transplanted women. Furthermore, the presence of HPV in an anal sample correlates with an increased risk of atypical anal cytology. HPV tests could be useful tools for identifying patients who require anal cytology.

Burden of anal squamous cell carcinoma, squamous intraepithelial lesions and HPV16 infection in solid organ transplant recipients: A systematic review and meta-analysis

“…Prevalence of HPV16 genotyping from anal cytology/swabs was reported in 4 studies, on a total of 254 samples (Figures 1B and 3A; Table S4). Studies were conducted in the United Kingdom, 25 Poland, 26 Australia, 16 and Brazil 27 . Three studies were in a kidney 25,27 and 1 in a liver transplant cohort 26 .…”

“…Six studies and a total of 328 satisfactory samples were included in final analyses (Figures 1C and 3B; Table S5). Two studies were conducted in the United States 28,29 and 1 each in the United Kingdom, 25 Portugal, 30 Australia, 16 and Brazil 27 all using liquid‐based cytology. Four studies were in a kidney transplant cohort, 25,27,28 1 was in a liver transplant cohort, 30 and 1 in a mixed cohort of kidney, pancreas, and liver transplants 29 .…”

“…Studies were conducted in the United Kingdom, 25 Poland, 26 Australia, 16 and Brazil. 27 Three studies were in a kidney 25,27 and 1 in a liver transplant cohort. 26 None of the studies included a healthy control group.…”

“…Two studies were conducted in the United States 28,29 and 1 each in the United Kingdom, 25 Portugal, 30 Australia, 16 and Brazil 27 all using liquid-based cytology. Four studies were in a kidney transplant cohort, 25,27,28 1 was in a liver transplant cohort, 30 and 1 in a mixed cohort of kidney, pancreas, and liver transplants. 29 Of note, all studies had unsatisfactory sample rates lower than 15%, except the study by Khan et al 29 with an unsatisfactory sample rate of 19% (data not shown).…”

Association of Infection With Human Papillomavirus and Development of End-Stage Kidney Disease in Taiwan

“…Thus, pretransplant vaccination and HPV screening in kidney transplant recipients are crucial. 25 Because ESKD is frequently a cause of future kidney transplantation and HPV reactivation is an important issue in kidney transplantation, it is reasonable to examine the associations between history of HPV infection and subsequent development of ESKD. To further explore the association between HPV and ESKD, we analyzed a large longitudinal, nationwide cohort.…”