Background/Purpose: Human papillomavirus (HPV) is responsible for 99.7% of cervical neoplasms and is the fourth most common cancer among women worldwide. Patients with systemic lupus erythematosus (SLE) have been shown to have a higher prevalence of HPV infection than the general population, with a greater frequency of high-risk serotypes and intraepithelial squamous lesions (SIL), particularly high-grade lesions (H-SIL). While an association has been described between immunosuppressive treatment and cyclophosphamide use, there is limited evidence on HPV progression in patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs).Our objectives were to assess the relationship between HPV infection and biologic therapy in SLE patients, as well as with factors associated with SLE disease course and HPV progression. To determine the prevalence of HPV infection in a Spanish cohort of SLE patients receiving biologic therapy.

Methods: We conducted a retrospective, multicenter, cross-sectional study including 232 women with SLE treated with bDMARDs. Clinical, laboratory, and treatment-related variables associated with SLE and HPV infection were reviewed. Logistic regression analysis was performed to evaluate associations between HPV infection, SLE-related disease activity, and HPV progression.

Results: A total of 232 women with SLE were included, with a mean age of 46 years. HPV infection was identified in 9.9% (n=23) of patients. Among infected patients, 65.5% (n=19) had SIL (53.9% L-SIL [n=7]; 46.2% H-SIL [n=6]). Two patients (2.1%) developed cervical cancer. All patients had received at least one bDMARD (100%); 52 patients (22.41%) received two, and 3 patients (1.29%) received three different bDMARDs. Among HPV-infected patients, three had received more than one biologic agent. No statistically significant associations were found between HPV infection, biologic therapy, SLE disease-related variables (SLEDAI, SLICC, number of previous flares, disease duration), or risk factors for HPV progression (smoking, leukopenia).No significant associations were observed between HPV infection and the analyzed potential risk or progression factors. The cohort included a homogeneous group of patients with high SLE activity but lacked a control group, which may limit the interpretation of associations. Additionally, socioeconomic data—potentially relevant to HPV risk—were not available. The observed HPV prevalence (9.9%) was lower than previously reported in Spain (14.3%), potentially influencing the absence of significant associations. This may be due to low screening adherence among patients, though data were insufficient to confirm this hypothesis.

Conclusion: The prevalence of HPV infection in this cohort was 9.9%, with 65.5% of HPV-positive patients presenting SIL and two cases of cervical cancer (2.1%). No significant associations were found between HPV infection, biologic therapy, SLE-related disease parameters, or HPV progression. HPV prevalence in this cohort was lower than the general prevalence reported in Spain.

Table 1. Baseline characteristics of the cohort

Table 2. Use of bDMARDs

Table 3. Logistic regression analysis between HPV+ status and potential risk factors

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/human-papillomavirus-infection-and-systemic-lupus-erythematosus-under-biologic-therapy-a-retrospective-analysis-in-a-multicenter-cohort/