Increased risk of cervical dysplasia in females with autoimmune conditions-Results from an Australia database linkage study.

Emma Foster,Joe Sasadeusz,Anneke Van Der Walt,Finlay Macrae,Helmut Butzkueven,Vilija G Jokubaitis,Julia M L Brotherton,Gary Unglik,C David H Wrede,Sharon Van Doornum,Michael J Malloy,Magdalena Grce

doi:10.1371/journal.pone.0234813

Abstract

BackgroundAutoimmune conditions (AICs) and/or their treatment may alter risk of human papilloma virus (HPV) infection and females with AICs are therefore at an increased risk of cervical dysplasia. However, inclusion of these at-risk populations in cervical cancer screening and HPV-vaccination guidelines, are mostly lacking. This study aimed to determine the prevalence of cervical dysplasia in a wide range of AICs and compare that to HIV and immunocompetent controls to support the optimisation of cervical cancer preventive health measures.MethodsData linkage was used to match cervical screening episodes to emergency department records of females with AICs or HIV to immunocompetent controls over a 14-year period. The primary outcome was histologically confirmed high-grade cervical disease. Results, measured as rates by cytology and histology classification per 1,000 females screened, were analysed per disease group, and intergroup comparisons were performed.ResultsFemales with inflammatory bowel disease (2,683), psoriatic and enteropathic arthropathies (1,848), multiple sclerosis (MS) (1,426), rheumatoid arthritis (1,246), systemic lupus erythematosus and/or mixed connective tissue disease (SLE/MCTD) (702), HIV (44), and 985,383 immunocompetent controls were included. SLE/MCTD and HIV groups had greater rates of high-grade histological and cytological abnormalities compared to controls. Increased rates of low-grade cytological abnormalities were detected in all females with AICs, with the exception of the MS group.ConclusionsFemales with SLE/MCTD or HIV have increased rates of high-grade cervical abnormalities. The increased low-grade dysplasia rate seen in most females with AICs is consistent with increased HPV infection. These findings support expansion of cervical cancer preventative programs to include these at-risk females.

Highlights

Human papillomavirus (HPV) is the most common sexually transmitted infection, and highrisk types such as human papilloma virus (HPV) 16 and 18 are oncogenic and associated with pre-malignant and malignant conditions of the cervix and anogenital lesions [1]
The increased low-grade dysplasia rate seen in most females with Autoimmune conditions (AICs) is consistent with increased HPV infection
Covariates analysed included number of screening episodes, area level socioeconomic status assigned from postcode in quintiles using the Australian Bureau of Statistics Socio-Economic Indexes for Areas Index of Relative Socio-Economic Disadvantage [16], remoteness area assigned from postcode using the Australian Standard Geographic Classification for 2011 [17], Aboriginal and/or Torres Strait Islander status, and country of birth in Major Categories (Appendix 3) [18]

Summary

Introduction

Human papillomavirus (HPV) is the most common sexually transmitted infection, and highrisk types such as HPV 16 and 18 are oncogenic and associated with pre-malignant and malignant conditions of the cervix and anogenital lesions [1]. Control of HPV infection relies upon an effective local immune response and diseases associated with impaired immunity, either due to the disease itself or immunomodulatory treatment, can increase the risk of HPVrelated conditions [2] Immunocompromised females, such as those with untreated human immunodeficiency virus (HIV), are most at risk of cervical, vaginal or vulval intra-epithelial dysplasia and HPV-related cancers [3,4]. Autoimmune conditions (AICs) and/or their treatment may alter risk of human papilloma virus (HPV) infection and females with AICs are at an increased risk of cervical dysplasia Inclusion of these at-risk populations in cervical cancer screening and HPV-vaccination guidelines, are mostly lacking. This study aimed to determine the prevalence of cervical dysplasia in a wide range of AICs and compare that to HIV and immunocompetent controls to support the optimisation of cervical cancer preventive health measures

Objectives

Methods

Conclusion