Human papilloma virus-related premalignant and malignant lesions of the cervix and anogenital tract in immunocompromised women.

Abstract

The number of immunocompromised patients is rising, and immunodeficiency is an independent risk factor for the development of premalignant and malignant lesions of the cervix and anogenital tract. The aim of this review was to summarize and update data on human papilloma virus (HPV) infections and HPV-based anogenital lesions detected in patients who were immunocompromised due to both organ transplantation and human immunodeficiency virus (HIV) infection. The incidence of HPV infections among solid organ recipients and HIV positive females is reported to be significantly higher when compared with age-matched healthy controls- i.e. higher by up to 65% and 46.6% respectively, vs 38% in the controls. These infections are also more often chronic, high risk HPV and multitype. Data suggest that HPV infections in these patients might not only occur more frequently, but that the course of the infection might also lead to faster oncogenesis. However, the treatment options for malignancies are limited; and this implies the need for intense primary and secondary prevention regimens. As infections with HPV types other than 16 and 18 and multitype infections are particularly frequently discovered in immunocompromised patients, they would probably benefit most from a nonavalent vaccine. Gynecological screening should be performed annually, including cervical smears and/ or HPV testing. In the group of non-responders, self-sampling methods should be considered.