International Journal of Gynecological Pathology 33:537–542, Lippincott Williams & Wilkins, Baltimore r 2014 International Society of Gynecological Pathologists Original Article Prevalence and Genotypes of HPV in Female Renal Transplant Recipients in North India Ritu Aggarwal, M.D., D.N.B., Vanita Suri, M.D., Shalini Awasthi, M.D., Jasmine Naru, M.Sc., Raje Nijhawan, M.D., Mukut Minz, M.S., and Vivekanand Jha, M.D., D.M. Summary: Estimation of the prevalence of high-risk human papillomavirus (HPV) genotypes in female renal transplant recipients is important for formulating strategies for prevention and screening of cervical cancer in the susceptible group. Data from developing countries are very limited. The study was prospective, cross-sectional, and hospital-based. Female renal transplant recipients, who had received the graft at least 6 mo earlier, were enrolled. Women who visited the outpatient unit for varied complaints and who underwent a normal cervical examination were recruited as controls. A pap smear was obtained in all women. HPV genotyping array kit was utilized for identifying 21 HPV genotypes. Forty renal transplant recipient women and 80 controls were enrolled. The median age of cases and controls was 40 yr (range, 24–69 yr) and 38 yr (range, 23–72 yr), respectively. The mean duration since transplant was 53 ± 42.6 mo (range, 6–168 mo). There was no evidence of cervical dysplasia in any pap smear. High-risk HPV was detected in 32.5% (13/40) and 17.5% (14/80) of cases and controls, respectively (P = 0.18). Of the 21 genotypes screened, 7 subtypes were detected. HPV 16 and 31 were the most common (5/13; 38.5%) subtypes observed in the cases, followed by HPV 18 (30.7%). HPV 16 was the most common subtype in controls (10/14; 71.4%). Five (38.5%) renal transplant recipients harbored multiple HPV genotypes, as compared with 4 (28.6%) controls (P = 1.0). The prevalence of high-risk HPV in female renal transplant recipients was 1.9 times that observed among controls, although there was no evidence of cervical dysplasia. Key Words: Cervical cancer— Cervical intraepithelial neoplasia—CIN—Immunocompromised—Kidney. Renal transplant recipients receive lifelong immuno- suppression for the prevention of graft rejection. This predisposes them to various cancers, particularly those that are virus-induced (1). Recent studies have demon- strated a higher susceptibility of female renal transplant recipients to human papillomavirus (HPV) (2–4). It is well established that persistent infection with high-risk HPV heralds the development of cervical neoplasia (5). The prevalence of high-risk HPV in female renal transplant recipients has been variably reported to range from as low as 5% to as high as 63% (6–12). Several authors have established a significantly increased risk for HPV-associated dysplasia and cancers of the anogenital tract (13–15). Cancer in immunosuppressed patients has a higher mortality; the cancer tends to persist, recur, and progress (16–19). Literature on the prevalence and distribution of genotypes of HPV in the cervix of From the Departments of Immunopathology (R.A., J.N.); Obstetrics and Gynecology (V.S., S.A.); Cytology and Gynecologic Pathology (R.N.); Renal Transplant Surgery (M.M.); and Neph- rology (V.J.), Post Graduate Institute of Medical Education and Research, Chandigarh, India. The authors declare no conflict of interest. Address correspondence and reprint requests to Ritu Aggarwal, MD, DNB, Department of Immunopathology, Room No. 19, 4th floor, Research Block ‘‘A’’, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. E-mail: ritu_immunopath@yahoo.co.in. 537 DOI: 10.1097/PGP.0b013e3182a54ada