Systemic lupus erythematosus, human papillomavirus infection, cervical pre-malignant and malignant lesions: a systematic review

Abstract

The purpose of this study was to review and evaluate systematically the scientific evidence on the relationship between systemic lupus erythematosus (SLE), human papillomavirus (HPV) infection, pre-cancerous cervical abnormalities, and cervical cancer. Establishing strict inclusion and exclusion criteria, we performed an extensive search for studies in MEDLINE and BIREME databases to assess the studies that evaluated the frequency of HPV infection, pre-cancerous cervical abnormalities, and cervical cancer in women with SLE. Secondary references were additionally obtained from the included articles. Thirty-three articles met the criteria previously established. Fifteen out of 18 studies that performed cytological analysis showed a higher frequency of squamous intraepithelial lesions in SLE patients compared with normal women. Moreover, three studies found a higher frequency of high-grade squamous intraepithelial lesions. Additionally, it was observed that women with SLE had a higher frequency of HPV infection, confirmed by molecular biology techniques. Curiously, despite the above findings, no increased frequency of cervical cancer was observed in the majority of the studies which addressed this issue. Five studies observed a relationship between cervical abnormalities and previous use of immunosuppressive drugs. This review suggests that SLE patients seem not to be at increased risk for developing cervical cancer; however, they should be considered at higher risk for HPV infection and cervical dysplasia than the general population. Thus, gynecological visits at shorter intervals seem to be a reasonable approach for those patients.

Prevalence of cutaneous warts in patients with systemic lupus erythematosus: a systematic review

“…Some of the previous studies have shown an increased prevalence of genital HPV infection in patients with SLE [14,15]. Similarly, the four selected articles for this review also showed a high prevalence of CW in SLE patients compared to the control group.…”

Pregnancy and menopause in patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome: practical guide from EULAR

“…[73][74][75] A relationship between cervical abnormalities and previous use of immunosuppressive drugs, particularly those exposed to cyclophosphamide in a cumulative dose-dependent way, has been reported. 76,77 Thus, a preventive counseling about cancer surveillance appears relevant in sexually active patients with SLE who receive immunosuppressive therapy, and gynecologic visits at shorter intervals than in general population seem to be a reasonable approach in these patients.…”

Evidence of a higher prevalence of HPV infection in HTLV-1-infected women: a cross-sectional study

“…These immunological abnormalities and the highest exposure to risk factors common to HTLV-1 and HPV could explain the high prevalence of HPV infection 31 . Other immunosuppressive diseases are also associated with a high prevalence of HPV infection, such as HIV infection 20 and systemic lupus erythematosus 32 . However, no difference was found in the proportion of CD4-T lymphocytes and in the HTLV-1 proviral load of HTLV-1-infected patients with HPV, compared with HTLV-1-infected women.…”

“…infection among HTLV-infected and uninfected groups when women were stratified into age ranges (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), 36-45, 46-55, and 56-65 years). Four positive cases of HPV infection (18.2%) were observed in HTLV-infected women with 46-55 years, whereas none was found in the control group at same age (p = 0.31) (data not shown).…”