Human papillomavirus type 18 infection in a female renal allograft recipient: a case report.
BACKGROUND
Human papillomavirus type 18 is the second most common cause of cervical cancer and is found in 7 to 20 % of cases of cervical cancer. The oncogenic potential of high-risk human papillomavirus is associated with expression of early proteins E6 and E7. Due to long-term immunosuppressive therapy, renal transplant recipients have a higher risk of developing persistent human papillomavirus infection.


METHODS
A 29-year-old white woman from Latvia with chronic focal segmental glomerulosclerosis received renal allograft transplantation and was prescribed immunosuppressive therapy with cyclosporine, prednisolone, and mycophenolate mofetil. Two weeks after renal transplantation, her cervical swab was positive for human papillomavirus consensus sequences. After 6 months, quantitative polymerase chain reaction showed a high viral load of 3,630,789 copies/105cells of high-risk human papillomavirus type 18 and expression of E6 and E7 oncogenes in her cervical swab and urine sample. One year after renal transplantation, the viral load in her cervical swab increased significantly to 7,413,102 copies/105cells. Messenger ribonucleic acid of human papillomavirus type 18 E6 and E7 oncogenes were also detected. Shortly after this, she had an unsuccessful pregnancy which resulted in a spontaneous abortion at 6/7 weeks. Two months after the abortion her viral load sharply decreased to 39 copies/105cells. Oncogenes E6 and E7 messenger ribonucleic acid expression was not observed in this period.


CONCLUSIONS
This case report represents data which show that immunosuppressive therapy may increase the risk of developing persistent high-risk human papillomavirus infection with expression of E6 and E7 oncogenes in renal transplant recipients. However, even during this therapy the immune status of a recipient can improve and contribute to human papillomavirus viral load reduction. Spontaneous abortion can be considered a possible contributory factor in human papillomavirus clearance.
August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia. maksims.cistjakovs@rsu.lv.
Maksims
M
Cistjakovs
August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia.
Alina
A
Sultanova
August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia.
Olga
O
Jermakova
August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia.
Svetlana
S
Chapenko
Gynecology and Maternity Unit, Pauls Stradins Clinical University Hospital, Riga, Latvia.
Baiba
B
Lesina-Korne
Transplant Research Laboratory, Riga Stradins University, Riga, Latvia.
Rafail
R
Rozental
Gynecology and Maternity Unit, Pauls Stradins Clinical University Hospital, Riga, Latvia.
Dace
D
Razeberga
August Kirchenstein Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia.
Modra
M
Murovska
Transplant Research Laboratory, Riga Stradins University, Riga, Latvia.
Ieva
I
Ziedina
D000022:Abortion, Spontaneous / Q000276:immunology* / Q000821:virology; D000328:Adult; D004268:DNA-Binding Proteins; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000276:immunology / Q000601:surgery*; D061809:Human Papillomavirus DNA Tests; D052161:Human papillomavirus 18 / Q000302:isolation & purification*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D009856:Oncogene Proteins, Viral; D030361:Papillomavirus Infections / Q000150:complications / Q000276:immunology*; D011183:Postoperative Complications / Q000276:immunology / Q000821:virology*; D011247:Pregnancy; D012333:RNA, Messenger; D012367:RNA, Viral; D014626:Vaginal Smears; D019562:Viral Load; D014775:Virus Activation
D004268:DNA-Binding Proteins; C052603:E6 protein, Human papillomavirus type 18; D007166:Immunosuppressive Agents; D009856:Oncogene Proteins, Viral; D012333:RNA, Messenger; D012367:RNA, Viral
Case report; HPV-18; Immunosuppressive therapy; Renal allograft transplantation