Low prevalence of human papillomavirus infection of the cervix in renal transplant recipients

An increased risk of anogenital tract malignancies has been noted among renal transplant recipients. A high prevalence of human papillomavirus (HPV) infection of the cervix in the female renal-transplant population has been assumed based on increasing evidence suggesting that HPV infection is the major risk factor for cervical intraepithelial neoplasia (CIN) and cervical cancer. It has been assumed that immunosuppression leads to either a reactivation of latent HPV or a reduction in the host's ability to contain a primary HPV infection, thereby increasing the risk of CIN and cervical cancer. The objective of this study was to evaluate the prevalence of human papillomavirus (HPV) infection in a population of iatrogenically immunosuppressed renal transplant recipients. Twenty-one women were recruited from the renal transplant clinic at Presbyterian Hospital and underwent a gynaecological examination which included colposcopy, a Papanicolaou smear, and a cervicovaginal lavage. Lavage samples were analysed for HPV DNA using L1 consensus primers and the polymerase chain reaction (PCR). No cases of cervical intraepithelial neoplasia (CIN) were detected in this cohort of 21 immuno-suppressed renal transplant recipients. HPV DNA was detected in only a single patient. Our data suggests that HPV infection is not highly prevalent among older, cytologically normal renal transplant recipients, particularly those who are currently monogamous or not presently sexually active. This study suggests that recent sexual behaviours are more important than past behaviours as a determinant of HPV status in transplant recipients, and also suggests that education concerning the avoidance of high-risk sexual behaviour is an important part of the care of the female renal transplant recipient. Our data is consistent with previous work suggesting that the incidence of CIN is declining in transplant recipients, and it also suggests that the prevalence of HPV infection may be declining as well.