Human papillomavirus (HPV) seroprevalence, cervical HPV prevalence and cervical lesions in systemic lupus erythematosus (SLE) and immunocompetent women

Introduction Women with systemic lupus erythematosus (SLE) have increased prevalence of precancer cervical squamous intraepithelial lesions (SIL). This study aimed to compare human papillomavirus (HPV) seroprevalence, cervical HPV-DNA detection and HPV-related cervical lesions between SLE and immunocompetent women. Methods In this cross-sectional study, women aged 18–45 years with SLE receiving immunosuppressive or disease-modifying antirheumatic drugs were compared with immunocompetent women, selected from the same hospital in Sao Paulo, Brazil. Eligible participants had no self-reported history of genital warts or any other HPV-related cervical, vaginal or vulvar lesions, nor received prior HPV vaccination. Cervical samples were tested for HPV-DNA using PapilloCheck and for SIL lesions by liquid-based cytology. A multiplex pseudovirion-based serology assay (PsV-Luminex) measured serum antibodies against eight of the HPV types targeted by non-valent (9vHPV) HPV vaccine. Results A total of 122 women with SLE and 132 immunocompetent women (mean age 34.3 and 32.5 years, respectively) were enrolled. Compared with immunocompetent women, SLE participants had higher prevalence of HPV-related cervical lesions (low-grade and high-grade SIL combined, 11.3% vs 2.4%, p=0.009), higher prevalence of at least one cervical HPV type (38.8% vs 20.2%, p=0.003), non-significantly higher prevalence of cervical high-risk HPV types (23.5% vs 14.9% p=0.286) and higher HPV seroprevalence to eight HPV types included in the 9vHPV vaccine (80.4% vs 59.7%, p=0.001). Conclusion Our findings underscore the importance of tailored cervical cancer screening and HPV vaccination of SLE women at young age.