Lupus

Human papillomavirus vaccine uptake in ethnically diverse women living with systemic lupus erythematosus

Background Women with systemic lupus erythematosus (SLE) are at an increased risk of infection from the human papillomavirus (HPV) and subsequently HPV-mediated malignancies and genital warts. The HPV vaccine is a highly effective intervention in preventing HPV infection and is recommended in SLE patients. We determined HPV vaccination rates and factors associated with decreased vaccination uptake in women living with SLE. Methods We conducted a cross-sectional study in which we enrolled women with SLE (aged 21–45) for whom the HPV vaccine is recommended for by the US Food and Drug Administration (FDA). The primary outcome was self-reported HPV vaccination as recommended by the Advisory Committee on Immunization Practices (ACIP). We collected demographics, clinical characteristics, knowledge on HPV and vaccines, and items for constructs of the Health Belief Model (HBM) and determined associations between these covariates and HPV vaccination status. Results We enrolled 75 women with SLE. Median age was 33 (IQR 27–40) and 20 (27%) had received HPV vaccination. Older women and Spanish-speaking patients were less likely to have received the HPV vaccine. When examining HBM constructs an increase in ‘perceived barriers’ (e.g. not knowing where to get the vaccine) was associated with no vaccination (r = −0.41, p < 0.01). Increased report of ‘cues to action’ (e.g. My doctors told me lupus increases risk for cervical cancer) was associated with increased HPV vaccination (r = 0.30, p < 0.01). After multivariable adjustment of significant covariates, age remained at significantly decreased odds for HPV vaccination (OR 0.82, 95% CI 0.73–0.93). Conclusion We found low HPV vaccine uptake among racial and ethnically diverse women with SLE. Older age, Spanish language, increased perceived barriers, and increased cues to action were significantly correlated with HPV vaccination. This data highlights potential strategies for providers to use to improve HPV vaccination in this patient population.

Comparing cytology, colposcopy and human papillomavirus cervical intraepithelial lesion screening methods in women with systemic lupus erythematosus

Objective To compare the performance of cytology, colposcopy and human papillomavirus in detecting cervical intraepithelial lesions in women with systemic lupus erythematosus. Methods Papanicolaou smears (normal, low-grade squamous intraepithelial lesion, high grade squamous intraepithelial lesion), colposcopy findings, human papillomavirus and co-testing (Papanicolaou smear + human papillomavirus) were compared with cervical biopsy findings in women with systemic lupus erythematosus. Sensitivity, specificity, false-positive and false-negative rates, positive and negative predictive values and likelihood ratios of cytologic smears, colposcopy findings, human papillomavirus and co-testing were determined. Results Cytology and colposcopy were performed in 170 systemic lupus erythematosus women (mean age and disease duration of 43.7±12.1 years and 9.7±5.3 years, respectively) and biopsies were performed in 55 patients (38.2% normal, 60.0% low-grade squamous intraepithelial lesion and 1.8% high grade squamous intraepithelial lesion). The sensitivity, specificity, positive predictive value and negative predictive value of cytology were 14.7% (95% confidence interval 5.5–31.8%), 95.2% (95% confidence interval 74.1–99.7%), 83.3% (95% confidence interval 36.4–99.1%) and 40.8% (95% confidence interval 27.3–55.7%), respectively. The sensitivity, specificity and positive predictive value of colposcopy findings were 100.0% (95% confidence interval 87.3–100.0%), 0.0% (95% confidence interval 0.0–19.2%) and 61.8% (95% confidence interval 47.7–74.2%), respectively. The sensitivity and specificity of co-testing were 8.0% (95% confidence interval 1.3–27.5%) and 100.0% (95% confidence interval 71.6–100.0%). The positive predictive value and negative predictive values were 100.0% (95% confidence interval 19.7–100.0%) and 36.1% (95% confidence interval 33.5–38.8%), respectively. Conclusions In systemic lupus erythematosus patients, colposcopy impressions were more sensitive than cytology and co-testing. However, cytology and co-testing were the most specific tests. The results should be interpreted with caution due to the small sample size.

Cervical cancer screening rates in Korean women of childbearing age with systemic lupus erythematosus

Objective Cervical cancer remains a leading cause of death among women of childbearing age despite the proven efficacy of screening in reducing mortality rates. Women with systemic lupus erythematosus (SLE) are at a higher risk for cervical cancer but tend to have lower screening rates. This study aimed to assess cervical cancer screening (CCS) rates and identify factors influencing screening uptake among Korean women of childbearing age with SLE. Methods Women aged 20-49 with SLE and age matched controls, randomly selected at a 1:5 ratio, were identified from the 2016-2017 Korean National Health Insurance Service-National Health Information Database (NHIS-NHID). Data from 10,981 women with SLE and 54,905 controls eligible for National Health Screening Program (NHSP) in 2018-2019 were analyzed. The CCS rate was determined based on participation in Papanicolaou test among eligible individuals for NHSP. Logistic regression was used to estimate odds ratios (ORs) for factors associated with CCS uptake. Results The CCS rate was significantly lower in women with SLE compared to controls (49.6% vs 52.1%, P < .0001). Logistic regression revealed that younger age, lower income, self-employment or medical aid insurance, and rural residence were associated with reduced CCS uptake in both groups. The highest CCS uptake occurred in the 40-44 age group for both women with SLE (OR 5.09, 95% CI 4.17-6.22) and controls (OR 4.65, 95% CI 4.26-5.07). Comorbidities increased CCS uptake among controls (OR 1.18, 95% CI 1.13-1.23), but were associated with mild non-significant decrease in uptake among women with SLE (OR 0.96, 95% CI 0.87-1.04). Conclusion National CCS program is often underutilized by Korean women of childbearing age with SLE, particularly among those with lower income and those of rural residency. Targeted interventions are needed to improve screening rates and address the unique challenges faced by this high-risk population.

Association between systemic lupus erythematosus and risk of cervical atypia: A meta-analysis

Background Previous studies showed conflicting results regarding the association between systemic lupus erythematosus (SLE) and risk of cervical atypia. Therefore, the present study aimed to make a meta-analysis to summarize results of studies regarding association between SLE and risk of cervical atypia. Methods We searched for articles published before March 2021 in in the following databases: PubMed, EMBASE, Web of Science, Medline and Google Scholar. Odds ratios (ORs) and relative risks (RRs) with their 95% confidence intervals (CIs) were computed to create a pooled effect size and 95% CI using STATA 12.0 software. Results The present meta-analysis showed that SLE was significantly associated with increased risks of cervical atypia (OR/RR = 2.94, 95% CI 2.22 to 3.89, I2 = 92.1%, p < .001), cervical cancer (OR/RR = 3.13, 95% CI 2.09 to 4.70, I2 = 84.7%, p < .001), squamous intraepithelial lesion (SIL) (OR/RR = 5.00, 95% CI 2.58 to 9.69, I2 = 88.9%, p < .001) and low-grade SIL (OR/RR = 3.14, 95% CI 1.29 to 7.67, I2 = 63.3%, p = .018) with random effects models. Conclusion In summary, findings of this meta-analysis demonstrated that SLE was associated with a higher risk of cervical pre-malignant lesions and carcinoma. It may be necessary for clinicians to remind women with SLE to screen human papillomavirus infection and be vaccinated as soon as possible. However, caution is required when interpreting our findings. Further studies, especially well-designed randomized controlled clinical trials are awaited to confirm the association between SLE and cervical atypia–associated diseases.