The impact of glucocorticoids and anti-cd20 therapy on cervical human papillomavirus infection risk in women with systemic lupus erythematosus.
OBJECTIVE
To identify the prevalence and factors associated with cervical human papillomavirus infection in women with systemic lupus erythematosus


METHODS
This cross-sectional study collected traditional and systemic lupus erythematosus-related disease risk factors, including conventional and biologic therapies. A gynecological evaluation and cervical cytology screen were performed. Human papillomavirus detection and genotyping were undertaken by PCR and linear array assay.


RESULTS
A total of 148 patients were included, with a mean age and disease duration of 42.5±11.8 years and 9.7±5.3 years, respectively. The prevalence of squamous intraepithelial lesions was 6.8%. The prevalence of human papillomavirus infection was 29%, with human papillomavirus subtype 59 being the most frequent. Patients with human papillomavirus were younger than those without the infection (38.2±11.2 vs. 44.2±11.5 years, respectively; p = 0.05), and patients with the virus had higher daily prednisone doses (12.8±6.8 vs. 9.7±6.7 mg, respectively; p = 0.01) and cumulative glucocorticoid doses (14.2±9.8 vs. 9.7±7.3 g, respectively; p = 0.005) compared with patients without. Patients with human papillomavirus infection more frequently received rituximab than those without (20.9% vs. 8.5%, respectively; p = 0.03). In the multivariate analysis, only the cumulative glucocorticoid dose was associated with human papillomavirus infection.


CONCLUSIONS
The cumulative glucocorticoid dose may increase the risk of human papillomavirus infection. Although rituximab administration was more frequent in patients with human papillomavirus infection, no association was found. Screening for human papillomavirus infection is recommended in women with systemic lupus erythematosus.
Instituto Mexicano del Seguro Social, Systemic Autoimmune Diseases Research Unit, Puebla, Mexico.
Claudia
C
Mendoza-Pinto
Instituto Mexicano del Seguro Social, Systemic Autoimmune Diseases Research Unit, Puebla, Mexico.
Mario
M
Garcia-Carrasco
Molecular Biology and Virology Laboratory, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, MetepecPuebla, Mexico.
Veronica
V
Vallejo-Ruiz
Instituto Mexicano del Seguro Social, Systemic Autoimmune Diseases Research Unit, Puebla, Mexico.
Alejandro
A
Taboada-Cole
Research and Posgraduate, Studies Secretary, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
Margarita
M
Muñoz-Guarneros
Department of Hematology, Instituto Mexicano del Seguro Social, Unidades Médicas de Alta Especialidad, Puebla, Mexico.
Juan Carlos
JC
Solis-Poblano
Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
Elias
E
Pezzat-Said
Immunology Department, Guadalajara, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Jalisco, Mexico.
Adriana
A
Aguilar-Lemarroy
Immunology Department, Guadalajara, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Jalisco, Mexico.
Luis Felipe
LF
Jave-Suarez
Research and Posgraduate, Studies Secretary, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
Luis Vazquez
LV
de Lara
Instituto Mexicano del Seguro Social, Systemic Autoimmune Diseases Research Unit, Puebla, Mexico.
Gloria
G
Ramos-Alvarez
Molecular Biology and Virology Laboratory, Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, MetepecPuebla, Mexico.
Julio
J
Reyes-Leyva
Instituto Mexicano de Seguro Social, Puebla, México.
Aurelio
A
Lopez-Colombo
D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects*; D002584:Cervix Uteri / Q000166:cytology / Q000821:virology; D003430:Cross-Sectional Studies; D004279:DNA, Viral; D005260:Female; D005838:Genotype; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000139:chemically induced* / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012307:Risk Factors; D000069283:Rituximab; D012959:Socioeconomic Factors; D002577:Uterine Cervical Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000821:virology; D014626:Vaginal Smears
D058846:Antibodies, Monoclonal, Murine-Derived; D004279:DNA, Viral; D005938:Glucocorticoids; D007155:Immunologic Factors; D000069283:Rituximab