Cervical Health in Systemic Lupus Erythematosus

Abstract

Objective: A health disparity exists for African American (AA) women with systemic lupus erythematosus (SLE) who have increased prevalence of human papilloma virus (HPV) infection and cervical neoplasia. We used a self-sampling brush to obtain cervical cells to assess cytology, HPV infection, and vaginal cytokine production in AA women with SLE.

Methods: Thirty AA women with SLE ages 18-50 years consented to participate. Clinical information was obtained by review of records and patient interviews, and surveys administered to assess cervical health history, knowledge of HPV, and satisfaction with the self-sampling brush. Vaginal samples were analyzed for cytology, HPV DNA and RNA, and vaginal cytokine RNA.

Results: Our cohort (mean 36.9, ±9.4 years) had moderate/severe SLE and were on immunosuppressives. The majority had history of abnormal pap smears (63%) with prevalent risk factors for HPV infection: multiple sex partners (9.5 ± 7), not vaccinated for HPV (83.3%), smoking (26.7%), and not using condoms (73.3%). Most were aware of HPV causing cervical cancer (70%) but were unaware of other HPV-related diseases. Most preferred self-sampling over traditional pap smear (80%). Abnormal cytology was detected in 13.3%. HPV DNA was detected in 70%, with half showing multiple types, and all showing active infection (+RNA). HPV-infected samples demonstrated RNA expression of multiple cytokines with no specific/ consistent pattern.

Conclusion: Our high-risk cohort lacked knowledge about HPV-related diseases and were not employing strategies to reduce their risk with vaccination and condoms. This study highlights the need for cervical health education, increased monitoring, and intervention in these high-risk women.

Keywords: HPV; SLE; cervical cancer; cervical dysplasia; gynecologic health; lupus.

FIG. 1.

(A) Cytokine heatmap. High expression of tested cytokines was associated with HPV positivity. Heatmap of Z-score normalized cytokine 2^−ddCt values across samples. The Z-score scale ranges from low expression (blue) to high expression (red) for each cytokine shown. Two samples, W19 and W2, had missing values for IL-1b and IL-4, respectively, and so had no Z-score values for those cytokines on the heatmap. (B) Cytokine BoxPlots. High expression of tested cytokines was associated with HPV positivity. Boxplots comparing expression levels between HPV-negative samples and HPV-positive samples for each cytokine. p-Values shown were computed using Mann–Whitney test. n = 9 for HPV-negative samples and n = 21 for HPV-positive samples. HPV, human papilloma virus; IL, interleukin.