HPV Infection Risk Rises for Women With CF and Lung Transplant

Human papillomavirus can be cause of cervical cancer

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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Women with cystic fibrosis (CF) who had a lung transplant are at higher risk of testing positive for the human papillomavirus (HPV), a virus that can cause many cancers, a French study found.

Researchers also observed that it was more common for these women than for the general population to have cervical dysplasia, or an abnormal growth of cells on the cervix, the lowermost part of the uterus.

Study findings are in line with similar research in Canada, which reported a four times higher likelihood of cervical dysplasia among female CF patients with a lung transplant than other women with CF. 

Cervical dysplasia is not cancer, but the precancerous cells can become malignant. Therefore, “cervical cancer screening and prevention should be promoted among people with CF,” the researchers wrote.

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Lung transplant seen to raise chance of high-risk HPV infection 4.5 times

The study, “Human papillomavirus prevalence, persistence and cervical dysplasia in females with cystic fibrosis,” was published in the Journal of Cystic Fibrosis.

A lung transplant may be recommended to people with severe CF if other treatments have failed to help.

But among the risks of a lung transplant is the need for life-long immunosuppression to help the organ survive, which increases a person’s risk of infections as well as cancers.

To determine how common HPV infection is among women with CF, the researchers went through results of Pap smear tests taken at a CF center in Lyon, France.

A Pap smear test checks a sample of cells gently collected from the surface of the cervix and nearby areas for cervical cancer or cell changes that may lead to cancer. An HPV test can be done at the same time.

The study included 85 women with CF, with 18 of them (21.2%) having received a lung transplant. Patients overall mean age was 31.9, and those with a transplant had a first such surgery at a mean of 69.8 months, about 5.8 years, ago.

Among all in this group, 27 women (31.8%) tested positive for HPV and 22 (25.9%) for high-risk HPV, meaning infection with a human papillomavirus known to cause cervical cancer. High-risk HPV was more than twice as common in women with a lung transplant than in those without one (44.4% vs. 20.9%).

A considerable proportion of those with a lung transplant, 43.5% continued to test positive for high-risk HPV one year later, as did 38% women without a lung transplant.

Having a lung transplant significantly increased a woman’s chance of high-risk HPV infection by 4.5 times, the researchers wrote. Condom use, a prior and full-term pregnancy, and age 30 or older — but not being vaccinated against HPV — significantly associated with a lower chance of high-risk HPV.

Strikingly, HPV vaccination was not significantly associated with a lower risk of [high-risk HPV] infection, and 6/22 (27%) of  patients [with high-risk HPV] were vaccinated,” the researchers wrote.

Cell changes were found in 15 (17.6%) women. Women with a lung transplant were about four times as likely as those without one to have such cell changes (44.4% vs. 10.4%).

Based on Pap smear test results, 14 women (16.5%) were referred for colposcopy, a procedure that uses a magnifying instrument to closely examine the cervix, vagina, and vulva.

The procedure found cervical dysplasia in 12 women (14.1%); it was low-grade in half of them while the other six had high-grade cervical dysplasia.

“Regular interactions between the CF team and gynecologists” and “dedicated consultations” are important to improving patients’ “sexual and reproductive health” and in preventing and screening for HPV-related diseases, the researchers concluded.

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