First Department of Obstetrics and Gynecology, Medical University of Warsaw, Pl, Starynkiewicza 1/3, 02-015, Warszawa, Poland.
Virol J. 2012 Jun 18;9:117. doi: 10.1186/1743-422X-9-117.
Immunosuppressive therapy protects the transplanted organ but predisposes the recipient to chronic infections and malignancies. Transplant patients are at risk of cervical intraepithelial neoplasia (CIN) and cervical cancer resulting from an impaired immune response in the case of primary infection or of reactivation of a latent infection with human papillomavirus of high oncogenic potential (HR-HPV).
The aim of this study was to assess the prevalence of HR-HPV cervical infections and CIN in 60 female kidney graft recipients of reproductive age in comparison to that in healthy controls. Cervical swabs were analyzed for the presence of HR-HPV DNA. HR-HPV-positive women remained under strict observation and were re-examined after 24 months for the presence of transforming HR-HPV infection by testing for HR-HPV E6/E7 mRNA. All the HR-HPV-positive patients were scheduled for further diagnostic tests including exfoliative cytology, colposcopy and cervical biopsy.
The prevalence of HR-HPV did not differ significantly between the study group and the healthy controls (18% vs 25%, p = 0.37). There was no correlation between HR-HPV presence and the immunosuppresive regimen, underlying disease, graft function or time interval from transplantation. A higher prevalence of HR-HPV was observed in females who had had ≥ 2 sexual partners in the past. Among HR-HPV-positive patients, two cases of CIN2+ were diagnosed in each group. In the course of follow-up, transforming HR-HPV infections were detected in two kidney recipients and in one healthy female. Histologic examination confirmed another two cases of CIN2+ developing in the cervical canal.
Female kidney graft recipients of reproductive age are as exposed to HR-HPV infection as are healthy individuals. Tests detecting the presence of HR-HPV E6/E7 mRNA offer a novel diagnostic opportunity in those patients, especially in those cases where lesions have developed in the cervical canal.
免疫抑制疗法可以保护移植器官，但会使受者更容易发生慢性感染和恶性肿瘤。在原发性感染或潜伏的高致癌潜能人乳头瘤病毒（HPV）重新激活的情况下，移植患者面临宫颈上皮内瘤变（CIN）和宫颈癌的风险。
本研究旨在评估 60 名生育期女性肾移植受者中 HPV 高危型（HR-HPV）宫颈感染和 CIN 的流行率，并与健康对照组进行比较。宫颈拭子用于分析 HR-HPV DNA 的存在情况。HR-HPV 阳性的女性接受严格观察，并在 24 个月后通过检测 HR-HPV E6/E7 mRNA 检测转化性 HR-HPV 感染的存在情况进行复查。所有 HR-HPV 阳性患者均安排进一步的诊断测试，包括脱落细胞学检查、阴道镜检查和宫颈活检。
研究组与健康对照组的 HR-HPV 患病率无显著差异（18%比 25%，p=0.37）。HR-HPV 的存在与免疫抑制方案、基础疾病、移植物功能或移植后时间间隔均无相关性。在过去有≥2 个性伴侣的女性中，HR-HPV 的患病率较高。在 HR-HPV 阳性患者中，两组各有 2 例 CIN2+。在随访过程中，在 2 例肾移植受者和 1 例健康女性中检测到转化性 HR-HPV 感染。组织学检查证实，在宫颈管内又有 2 例发展为 CIN2+。
生育期女性肾移植受者与健康个体一样容易感染 HR-HPV。检测 HR-HPV E6/E7 mRNA 的存在为这些患者提供了一种新的诊断机会，尤其是在宫颈管内已出现病变的情况下。
