The Potential Role of Human Papillomavirus Infection in Bell's Palsy: A Hypothesis-Generating Study Based on a Nationwide Cohort.

Kuan‐Ying Li ,Yao-Min Hung,Renin Chang,Hei-Tung Yip,Mei‐Chia Chou ,James Cheng‐Chung Wei

doi:10.3389/fmed.2021.616873

Abstract

Objective: Our purpose was to investigate whether people with a previous human papillomavirus (HPV) infection were associated with an increased risk of Bell's palsy (BP).Methods: By using Taiwan population-based data, patients aged > 18 years with HPV infection (n = 22,260) from 2000 to 2012 were enrolled and compared with control subjects who had never been diagnosed with an HPV infection at a 1:4 ratio matched by sex, age, index date, and co-morbidities (n = 89,040). The index date was the first date of HPV diagnosis. All the patients were tracked until the occurrence of BP. Cox proportional hazards regression was applied to estimate the hazard ratios (HRs) for the development of BP in both groups.Results: The HPV group had 1.25 [95% confidence interval (CI) = 1.03–1.51] times higher risk of BP compared with the non-HPV group after adjusting for sex, age, and co-morbidities. The association of HPV and BP was significant in the sensitivity analyses. In the subgroup analysis, the impact of HPV infection on the risk of BP was more pronounced in the elderly > 50 years [adjusted hazard ratio (aHR) =1.86; 95% CI = 1.37–2.52], hypertension (aHR = 1.65; 95% CI = 1.17–2.31), and chronic obstructive pulmonary disease (aHR = 2.14, 95% CI 1.333.43) subgroups.Conclusions: Patients with HPV infection have a higher risk of subsequent BP compared with non-HPV patients. More rigorous studies are needed to confirm if and how specific HPV genotypes are associated with BP and the possible role of vaccines in disease prevention.

Highlights

Bell’s palsy (BP), defined as acute peripheral facial nerve palsy of unknown cause, is the most common acute mono-neuropathy [1]
We identified patients who had been diagnosed with Human papillomaviruses (HPV) infection (ICD-9-CM codes 079.4, 078.1, 078.10–078.12, 078.19, 795.05, 795.09, 795.15, 795.19, 796.75, and 796.79) between 2000 and 2012 as the HPV group
The crude HR of HPV was 1.29; the adjusted HRs (aHRs) after adjusting for demographic variables, including sex, age, and co-morbidities, was 1.25

Summary

Introduction

Bell’s palsy (BP), defined as acute peripheral facial nerve palsy of unknown cause, is the most common acute mono-neuropathy [1]. This disease affects 11–40 people per 100,000 annually [2]. Investigators proposed that immune alterations related to a previous viral infection have an important role in the etiopathogenesis of BP [8] The reasons for this include alterations in lymphocyte subsets in the peripheral blood during the acute stage of the disease [9, 10]. The shared pathogenesis between these autoimmune diseases and BP is based on a viral infection and a subsequent autoimmune reaction [24, 25] These findings suggest a possible association between HPV infection and BP. We conducted this original nationwide population-based cohort study to assess the incidence rate and risk of BP in people with a history of HPV infection when compared with those without HPV infection

Methods

Results

Conclusion