People living with HIV and recipients of solid organ transplants have a significantly higher risk of developing cancers associated with human papillomavirus (HPV), namely anal, penile, vulvar, and cervical cancers. This conclusion comes from a retrospective case-control study conducted in Sweden.
According to findings reported by Christina Carlander, MD, PhD, from the Karolinska Institutet in Stockholm, individuals with HIV are over four times more likely to develop any HPV-related cancer compared to age- and sex-matched controls in the general population (adjusted odds ratio [aOR] 4.50, 95% CI 3.46-5.84).
Transplant recipients also face increased risk, with more than double the likelihood of developing these cancers (aOR 2.23, 95% CI 1.85-2.68). Specifically, those who have undergone heart (aOR 2.91), lung (aOR 2.71), kidney (aOR 2.17), and liver (aOR 1.89) transplants show significantly heightened odds of these HPV-related cancers.
Importance of Prevention Strategies
Co-author Eva Meglic, MSc, emphasizes the critical need for targeted prevention strategies in immunosuppressed populations. She suggests that there is still significant room for improvement in awareness and the implementation of preventive measures within clinical practice.
For individuals with HIV, the study indicated particularly heightened risk for anal (aOR 58.79), penile (aOR 8.05), vulvar (aOR 7.76), and cervical (aOR 2.55) cancers, with low CD4 counts—indicative of advanced or poorly controlled HIV—exacerbating these risks.
Moreover, transplant recipients are also at increased odds for the same four cancers: anal (aOR 2.70), penile (aOR 6.01), vulvar (aOR 7.07), and cervical (aOR 1.87).
No associations were found for HPV-related vaginal or oropharyngeal cancers in either demographic group.
Variable Risks and Individualized Prevention
Long-term immune function impairment makes people with HIV and transplant recipients more vulnerable to HPV-related cancers. This impairment reduces the immune system’s ability to eliminate persistent HPV infections and prevents precancerous lesions from progressing to cancer.
The varying risks associated with HPV-related cancers are influenced by an individual’s immune status, treatment history, and sociodemographic factors, underscoring the necessity for an individualized and risk-informed approach to prevention.
The larger risks experienced by these two groups highlight the pressing need for timely vaccination against HPV, maintaining effective HIV viral suppression, optimizing immunosuppressive regimens where applicable, and enhancing access to suitable screening and early detection strategies for high-risk populations.
Study Overview
This case-control study examined Swedish adults between 1983 to 2024, involving a total of 32,093 individuals diagnosed with HPV-related cancers and 320,930 matched controls free of any HPV-related cancers.
Approximately two-thirds of study participants were women, and around 40% were under 50 years old at the time of cancer diagnosis. Cervical cancer was the most prevalent type (42%), followed by oropharyngeal (35%), anal (9%), vulvar (7%), penile (5%), and vaginal (1%) cancers.
Lower income and being unmarried were correlated with higher odds of HPV-related cancers among those living with HIV, potentially indicating disparities in healthcare access, preventive care engagement, or cancer detection.
While associations with sociodemographic factors were less pronounced in transplant recipients, the findings suggest possible disparities in cancer prevention and diagnosis across both groups.
Limitations of the Study
The study faced limitations, including the absence of data on behavioral risk factors such as smoking, sexual behavior, and alcohol consumption, which could confound associations with non-HPV-related oropharyngeal and anal cancers. Moreover, some cancers may have been developing prior to organ transplantation.
Disclaimer: This information is intended for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Fuente: https://www.medpagetoday.com/transplantation/transplantation/121999
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