High risk of human papillomavirus type 16 infections and of development of cervical squamous intraepithelial lesions in systemic lupus erythematosus patients.
OBJECTIVE
To determine rates of human papillomavirus (HPV) infections, abnormal cervical smears, and squamous intraepithelial lesions (SIL) among women with systemic lupus erythematosus (SLE).


METHODS
We investigated 30 women with SLE, 67 with abnormal smears from colposcopy clinics, and 15 community subjects with normal smears. Polymerase chain reaction results for viral DNA and HPV-16 sequencing data were correlated to cytology and colposcopic findings.


RESULTS
SLE and colposcopy patients were more likely (P < 0.05) to be HPV positive (15 [54%] and 37 [67%] patients, respectively) and HPV-16 DNA positive (16 [57%] and 17 [31%] patients, respectively) than community subjects (0% HPV DNA positive and 1 [6%] HPV-16 DNA positive). SLE patients were also more likely to be HPV-16 DNA positive than colposcopy patients (P < 0.05). SLE patients with a high HPV-16 viral load more frequently had SIL (n = 6) than those with a low HPV-16 viral load (n = 1; P < 0.05). HPV and HPV-16 DNA positivity were not associated with previous or current drug therapy for SLE patients. All HPV-16 DNA sequences from 6 SLE and 5 colposcopy patients were the European-type variant. Eighteen (60%) SLE patients had a previous or current cervical abnormality. At the time of study, 5 (17%) SLE patients had an abnormal cervical smear and 8 (27%) had SIL. For those diagnosed with SLE for >10 years, the rate of SIL was 44% lower than those with SLE for <5 years (odds ratio 0.56, 95% confidence interval 0.1-3.5).


CONCLUSIONS
UK women with a recent SLE diagnosis had disturbingly elevated levels of HPV infections (particularly with European HPV-16 variants at a high viral load), abnormal cervical cytology, and SIL.
Nath
Rahul
R
St Thomas' Hospital, London, UK.
Mant
Christine
C
Luxton
Jennifer
J
Hughes
Graham
G
Raju
K Shanti
KS
Shepherd
Phillip
P
Cason
John
J
D000293:Adolescent; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D003127:Colposcopy; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000453:epidemiology*; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000473:pathology; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D019562:Viral Load; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000473:pathology / Q000821:virology
D004279:DNA, Viral; D007166:Immunosuppressive Agents