Objective Patients with systemic lupus erythematosus (SLE) on immunosuppression have increased risk of human papillomavirus virus (HPV) infection, which causes premalignant cervical changes and cervical cancer. In the UK, females are invited from the age of 25 for cervical screening (CS).¹

HPV vaccination has been recommended with a 3-dose schedule in immunosuppressed patients.^{2 3} Current guidelines do not state an age limit up to when this can be offered,² but the vaccine (Gardasil®9) has a licence to be given up until the age of 45. We conducted an audit of HPV vaccine and CS uptake amongst a cohort of lupus patients from a tertiary lupus centre.

Methods We collected data from female patients attending in-person appointments at a tertiary lupus clinic in London via convenience sampling, from April to September 2023. This was in the form of an anonymised questionnaire which was distributed in printed and QR code format. Partially filled surveys and those who had never been on immunosuppressant medication were excluded.

Results Responses from 80 patients were included. The median participant age was 38 (IQR 52–31). The majority (83.8%, 67/80) were not vaccinated against HPV or had unclear vaccine status. A lack of information was the main barrier to HPV vaccination (86.3%, 44/51). Regular cervical screening was undertaken in 76.2% (61/80). Of the 5/80 patients who were aged above 64 (the cut-off age at which CS screening is offered in the UK), all but one of them stated that they had previously taken part in regular CS when they were of age. Of those screened, 21.3% (13/61) had HPV. The majority with HPV had not been vaccinated (69.2%, 9/13) and 38.5% (5/13) required treatment for HPV. All patients on immunosuppressant medication at the time of vaccination received 2 doses instead of a 3-dose schedule.

Conclusion Nearly one quarter of patients with lupus on immunosuppression do not take up cervical screening. Most (>80%) are not vaccinated against HPV. There is a need to raise patient awareness on the increased risks of HPV infection in lupus in females treated with immunosuppression, and the opportunities available to prevent cervical cancer.

References

1. Gov.UK. Cervical screening: programme overview. [internet]. 2021. [cited 2023 Oct]. Available from: https://www.gov.uk/guidance/cervical-screening-programme-overview

2. Gov.UK. HPV vaccination guidance for healthcare practitioners. [internet]. 2023. [cited Nov 2023]. Available from: https://www.gov.uk/government/publications/hpv-universal-vaccination-guidance-for-health-professionals/hpv-vaccination-guidance-for-healthcare-practitioners

3. Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Annals of the Rheumatic Diseases 2020;79:39–52.