[Question #4237] Immunosuppresants and HPV

31 months ago
I am male. 
I will be taking mycophenolate and tacrolimus -- both are powerful immunosuppressant. How much should I need to be worried about HPV?  I have oral herpes. My doc warned that I will have more outbreak. I am taking anti-viral for it.  I am not worried about HSV 1. 


My sexual history: I have two protected sex in the 90s while I was in the college. I am not sexually active for a long number of years.   

I took HPV vaccination recently, but it is good for new infection not for the old infection. 


How soon will HPV reactivate if I have it?  How often should I need to get tested for it?
I am not gay. Should I still need to go:

Anal pap 

 oral HPV testing



Just so I am ahead of everything.




Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Welcome to our Forum and thanks for your question.  You are correct, both mycophenolate and tacrolimus are powerful suppressants of the cellular immune system and can increase the risk for recurrent manifestations of HPV.   Precisely how often pre-existing infections re-activate is not well known although the higher the dose of immunosuppressive medications, the more likely reactivation is to occur.   In your case however, your overall risk for having acquired HPV from two protected sexual encounters years ago is low.  There is no specific testing needed.  Instead, my suggestion would be that, should you notice new skin lesions, see a dermatologist for evaluation.  Otherwise I would not worry.  You certainly do not need anal PAP smears or oral testing for HPV at this time. 

I hope this comment is helpful.  EWH
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31 months ago
Thanks for the response. The transplant team said if the manifestation does not occur in the first two years, it will near occur. They see often CIN 3 in the first two years. 
Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
I would expect that his generalization in part reflects the facts that persons with transplants tend to be more heavily medicated with immunosuppressant rugs in the years relatively soon after transplantation.  As the medication dose is lowers, the degree of immunosuppression, and therefore the risk of re-activation also diminish.  In your case, I would add that you may not even be infected with HPV given your history.  EWH
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31 months ago
Thank you for the response.


I spoke with transplant team today.

We may prescribe the following. It depends upon the patients:


Prednisolone

Azathioprine 

cyclosporine



I assume the above 3 less potent than previous two that I already mentioned.






Edward W. Hook M.D.
Edward W. Hook M.D.
31 months ago
Yes they are.  Those are the sorts of drugs used for maintenance following transplant.  Of course there is still a relationship with the dose- as I'm sure you know, higher doses are more immunosuppressive.  EWH---