Anal Human Papillomavirus Infection in Kidney Transplant Recipients Compared With Immunocompetent Controls.

Background: Kidney transplant recipients (KTRs) have increased risk of human papillomavirus (HPV)-related anogenital (pre)cancers, including anal high-grade intraepithelial lesions and cancer. Previous studies on anal high-risk HPV (hrHPV) among KTRs are sparse.
Methods: In a cross-sectional study, we included 247 KTRs and 248 controls from a dermatology department and 5 nephrology departments in Denmark during 2016-2017. All participants provided an anal cytobrush sample that was tested for HPV DNA. Participants completed a questionnaire on lifestyle and sexual habits. We used logistic regression to estimate odds ratios (ORs) of anal hrHPV in KTRs compared with controls and risk factors for anal hrHPV in KTRs.
Results: The anal hrHPV prevalence was higher in female KTRs (45.5%) than in controls (27.2%). Female KTRs had almost 3-fold higher adjusted odds of anal hrHPV than controls (adjusted OR, 2.87 [95% confidence interval, 1.57-5.22]). In contrast, among men we did not observe increased prevalence or odds of anal hrHPV in KTRs compared with controls (prevalence, 19.4% vs 23.6%; adjusted OR, 0.85 [95% 95% confidence interval, .44-1.64]). Among hrHPV-positive KTRs, 63% and 52% of men and women, respectively, were infected with hrHPV types covered by the nonavalent HPV vaccine (type 16, 18, 31, 33, 45, 52, or 58). Current smoking, >10 lifetime sexual partners, history of genital warts, and among men having had receptive anal sex were risk factors for anal hrHPV in KTRs.
Conclusions: Female KTRs had an increased risk of anal hrHPV compared with immunocompetent controls. Our findings indicate that pretransplant HPV vaccination should be considered to prevent anal high-grade intraepithelial lesions and cancer caused by anal hrHPV infection in KTRs.
Clinical Trials Registration: NCT03018327.
Competing Interests: Potential conflicts of interest. H. K. L. has received lecture and conference registration fees from LEO Pharma. S. K. K. has received a lecture fee from Merck and a research grant from Merck through her institution. M. H. reports research grants, unrelated to this work, from LEO Pharma, Lutronic, Mirai Medical, Studies&Me, and Venus Concept; lecture payments from Galderma Nordic; and reports receipt of equipment from Cherry Imaging, Cynosure, Lutronic, Venus Concept, PerfAction Technologies, MiraDry, Sientra, and Mirai Medical. J. H. B. has received honoraria from Hologic, Qiagen, and BD Diagnostics Systems for lectures and reports a leadership role in the Danish National Board of Health as an appointed expert on HPV (public health appointment), a National Board of Health appointed member, and a member of the National Cervical Screening Steering Committee (public health appointment). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed
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