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Lupus, HPV and HPV Vaccine

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HPV and the HPV Vaccine

Lupus and HPV: Heightened Susceptibility
By A. G. Moore 9/27/2013

Human Papilloma Virus
Laboratory of Tumor Virus Biology, National Cancer Institute
Wikimedia Commons, Public Domain

HPV has been in the news lately, mostly because of Michael Douglas’ bout with throat cancer. Most of us learned something from him when he announced that his cancer had been caused by the HPV virus. What I have learned since then is that women who have lupus are at increased risk of contracting the HPV virus. And once they have the virus, they have an increased risk of developing pre-cancerous lesions in the cervix. For the young, those who have not yet been sexually active and therefore may be virus-free, there is a vaccine. Unfortunately, the safety of this vaccine has been questioned, especially as it relates to lupus.

HPV stands for human papillomavirus. According to the U.S. Center for Disease Control (CDC), HPV is so widespread that just about anyone who has had sexual contact–even with a single person–is at risk. In most cases, there are no symptoms of HPV infection and no apparent consequences; however, a person who is symptom-free may still transmit the virus to others and these people may not have a benign experience.

One citation I came across, Systemic lupus erythematosus, human papillomavirus infection, cervical pre-malignant and malignant lesions: a systematic review, describes an effort to quantify exactly what the increased risk of HPV infection and cervical cancer is in women who have SLE. The results were surprising, at least to the authors. They discovered that though higher rates of HPV infection and pre-cancerous lesions can be documented in people with SLE, this increased risk did not carry over to cancer. The authors of this study conclude that though the analysis did not support the idea that women with lupus have higher rates of HPV-associated cervical cancer, this group does have more gynecological issues related to HPV, therefore…”gynecological visits at shorter intervals seem to be a reasonable approach for those patients”.

While this one analysis seems to indicate that women with SLE are not at higher risk for cervical cancer from HPV infection, there are some in the medical community who still think there may be a causal link. For example, in an article published by the Johns Hopkins Lupus Center, I found the following statement: “Certain studies have shown an elevated risk of cervical cancer …..in women with lupus.” Along with this statement is the suggestion that the increased rate of cervical cancer may be associated with STD infection.

Likewise, a  2010 American College of Rheumatology press release, People with Lupus Might Be at a Greater Risk for Cancer , cites the results of a study that shows women with lupus are at increased risk of developing cervical cancer.  This study  raises the possibility that, in lupus patients,  an association may exist between increased HPV infection and cervical cancer.  The study is considered significant partly because of its size: 13, 492 participants were observed over a period of 9 years. I think  the ACR press release is worth checking out because, besides discussing cervical cancer,  it offers information about a variety of cancers that  may affect people with lupus.

Evidence for HPV-associated cervical cancer in women with lupus is suggestive but not compelling; what is clear, is that HPV is a greater problem for people who have lupus than it is for the general population. Women with lupus are more likely to become infected and once they are infected, are more likely to develop squamous intraepithelial lesions–these are the precancerous cells doctors look for when they perform a pap smear.

As for the HPV vaccine: research does raise interesting questions. One study persuasively describes six cases where an exacerbation or even precipitation of lupus occurred after HPV vaccination. The authors of this article state:”…a temporal association between immunization…and the appearance of a spectrum of SLE-like conditions is reported.” Contrasting with this study is another, published in the journal Pediatric Rheumatology. This study enrolled 27 patients with SLE who ranged in age from 12 to 26. The conclusion: “HPV vaccine was generally safe and well-tolerated in our patient population of adolescents and young women.” An important note here is that the doctors who interpreted the results of this study have ties to pharmaceutical companies.

A third study, Immunogenicity of the Bivalent Human Papillomavirus Vaccine in Adolescents with Juvenile Systemic Lupus Erythematosus or Juvenile Dermatomyositis, offers insight into the efficacy and safety of  HPV vaccination. The study describes the “immunogenic” effect of the vaccine. This is a measure of the actual level of immunity to the HPV virus bestowed by vaccination. It seems that there is a weaker response to vaccination in lupus patients than there is in healthy subjects.

As for safety: no adverse reactions were noted in this study and no exacerbation of disease was associated with vaccination. The researchers who conducted and reported on these results do not have any listed connection to a pharmaceutical company, though I cannot be certain that this is the case.

While my discussion of the HPV virus has focused on women with lupus, a couple of points should be made before I leave off: HPV infects both men and women–I don’t know if men with lupus are also at greater risk for infection; HPV can infect many sites on the body–some you might not think likely; A variety of HPV strains are floating around–not all of them lead to cancer and infection with more than one strain is possible.

Readings about HPV and Lupus:

http://www.ncbi.nlm.nih.gov/pubmed/21140928

http://rd.springer.com/article/10.1007/s10067-010-1606-0

http://virus.stanford.edu/papova/HPV.html

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