Monday, November 7, 2011

AASLD: High-Risk HPV Seen in Low-Risk Liver Tx Patients

By Charles Bankhead, Staff Writer, MedPage Today
Published: November 06, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

SAN FRANCISCO -- A substantial proportion of women evaluated for liver transplant had coexisting infection with the hepatitis C virus (HCV) and high-risk human papillomavirus (HPV), suggesting a need for close surveillance of female transplant candidates, investigators reported here.

Ten of 62 patients (16.1%) tested positive for cancer-associated strains of HPV. All 10 patients had an HCV etiology for liver disease, but nine of the 10 did not have a high-risk history associated with HPV infection.

The strong association between HCV and high-risk HPV could reflect impairment of T-cell function by HCV, Phyllis Tarallo, MD, of Columbia University in New York City, said at the American Association for the Study of Liver Diseases (AASLD).

"This was a totally unexpected finding that had not been previously reported and we're trying to find an explanation for the association," Tarallo told MedPage Today. "Until we figure out the meaning, we think women who are liver transplant candidates should be followed closely."

Transplant recipients have an increased risk of cancer secondary to immunosuppression, including virally induced malignancies such as cervical, vaginal, vulvar, and perianal cancer. About 90% of women with cervical cancer test positive for HPV.

The prevalence of high-risk HPV in female liver transplant candidates had not been examined previously, Tarallo and colleagues noted in a poster presentation. They undertook the study to determine the prevalence of HPV and identify potential opportunities to prevent malignancies secondary to HPV infection.

They prospectively studied 62 female liver transplant candidates who had a mean age of 54. Each of the women had a Pap smear and assessment by HPV DNA assay.

Investigators also examined the women's history of factors associated with HPV infection, including prior Pap smear and HPV test results, smoking history, sexual and reproductive history, and prior sexually transmitted infections, as well HIV status, use of immunosuppressive drugs, and hepatitis history (any type).

A review of their medical history showed that 24 (39%) of the women had a history of high-risk behaviors.

Tarallo reported that 10 of the women tested positive for HPV strains associated with cancer (high risk). Five of the 10 also had atypia on Pap smear cytology. All 10 of the women had HCV infection as the causative factor of the liver pathology that led to evaluation for transplantation.

Nine of the 10 women had a negative history for high-risk behaviors associated with HPV. All nine had not been sexually active in more than 10 years.

In contrast, none of the women who reported high-risk behaviors associated with HPV tested positive for HPV or HCV.

In an analysis of risk factors associated with HPV, HCV infection emerged as the only significant predictor of high-risk HPV (OR 24.4, P=0.0013).

The observation of positive HPV status in women who had not been sexually active for more than a decade suggests, "a reactivation of dormant HPV," the investigators concluded. "An association between hepatitis C and high-risk HPV could involve impairment of T-cell function by HCV."

Tarallo had no relevant disclosures. Co-investigator Robert S. Brown disclosed relationships with Gilead, Merck, Vertex, Novartis, Salix, Tibotec, GlobeImmune, and Genentech.

American Association for the Study of Liver Diseases
Source reference:
Tarallo P, et al "HCV infection is associated with high-risk HPV infection in female liver transplant candidates" AASLD 2011; Abstract 469.

Complete AASLD Coverage »From Medpage

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