High-risk human papilloma virus infection and cervical neoplasm in female inflammatory bowel disease patients: a cross-sectional study

Miao Li; Qing-Fan Yang; Qian Cao; Jian Tang; Yu Gao; Min Zhi; Kang Chao; Ming-Li Su; Wei-Min Huang; Yan Yi; Sui-Yan Xia; Ling-Jie Huang; Yuan Zhao; Xiao-Hong Wang; Xiao-Ying Liu; Lin Lin; Pin-Jin Hu; Xiang Gao

doi:10.1093/gastro/goy053

High-risk human papilloma virus infection and cervical neoplasm in female inflammatory bowel disease patients: a cross-sectional study

Gastroenterol Rep (Oxf). 2019 Feb 15;7(5):338-344. doi: 10.1093/gastro/goy053. eCollection 2019 Oct.

Authors

Miao Li^{1

2}, Qing-Fan Yang^{1

2}, Qian Cao³, Jian Tang^{1

2}, Yu Gao^{2

4}, Min Zhi^{1

2}, Kang Chao^{1

2}, Ming-Li Su^{1

2}, Wei-Min Huang^{2

5}, Yan Yi^{2

5}, Sui-Yan Xia^{2

5}, Ling-Jie Huang³, Yuan Zhao³, Xiao-Hong Wang^{2

4}, Xiao-Ying Liu^{2

4}, Lin Lin^{2

4}, Pin-Jin Hu^{1

2}, Xiang Gao^{1

2}

Affiliations

¹ Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
² Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
³ Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
⁴ Obstetrical Department, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
⁵ Medical Diagnostic Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.

Abstract

Background and aim: This cross-sectional study investigated the prevalence and risk factors of high-risk human papilloma virus (HPV) infection, especially types 16 and 18, and cervical neoplasia in female Inflammatory bowel disease (IBD) patients.

Methods: From July 2014 to January 2017, sexually active, female, Chinese IBD patients (21-60 years) and age-matched controls underwent cervical ThinPrep cytology testing (TCT) and high-risk HPV-DNA detection, and completed questionnaires about awareness of cervical cancer and HPV. Cervical dysplasia was categorized as cervical intraepithelial neoplasia (CIN) 1, 2 and 3.

Results: Of 124 IBD patients (30 ulcerative colitis and 94 Crohn's disease), 17 (13.7%) had high-risk HPV among whom 9 (7.3%) had HPV 16/18 infection and 4 (3.2%) had cervical CIN (3 CIN 3, 1 CIN 1) by pathology. Among 372 controls, 33 (8.9%) had high-risk HPV and only 1 (0.3%) had HPV 16 infection. Cervical TCT detected atypical squamous cells of unknown significance in one control; no control had CIN. The HPV 16/18 infection rate and CIN prevalence were significantly higher in IBD patients than controls (both P < 0.001). The HPV-infection rate was higher in patients administered methotrexate [P = 0.005, odds ratio (95% confidence interval) 4.76 (1.471-15.402)] or more than two immunosuppressants [P = 0.013, odds ratio (95% confidence interval) 3.64 (1.255-10.562)]. Thiopurine, steroid, infliximab and disease behavior/location were not associated with HPV infection. Only 29.3% of patients had undergone cervical-cancer screening. Awareness of HPV infection and HPV-related cervical cancer was poor (28.2%).

Conclusions: Female IBD patients are at increased risk of high-risk HPV infection and cervical neoplasia, which may be associated with immunosuppressants. Education and routine follow-up with HPV-DNA testing and TCT are recommended, especially in female Chinese IBD patients.

Keywords: Inflammatory bowel disease; cervical intraepithelial neoplasia; high-risk human papilloma virus.