High Prevalence of Genital Human Papillomavirus Infection in Patients With Primary Immunodeficiencies

Michael Gernert,Matthias Fröhlich,Eva Christina Schwaneck,Patrick-Pascal Strunz,Marc Schmalzing,Hans-Peter Tony,Regina Renner,Matthias Kiesel,Jan Portegys

doi:10.3389/fimmu.2021.789345

Abstract

BackgroundGenital human papillomavirus (HPV)-infections are common in the general population and are responsible for relevant numbers of epithelial malignancies. Much data on the HPV-prevalence is available for secondary immunodeficiencies, especially for patients with human immunodeficiency virus (HIV)-infection. Little is known about the genital HPV-prevalence in patients with primary immunodeficiencies (PIDs).MethodsWe performed a cross-sectional study of patients with PIDs and took genital swabs from male and female patients, which were analyzed with polymerase chain reaction for the presence of HPV-DNA. Clinical and laboratory data was collected to identify risk factors.Results28 PID patients were included in this study. 10 of 28 (35.7%) had HPV-DNA in their genital swabs. 6 patients had high-risk HPV-types (21.4%). Most patients had asymptomatic HPV-infections, as genital warts were rare (2 of 28 patients) and HPV-associated malignancy was absent. Differences in the HPV-positivity regarding clinical PID-diagnosis, duration of PID, age, sex, immunosuppression, immunoglobulin replacement, or circumcision in males were not present. HPV-positive PID patients had higher numbers of T cells (CD3+), of cytotoxic T cells (CD3+/CD8+), of transitional B cells (CD19+/CD38++/CD10+/IgD+), and of plasmablasts (CD19+/CD38+/CD27++/IgD-) compared to HPV-negative.ConclusionPID patients exhibit a high rate of genital HPV-infections with a high rate of high-risk HPV-types. Regular screening for symptomatic genital HPV-infection and HPV-associated malignancy in PID patients seems recommendable.

Highlights

Genital human papillomavirus (HPV)-infections are common in the general population and are responsible for relevant numbers of epithelial malignancies
Autoimmune features of primary immunodeficiency (PID) were seen in 39.3% of the patients, lymphoproliferation in 46.4%, and granulomatous lesions in 35.7%
We describe a cohort of patients with primary immunodeficiencies, who exhibit a high rate of HPV-positivity in genital swabs

Summary

Introduction

Genital human papillomavirus (HPV)-infections are common in the general population and are responsible for relevant numbers of epithelial malignancies. Low-risk types are type 6 and 11, for example These are found in genital warts (condylomata acuminata) and usually do not cause malignancies. The high-risk types cause precancerous lesions like cervical intraepithelial neoplasia (CIN), and vulvar, vaginal, anal, and penile intraepithelial neoplasia (VIN, VAIN, AIN, and PIN, respectively). Those lesions can progress into the respective invasive cancers with cervical cancer being the fourth most common cancer in women worldwide [4]. These HPV-types are named probably or possibly carcinogenic [3]

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