Background/Purpose: The most common cause of cervical cancer is persistent human papillomavirus (HPV) infection in the cervical epithelium, causing precancerous cervical dysplasia and ultimately cervical cancer in a complex oncogenic pathway. HPV is commonly cleared by the immune system; however, an impaired immune system can facilitate the persistence of HPV infection in the cervix leading to increased risk of progression to cervical dysplasia and cancer. Women with autoimmune diseases have impaired immune systems through the presence of both rheumatic disease and immunosuppressive medications, and increased rates of cervical dysplasia have been reported in women with systemic lupus erythematous and rheumatoid arthritis. However, women with systemic vasculitis have not been included in these analyses. This study aims to fill this gap and evaluate the risk of cervical dysplasia in the female vasculitis population.

Methods: We performed a retrospective chart review of the women with vasculitis at The Ohio State University Wexner Medical Center. Criteria for inclusion included: female, diagnosis of vasculitis, documented Papanicolau (Pap) smear after date of vasculitis diagnosis and in years 2010-2019.

Results: We identified 119 patients for inclusion in this study. Of the 254 total Pap smears, 44 pap smears (17% of 254) in the 119 patients had abnormal results. Of the 254 Pap smears analyzed, 26 pap smears (10%) in 16 patients showed Atypical Squamous Cells of Undetermined Significance (ASC-US), 15 (6%) in 10 patients had Low-Grade Squamous Intraepithelial Lesion (LSIL), and 1 each resulted with Atypical Squamous Cells-Cannot Rule Out High Grade Squamous Intraepithelial Lesion, High-Grade Squamous Intraepithelial Lesion, and Squamous Cell Carcinoma. Additionally, 112 of the Pap smears were also tested for high-risk HPV, and nearly 20% (21 Pap smears in 85 patients) tested positive for this.

Conclusion: Out study show insights into the prevalence of cervical dysplasia and HPV infection in the female vasculitis population. The United States incidence of abnormal Pap smears is 4% with 2.8% resulting as ASC-US and 0.97% as LSIL; we found more than quadruple the rate of ASCUS and six-fold the rate of LSIL in our study population. We found a higher rate of high-risk HPV-positive pap smears in our vasculitis patient population compared to the 11% reports for SLE patients in prior studies. These elevated rates of cervical abnormalities should be considered for cervical cancer screening recommendations in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cervical-dysplasia-and-hpv-infection-in-women-with-vasculitis/