Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic, autoimmune, multisystemic disease that affects women of reproductive age. Women with SLE have an increased risk of cervical abnormalities and cervical human papillomavirus (HPV) infection. Studies have investigated risk factors for cervical infection with HPV, with contradictory results. The role of biological therapy on the risk of HPV infection in women with SLE has not been explored.  The objective of our study was to identify the prevalence and factors associated with cervical infection by HPV in women with SLE.

Methods: In this cross-sectional study, we investigated 148 women with SLE. A structured questionnaire was administered to identify traditional and SLE-related disease risk factors. A gynecological evaluation and cervical cytology was made. Polymerase chain reaction for viral DNA was performed for HPV determination. 

Results: The mean (± SD) age and disease duration of SLE patients were 42.5 ± 11.8 years and 9.7 ± 5.3 years, respectively. The prevalence of squamous intraepithelial lesions was 6.8%. The prevalence of HPV infection was 29%, with HVP 18 being the most frequent type (found in 25.5% of  patients without multiple infections). HPV (+) patients were younger than HPV (-) patients (38.2 ± 11.2 vs. 44.2 ± 11.5; p = 0.05) and were receiving a higher daily dose of prednisone (12.8 ± 6.8 mg vs. 9.7 ± 6.7 mg; p = 0.01). In the multivariate logistic analysis, only age at the time of the study was associated negatively with HPV infection (B= 0.04, OR 0.95, 95% CI: 0.95-0.98). There was a non-significant trend to more-frequent administration of immunosuppressive and biologic therapy with rituximab in HPV (+) patients.

Conclusion: Women with SLE, and especially younger patients, had an increased prevalence of cervical HPV infection. Conventional and biologic therapy with rituximab may not influence HPV infections. Screening for HPV infection is recommended in patients with SLE.

Table Sociodemographic, clinical and treatment characteristics of systemic lupus erythematosus patients with and without cervical human papillomavirus infection

Variable	VPH +  (n=43)	VPH – (n=105)	P
Age, mean ± SD DE years	38.2 ± 11.2	44.2 ± 11.5	0.05
Current smoker, n (%)	4 (9.3)	12 (11.4)	0.4
Age at first intercourse, mean ± SD	20.4 ± 3.4	20.5 ± 3.8	0.8
Number of sexual partners, mean ± SD	1.65 ± 1.0	1.42 ±0.8	0.16
Oral contraceptive use, n (%)	1 (2.3)	0 (0)	0.29
Disease duration, mean ± SD years	9.5 ± 6.2	9.8 ± 6.1	0.77
Current medication    Antimalarials, n (%)    Prednisone (mg/d), mean ± SD    Immunosuppressive therapy, n (%)    Azathioprine, n (%)    Methotrexate, n (%)    Leflunomide, n (%)    Mycophenolic acid, n (%)    Rituximab	36 (83.7) 12.8 ±6.8 25 (58.1) 16 (37.2) 5 (11.6) 5 (11.6) 4 (9.3) 7 (16.2)	81 (77.1) 9.7 ± 6.7 57 (54.1) 30 (28.5) 25 (23.8) 6 (4.7) 1 (0.9) 9 (8.5)	0.5 0.01 0.7 0.33 0.17 0.28 0.02 0.24

 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-associated-with-cervical-human-papillomavirus-infection-in-women-with-systemic-lupus-erythematosus-the-role-of-rituximab/