Issue 21

Clinical Question

What is the prevalence of, and risk factors for, human papillomavirus (HPV) infection among IBD patients?

Editor’s Bottom Line

Anal HPV infection and high-risk HPV genotypes are common among IBD patients. This may have implications for vaccination strategies and cancer screening. 

Reference

Vuitton L, Jacquin E, Parmentier AL, et al. High Prevalence of Anal Canal High-Risk Human Papillomavirus Infection in Patients With Crohn’s Disease. Clin Gastroenterol Hepatol. 2018;16(11):1768–76.e5; https://doi.org/10.1016/j.cgh.2018.03.008.

Synopsis

The incidence of anal canal cancers—particularly squamous cell carcinomas, which are driven by HPV—is increasing in the general population. To document the prevalence of, and risk factors for, HPV in the IBD population, researchers at a French hospital examined anal canal tissue samples and clinical and demographic characteristics from 469 consecutive patients with or without IBD.

Patients were a median 54 years of age and 52% were women. One-hundred and one patients had IBD, including 70 with Crohn’s disease.

The investigators found the prevalence of HPV DNA was similar in the general and IBD population (34.0% vs. 31.4%, respectively). However, 18% of the overall population had high-risk HPV genotypes, compared to 30% of Crohn’s disease patients (P=0.005). At 13.8%, the prevalence of high-risk HPV among ulcerative colitis patients was similar to that of the general study population. HPV was more common among women, both in the general population and among IBD patients (43.4% and 68.6%, respectively).

The most prevalent genotype was HPV16, a particularly high-risk genotype that was detected in 7% of all patients. Women were significantly more likely than men to have high-risk HPV (23.1% vs.12.8%, respectively; P=0.0035). Multivariate analyses in the overall population found female gender, a history of sexually transmitted disease, number of sexual partners, current smoking, and use of immunosuppressive drugs were all independent risk factors for high-risk HPV infection.

Details

Study Design: Prospective, observational
Funding: Besançon University Hospital provided a research grant
Allocation: Not applicable
Setting: Single-center
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.