Background/Purpose: Persistent human papillomavirus (HPV) infection is the cause of cervical cancer. Patients with immune-mediated inflammatory diseases (IMIDs) exposed to immunosuppressive therapy are at increased risk of persistent HPV infection. HPV vaccination is safe, prevents the onset of cervical cancers and reduces the mortality related to cervical cancer. HPV vaccination coverage is however worryingly low in IMIDs patients. 

We aimed to assess the knowledge and drivers of HPV vaccination among patients with IMIDs in France based on a questionnaire survey.

Methods: A cross-sectional survey was conducted between April 1 and May 31, 2024, in France to analyze IMIDs patients’ knowledge and drivers of HPV vaccination. The questionnaire was anonymized and distributed through i) QR code format in patients attending in-person appointments at a tertiary care center in Paris, ii) patients mailing list and iii) networks of national associations dedicated to IMIDs patients. Data on knowledge and drivers of HPV vaccine were collected through 19 queries. Partially filled surveys (< 60% of answers completed) and patients without IMIDs were excluded.

Results: A total of 389 patients participated to the study. After exclusion of partially filled surveys (n=28) and patients without IMIDs (n=11), a total of 350 questionnaires were completed and analyzed. Patients were mostly women (n=301/350, 86%). The distribution of age was as follows: < 20 years (n=5/350, 1%), 20-40 years (n=88/350, 25%), 41-65 years (n=198/350, 57%) and > 65 years (n= 59/350, 17%). Patients self-reported IMIDs that were mostly systemic lupus (n= 87/350, 25%), Sjögren syndrome (n= 63/350, 18%), immune‐mediated myositis (n= 43/350, 12%), systemic vasculitis (n= 38/350, 11%), systemic sclerosis (n=37/350, 11%) and myasthenia gravis (n=37/350, 11%).

Only 26 patients (n=26/350, 7%) reported routine HPV vaccination. Almost 20% (n=66/350) of patients did not know that cervical cancer is caused by HPV, 53% (n=186/350) were unaware that HPV infection is more prevalent in immunosuppressed patients and 23% (n=81/350) ignored the existence of an effective vaccine. Around 10% of patients (n=35/350) falsely believed that IMIDs contraindicated HPV vaccination and 33% (n=116/350) did not know that HPV vaccination might be proposed in young adults.

Although HPV vaccine is most effective when administered prior to any HPV exposure, 50% of patients (n=151/303) would accept catch up vaccination while 31% (n=94/303) expressed vaccine hesitation. Concerns about potential side effects following vaccination were expressed by 44% of patients (n=140/320). Eventually, 66% of patients (n=199/303) would be more likely to be vaccinated if the advice came from a rheumatologist. 

Conclusion: More than 90% of IMIDs patients are not vaccinated against HPV. Our survey shows that knowledge on HPV infection and vaccination is extremely limited, knowing that concerns and expectations of IMIDs patients regarding HPV vaccination should be addressed to improve prevention of HPV-related diseases.

« Back to ACR Convergence 2024

ACR Meeting Abstracts - https://acrabstracts.org/abstract/national-survey-on-patients-knowledge-and-drivers-of-human-papillomavirus-hpv-vaccination-in-immune-mediated-inflammatory-diseases-imids/