High-risk human papilloma virus infection and cervical neoplasm in female inflammatory bowel disease patients:a cross-sectional study

Background and aim:This cross-sectional study investigated the prevalence and risk factors of high-risk human papilloma virus(HPV)infection,especially types 16 and 18,and cervical neoplasia in female Inflammatory bowel disease(IBD)patients.Methods:From July 2014 to January 2017,sexually active,female,Chinese IBD patients(21–60 years)and age-matched controls underwent cervical ThinPrep cytology testing(TCT)and high-risk HPV-DNA detection,and completed questionnaires about awareness of cervical cancer and HPV.Cervical dysplasia was categorized as cervical intraepithelial neoplasia(CIN)1,2 and 3.Results:Of 124 IBD patients(30 ulcerative colitis and 94 Crohn’s disease),17(13.7%)had high-risk HPV among whom 9(7.3%)had HPV 16/18 infection and 4(3.2%)had cervical CIN(3 CIN 3,1 CIN 1)by pathology.Among 372 controls,33(8.9%)had high-risk HPV and only 1(0.3%)had HPV 16 infection.Cervical TCT detected atypical squamous cells of unknown significance in one control;no control had CIN.The HPV 16/18 infection rate and CIN prevalence were significantly higher in IBD patients than controls(both P<0.001).The HPV-infection rate was higher in patients administered methotrexate[P=0.005,odds ratio(95%confidence interval)4.76(1.471–15.402)]or more than two immunosuppressants[P=0.013,odds ratio(95%confidence interval)3.64(1.255–10.562)].Thiopurine,steroid,infliximab and disease behavior/location were not associated with HPV infection.Only 29.3%of patients had undergone cervical-cancer screening.Awareness of HPV infection and HPVrelated cervical cancer was poor(28.2%).Conclusions:Female IBD patients are at increased risk of high-risk HPV infection and cervical neoplasia,which may be associated with immunosuppressants.Education and routine follow-up with HPV-DNA testing and TCT are recommended,especially in female Chinese IBD patients.