Lupus and HPV
- High risk of human papillomavirus type 16 infections and of development of squamous intraepithelial lesions in systemic lupus erythematosus patients
- Arthritis & Rheumatism, Volume 57, Number 4, May 2007, pp. 619 - 625
What is the topic?
Human papillomavirus (HPV) has been the subject of growing public attention, not only because of its link to cervical cancer, but also because of the recent approval of two vaccines that may help protect young women against cervical cancer. HPV has a number of different types, and infections with HPV type 16 and type 18 are most commonly associated with cervical cancer. Even minor genetic differences within the same type of HPV can greatly affect their cancer-causing potential. Previous studies have suggested that women with lupus may not be able to produce an effective immune response to HPV. There are also studies reporting that women with lupus have a heightened risk of developing abnormal PAP smears and early changes that put them at risk for cervical cancer.
What did the researchers hope to learn?
The researchers wanted to determine whether lupus patients are at enhanced risk of HPV infections, in particular the more serious sub-types of HPV, and if so, was this heightened risk related to the use of immunosuppressive therapies (including steroids) to control lupus disease activity.
Who was studied?
Three groups of women were studied: 30 who had been diagnosed with lupus, 67 non-lupus patients with abnormal cervical smears, and 15 community volunteers who had normal cervical smears. The 30 lupus patients and the 67 non-lupus patients with abnormal cervical smears were randomly selected from clinics at the same regional hospital in London; the community volunteers were from the same locality.
How was the study conducted?
The researchers obtained PAP smear samples from all the women in the study. They used a gene-detection technique called polymerase chain reaction (PCR) to determine the types of HPV in the cervical cells.
What did the researchers find?
The researchers found that the women with lupus had a very high rate of infection with a particular sub-type of HPV-16, and those lupus patients who had large amounts of this virus had a higher rate of abnormal cervical smears. They also found a much higher rate of abnormal PAP smears among lupus patients than previously reported, with the rate significantly higher among women in the first five years following their diagnosis than for those who had lupus for more than 10 years.
The researchers also noted that lupus patients with normal smears were more likely to be receiving hydroxychloroquine (Plaquenil) than those with abnormal smears; since hydroxychloroquine is used to manage mild cases of lupus, they concluded that cervical disease is associated with either more severe lupus or more potent drugs. They were unable to demonstrate any further associations of cervical disease with specific treatments, which contrasted with reports from other studies.
What were the limitations of the study?
The researchers pointed out several limitations to their study, most notably the small number of patients with lupus and the fact that all had active disease and were receiving treatment. It is unclear whether this finding was from lupus or the treatments, this study was simply too small to determine that. Although people with mild lupus are likely to be treated with hydroxychloroquine, this treatment is not necessarily stopped in people with more severe illness, as other treatments are added on. It is not possible to interpret the relationship that they found between better outcomes and Plaquenil at this time.
What do the results mean for you?
Despite its limitations, the study does provide further evidence that women with lupus are at greater risk for HPV-16 infection and the subsequent pre-cancerous cervical abnormalities that have been linked to HPV. It suggests that women with lupus should be investigated regularly for these cervical changes, especially in the first five years following their lupus diagnosis.