Background/Purpose: Women with SLE are at increased risk for cervical neoplasia likely due to infection with high risk (HR) HPV and thus should be considered for HPV vaccination. We previously showed qHPV vaccine to be safe and immunogenic in women with SLE. We sought to determine frequency of HRHPV infection and uptake of HPV vaccination in our regional female lupus population. The qHPV vaccine was approved for use in 2006 for women ages 9-26 years.

Methods: Data were analyzed from our electronic health records (EPIC) for women with ICD 10 or ICD 9 billing codes for SLE seen June 6, 2007 – May 1, 2017 at our regional medical center which services a large urban, suburban & rural population. This study was approved by the Central Michigan University/Covenant Medical Center institutional review board. Statistical analyses consisted of student’s t-test, chi square, and Z test for proportions using SPSS v. 24 software.

Results: 1349 women with SLE were seen at our regional medical center, mean age=53 yrs., of which 70.8%=Caucasian, 20.8%=African American, and the rest other race/ethnicity, with 49% having exposure to cigarette smoke. HRHPV testing was performed in only 195 of these women (14.5%, mean age=50 years), of which 33 (16.9%) were positive. Those testing positive for HRHPV were slightly younger (P<0.05) than those testing negative, with no statistical difference in smoking or race between the 2 groups (Table 1).

Table 1: Comparison for Women HRHPV+ vs. HRHPV-  (N=195 tested)

Comparing our proportion testing positive for high risk HPV (0.169) vs. NHANES* (0.088), we calculated a z=3.99 (p<0.001) indicating HPV infection is significantly higher (2X) in our regional female SLE population. Of the 238 women who were eligible to receive an HPV vaccine, only 16.0% (38/238) were tested for HRHPV with 9 being positive, and only 4.6% (11/238) were vaccinated. Of the 11 that were vaccinated, only one woman had testing for HRHPV and this female was positive for HR HPV.

Conclusion:  HPV infection is 2 fold increased in our regional female lupus population compared to population controls. Despite the fact that HPV related cervical disease and neoplasia are increased in women with SLE, the frequency of testing for HRHPV testing is low (14.5%) and vaccination rate even lower (4.6%) in our region. This highlights the importance of the need for monitoring for HRHPV and including HPV vaccination as part of general health care in this vulnerable population. Promoting awareness of this problem with primary care doctors and the lupus community would improve uptake of prophylactic HPV vaccination and be beneficial to gynecologic health in women with SLE.

Reference:* Dunne EF, et al. HPV 6, 11, 16 and 18 prevalence among females in the US-NHANES, 2003–2006: opportunity to measure HPV vaccine impact? J Infect Dis. 2011;204(4):562-5.[DJP1]