Background Persistent infection by high-risk oncogenic Human Papillomavirus (HPV) is the main cause of the development of dysplastic or malignant lesions of the cervix. Furthermore, a few life habits, such as smoking, sexual habits and hormonal contraception, are known risk factors for cervical HPV infection. In addition, increased frequency of persistent HPV infection or high-grade intra-epithelial lesions rates was anecdotally described in patients affected by immune-mediated diseases, such as systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis (SSc), in comparison with the general population.
Objectives To determine the prevalence of persistent HPV infection in an SSc patients series and its possible correlation with the disease clinical features.
Methods The study retrospectively evaluated 52 consecutive female SSc patients (age 56.7±11.2SD years, disease duration 12.1±7.4SD years), classified according to the ACR/EULAR 2013 criteria, referring to our university-based Rheumatology Unit. Detection of HPV DNA and viral genotyping in cervical swabs were carried out. Moreover, abnormal Papanicolau test smears were classified using the Bethesda system.
Results Fourteen(26.9%) patients presented a cervical swab positive for HPV infection,including12 infected by high risk or probable-high risk HPV types. Six (11.5%) patients presented multiple infection (≥2 HPV types), including one case with high-grade intra-epithelial lesion.
Only tabagism was significantly correlated to HPV infection; namely,smoking habit was observed in 41.6% of SSc patients with and in 21.7% of those without HPV infection, respectively; p=0.006); moreoverimmunesuppressive therapies, namely mofetil mycophenolate, cyclophosphamide or rituximab, tended to be associated withHPV infection (presence/absence 21.4 vs 21.7%; p=0.055).
More interestingly, amongSSc patients over 50, HPV infection was found in 9/38 (23.7%) individuals, a frequency markedly higher than that expected in age-matched general population from the same geographical area (5%).
Conclusions Persistent HPV infection was observed in over a quarter of SSc patients, notably in women over 50. The HPV positivity was not related to SSc clinical features, while a significant association with tabagism and immunesuppressive therapies was evidenced. Considering the possible clinico-prognostic implication on the overall disease outcome, routinely gynaecological screening of SSc female patients ishighly recommendable.
Disclosure of Interest None declared