HPV infection and vaccination in Systemic Lupus Erythematosus patients: what we really should know

Abstract

Patients with Systemic Lupus Erythematosus (SLE) are at increased risk for infections. Vaccination is a powerful tool to prevent infections, even in immunocompromised patients. Most non-live vaccines are immunogenic and safe in patients with SLE, even if antibody titres are frequently lower than those of healthy controls. Human papillomavirus (HPV) infections are more prevalent in SLE patients when compared to the healthy population. Low-risk types of this virus cause anogenital warts, while high risk types are strongly related to pre-malignant cervical abnormalities and cervical cancer. HPV vaccines have been developed to prevent these conditions. Although little is known about HPV vaccination in SLE, few studies in patients with autoimmune rheumatic diseases (AIRDs) have shown that HPV vaccines are safe, and capable to induce an immunogenic response in this group of patients. To date, available data suggest that HPV vaccines can be given safely to SLE patients. Given the increased incidence of cervical abnormalities due to HPV in SLE patients, this vaccination should be encouraged.

Fig. 1

a Sequential steps for cervical cancer: Infection with carcinogenic HPV type(s), followed by detectable viral persistence, linked to the progression of cervical premalignant lesion, and finally, invasion (Adapted from Schiffman M. et al.) [50]. b Colposcopy of normal cervix, high-grade squamous intraepithelial lesion (HSIL) and Squamous Cell Carcinoma

Fig. 2

Important events regarding cervical cancer and HPV. Abbreviations: bHPV, bivalent vaccine; qHPV, quadrivalent vaccine; 9vHPV, 9-valent vaccine; HPV, human papillomavirus; FDA, Food and Drug Administration. Adapted from Lees et al. [16]