Análise do impacto da infecção pelo HPV e alterações citopatológicas cervicais em uma coorte de pacientes com lúpus eritematoso sistêmico

Abstract

Systemic lupus erythematosus (SLE) is a chronic inflammatory condition, which occurs predominantly in women, whose immunological alterations associated with the disease itself and immunosuppressive therapy may determine an increased risk of neoplasms and infections. In this context, there is attention to the relationship between SLE and cervical cancer, the fourth most prevalent neoplasm among women in the world and the second among low- and middle-income countries, where the human papillomavirus (HPV) infection is a primary condition for development. Several studies have evaluated the relationship between SLE and cervical carcinoma. Most of them did not observe a positive association between them, but, curiously, cervical squamous intraepithelial lesions, considered pre-malignant lesions, as well as the prevalence of HPV infection are more frequent in patients with SLE. Nevertheless, little is known about the progression of cervical dysplasia and HPV infection in this group of patients, as well as the clinical consequences that these alterations may cause in the course of the disease. Thus, the present study aims to assess the long-term clinical impact of HPV infection and cervical cytopathological changes in a cohort of patients with SLE, whose investigation of HPV infection/cervical lesions was performed at the time of inclusion. The evolutionary analysis was carried out through retrospective and prospective collection of clinical and sociodemographic data, in addition to the research of all cytopathological exams of the uterine cervix performed during the follow-up period. A total of 174 patients were evaluated, during a mean of 12 years follow-up. It was observed an increase in endstage renal disease in patients who had cervical squamous intraepithelial lesions at inclusion, a greater variation in the disease damage index in the group of patients with cervical lesions associated with HPV infection and more frequent use of hydroxychloroquine in the group without initial cervical lesions. Furthermore, the present investigation revealed a low rate of sequential cytopathological exams, since only 43 patients (24.7%) underwent the exam after the initial collection. The data demonstrate the current inadequacy of cervical cancer screening in patients with SLE, a considered high risk group for human papillomavirus infection, as well as the need for greater guidance from rheumatologists, general practitioners, and gynecologists on appropriate specific screening. In addition, it was observed that HPV infection and cervical dysplasia may be associated with clinical changes in SLE.