P1187Human Papillomavirus Epidemiology in Anti-TNFα–Treated Women: Contrasting Patterns Between Inflammatory Bowel Disease Patients and Rheumatoid Arthritis

Abstract Background Human papillomavirus (HPV) infection is a significant concern for women receiving anti-tumor necrosis factor alpha (anti-TNFα) therapy. However, comparative data on HPV prevalence in inflammatory bowel disease (IBD) patients versus those with rheumatoid arthritis (RA) receiving the same immunosuppressive treatment are limited. This study aimed to assess overall HPV positivity, the prevalence of high-risk HPV subtypes (HPV16/18), and cervical cytology findings in women with IBD and RA treated with anti-TNFα. It also sought to explore whether differences in sexual function may account for the observed variations. Methods This cross-sectional study included 47 women with IBD and 39 women with RA who had been treated with anti-TNFα therapy for at least 6 months. All participants underwent HPV DNA testing and Papanicolaou (PAP) cytology. Sexual activity was evaluated using the Female Sexual Function Index (FSFI). Statistical analyses were performed using chi-squared tests and independent-sample t-tests. Results HPV positivity was significantly lower in IBD patients compared to those with RA (approximately 21% 10 out of 47 vs. 43% 17 out of 39; p 0.05). The detection of high-risk HPV16/18 subtypes was much less frequent in IBD patients (5% 2 out of 47) than in RA patients (21% 8 out of 39; p 0.01). No significant differences were found in the rates of premalignant or malignant PAP abnormalities between the two groups (IBD: 6% vs. RA: 8%; p 0.05). FSFI scores were significantly lower in women with IBD, indicating reduced sexual function and lower levels of sexual activity compared to those with RA (mean FSFI: 18.3 ± 5.1 vs. 22.9 ± 4.7; p 0.01). The frequency of sexual intercourse showed a moderate inverse correlation with HPV detection (r = −0.41; p 0.01). Conclusion Women with IBD receiving anti-TNFα therapy demonstrated a significantly lower prevalence of HPV infection and fewer high-risk HPV16/18 subtypes compared to women with RA treated with the same biologic therapy. Cervical cytological abnormalities did not differ between the two groups. The lower levels of sexual activity in IBD patients, as reflected by reduced FSFI scores, may partially explain their decreased exposure to HPV. These findings highlight the importance of including sexual health assessments when evaluating HPV risk in women undergoing long-term immunosuppressive therapy. References: Ricci C, Scaldaferri F, Colombo F, Armuzzi A, Lopetuso LR, Leone S, Gasbarrini A, Scambia G, De Vincenzo RP. Prevalence of cervical HPV and attitude towards cervical screening in IBD patients under immunomodulatory treatment: a multidisciplinary management experience. Eur Rev Med Pharmacol Sci. 2020 Jan;24(2):564-570. Szydlarska D, Jakubowska A, Rydzewska G. Assessment of sexual dysfunction in patients with inflammatory bowel disease. Prz Gastroenterol. 2019;14(2):104-108. doi: 10.5114/pg.2019.85893. Waisberg MG, Ribeiro AC, Candido WM, Medeiros PB, Matsuzaki CN, Beldi MC, Tacla M, Caiaffa-Filho HH, Bonfa E, Silva CA. Human papillomavirus and chlamydia trachomatis infections in rheumatoid arthritis under anti-TNF therapy: an observational study. Rheumatol Int. 2015 Mar;35(3):459-63. Conflict of interest: Dr. Mitrovic, Milos: No conflict of interest Knezevic, Tamara: No conflict of interest Kalaba, Ana: No conflict of interest Odanovic, Olga: No conflict of interest Kralj, Djordje: No conflict of interest Markovic, Srdjan: No conflict of interest