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AASLD 2011: High Rate of Cancer-Causing HPV among Women with Hepatitis C Awaiting Liver Transplants

Nearly 1 in 5 women undergoing liver transplantation -- most of them due to chronic hepatitis C virus (HCV) infection -- were also infected with cancer-causing types of human papillomavirus (HPV), even though their behavioral risk was low, researchers reported at the American Association for the Study of Liver Diseases Liver Meeting (AASLD 2011) this week in San Francisco.

Phyllis Tarallo from Columbia University and colleagues looked at the prevalence of and risk factors for "high-risk" or oncogenic HPV types among female liver transplant candidates. HPV causes cervical cancer, anal cancer, genital cancers, and some mouth and throat cancers.

Health screening for women prior to being put on a liver transplant waiting listing has traditionally included Pap smears, which can detect pre-cancerous cell changes at a treatable stage; HPV testing is now also used to screen for cervical cancer. But the prevalence of high-risk HPV in this population has not been studied, the investigators noted as background.

This analysis included 62 female liver transplant candidates (average age 54 years) who received liquid-based Pap smears with high-risk HPV testing as part of their pre-transplant evaluation, all done by a single provider.

Results

• 39% of the women reported risky behavior known to be associated with HPV infection (e.g., starting sex at an earlier age, having multiple sex partners).
• 10 of 62 participants (16%) had evidence of high-risk HPV types at baseline, including 5 with atypical cells that could potentially progress to cancer.
• All women who tested positive for high-risk HPV types had hepatitis C as their underlying cause of liver disease.
• Within this group, 90% reported no history of risky behavior associated with HPV infection.
• In contrast, none of the women who reported risky behavior but were HCV negative had cancer-causing HPV.
• There was a statistically significant relationship between high-risk HPV infection and HCV infection (odds ratio 24.4, or 24-fold higher risk).
• None of the other potential risk factors analyzed were significant predictors of HPV infection, including age at first intercourse, most recent sex, number of lifetime sex partners, smoking, use of birth control pills, history of other sexually transmitted infections, HIV status, and use of immunosuppressive drugs.

Based on these findings, the researchers concluded, "In this study we provide evidence of a strong association between HCV and HPV in liver transplant candidates that has not been previously reported."

"HPV positivity was observed in non-sexually active women, suggesting a reactivation of dormant HPV," they continued. "An association between hepatitis C and high-risk HPV could involve impairment of T-cell function by hepatitis C."

"These data support close surveillance in women’s health screening for liver transplant candidates," they recommended.

These results may be particularly relevant to HIV/HCV coinfected individuals, since people with HIV -- women and men alike -- have been shown to have higher prevalence of high-risk HPV types, more persistent infection, and possibly faster progression to cancer.

Investigator affiliations: Surgery, Columbia University, New York, NY; School of Nursing, Columbia University, New York, NY.

11/8/11

Source

PA Tarallo, J Smolowitz, A Siegel, et al. HCV Infection is Associated With High-Risk HPV Infection in Female Liver Transplant Candidates. 62nd Annual Meeting of the American Association for the Study of Liver Disease (AASLD 2011). San Francisco, November 4-8. 2011. Abstract 469.