LOW-PREVALENCE OF HUMAN PAPILLOMAVIRUS INFECTION OF THE CERVIX IN RENAL-TRANSPLANT RECIPIENTS

Background. An increased risk of anogenital tract malignancies has bee n noted among renal transplant recipients. A high prevalence of human papillomavirus (HPV) infection of the cervix in the female renal-trans plant population has been assumed based on increasing evidence suggest ing that HPV infection is the major risk factor for cervical intraepit helial neoplasia (CIN) and cervical cancer. It has been assumed that i mmunosuppression leads to either a reactivation of latent HPV or a red uction in the host's ability to contain a primary HPV infection, there by increasing the risk of CIN and cervical cancer. The objective of th is study was to evaluate the prevalence of human papillomavirus (HPV) infection in a population of iatrogenically immunosuppressed renal tra nsplant recipients. Methods. Twenty-one women were recruited from the renal transplant clinic at Presbyterian Hospital and underwent a gynae cological examination which included colposcopy, a Papanicolaou smear, and a Lavage samples were analysed for HPV DNA using L1 consensus pri mers and the polymerase chain reaction (PCR). Results. No cases of cer vical intraepithelial neoplasia (CIN) were detected in this cohort of 21 immunosuppressed renal transplant recipients. HPV DNA was detected in only a single patient. Conclusions. Our data suggests that HPV infe ction 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 sex ual behaviours are more important than past behaviours as a determinan t of HPV status in transplant recipients, and also suggests that educa tion concerning the avoidance of highrisk sexual behaviour is an impor tant part of the care of the female renal transplant recipient. Our da ta is consistent with previous work suggesting that the incidence of C IN is declining in transplant recipients, and it also suggests that th e prevalence of HPV infection may be declining as well.