{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:05:03Z","timestamp":1789452303905,"version":"build-2803163510"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent high-risk human papillomavirus (hrHPV) infection is the main cause of cervical carcinogenesis, and impaired immune surveillance may increase the risk of viral persistence and progression to high-grade lesions. This study aimed to evaluate the association between immunosuppression and high-grade cervical lesions (CIN2+) and to examine its association with HPV status, cytological findings, and histopathological outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective comparative cohort study included women evaluated with cervical cytology, HPV testing, colposcopy, and\/or histopathology between 2019 and 2024 at two participating centers. After exclusions, 370 women were analyzed, including 313 immunocompetent controls and 57 immunosuppressed patients. HIV-infected women were excluded. The primary outcome was CIN2\u2009+\u2009. Logistic regression analysis was performed to evaluate associations with high-grade cervical disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall HPV positivity was similar between groups, but immunosuppressed women had a significantly higher prevalence of hrHPV infection. Endocervical curettage (ECC) was performed more frequently in the immunosuppressed group, and ECC positivity was also higher. Final histopathology showed fewer normal findings in immunosuppressed women, with numerically higher rates of CIN2, CIN3, and cancer. In multivariable analysis, immunosuppression remained associated with CIN2\u2009+\u2009after adjustment (adjusted OR 1.7, 95% CI 1.0-3.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). HPV16, multiple HPV infection, and HSIL cytology were also associated with CIN2\u2009+\u2009in the adjusted model. Exploratory subgroup estimates for renal transplantation and selected immunosuppressive therapies were based on small samples and should be interpreted cautiously.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Immunosuppression was associated with a higher risk of high-grade cervical lesions and a less favorable cervical disease profile, supporting closer surveillance in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1903427","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:36:36Z","timestamp":1789450596000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Immunosuppression as an associated risk factor for high-grade cervical lesions: a comparative study of cytology, HPV, and histopathology"],"prefix":"10.3389","volume":"13","author":[{"given":"Merve","family":"Bakt\u0131ro\u011flu","sequence":"first","affiliation":[{"name":"Department of Gynecological Oncology, Canakkale Mehmet Akif Ersoy State Hospital","place":["Canakkale, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Nuri","family":"Duran","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ezine State Hospital","place":["Canakkale, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harika","family":"Yumru","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamdullah","family":"S\u00f6zen","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Faculty of Medicine, Istanbul University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samet","family":"Topuz","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Faculty of Medicine, Istanbul University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yavuz","family":"Saliho\u011flu","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Faculty of Medicine, Istanbul University","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1591297","DOI":"10.3389\/fimmu.2025.1591297","article-title":"Immune responses to human papillomavirus infection and vaccination","volume":"16","author":"Kiamba","year":"2025","journal-title":"Front 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Review of the literature and new data of a vaginal gel containing silicate dioxide, citric acid, and selenite","volume":"17","author":"Huber","year":"2021","journal-title":"Women\u2019s Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1186\/s12916-023-02965-w","article-title":"Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies","volume":"21","author":"Bowden","year":"2023","journal-title":"BMC Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"107927","DOI":"10.1016\/j.ypmed.2024.107927","article-title":"Prevalence of cervical human papillomavirus in kidney transplant recipients: a systematic review and meta-analysis","volume":"182","author":"Ring","year":"2024","journal-title":"Prev Med (Baltim)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"905548","DOI":"10.3389\/fonc.2022.905548","article-title":"Risk of human papillomavirus infection and cervical intraepithelial lesions in Chinese renal transplant recipients","volume":"12","author":"Chen","year":"2022","journal-title":"Front Oncol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1186\/s12905-025-03813-0","article-title":"Anogenital high-risk HPV prevalence and screening considerations in female transplant recipients: a cross-sectional study","volume":"25","author":"Hillen","year":"2025","journal-title":"BMC Womens Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e0234813","DOI":"10.1371\/journal.pone.0234813","article-title":"Increased risk of cervical dysplasia in females with autoimmune conditions\u2014results from an Australia database linkage study","volume":"15","author":"Foster","year":"2020","journal-title":"PLoS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e95","DOI":"10.3346\/jkms.2025.40.e95","article-title":"Risk for human papillomavirus-associated gynecologic cancers among women of childbearing age with rheumatic diseases: a population-based cohort study","volume":"40","author":"Lee","year":"2025","journal-title":"J Korean Med Sci"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1093\/ecco-jcc\/jjab036","article-title":"Increased risk of high-grade cervical neoplasia in women with inflammatory bowel disease: a case-controlled cohort study","volume":"15","author":"Goetgebuer","year":"2021","journal-title":"J Crohns Colitis"},{"key":"B17","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1002\/ijgo.16074","article-title":"Yield of endocervical curettage in detecting cervical intraepithelial neoplasia grade 2 or higher during colposcopy: a prospective, cross-sectional study","volume":"169","author":"Jareemit","year":"2025","journal-title":"Int J Gynaecol Obstet"},{"key":"B18","doi-asserted-by":"publisher","first-page":"105657","DOI":"10.1016\/j.jcv.2024.105657","article-title":"Human papillomavirus negative high grade cervical lesions and cancers: suggested guidance for HPV testing quality assurance","volume":"171","author":"Pr\u00e9tet","year":"2024","journal-title":"J Clin Virol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"839","DOI":"10.3390\/diagnostics16060839","article-title":"Opportunistic and organized cervical cancer screening: impact on lesion severity and surgical outcomes in 9830 cervical conizations","volume":"16","author":"Preti","year":"2026","journal-title":"Diagnostics"},{"key":"B20","doi-asserted-by":"publisher","first-page":"396","DOI":"10.3390\/cancers18030396","article-title":"Human papillomavirus testing and size of CIN3: implications for the risk of microinvasive cervical carcinoma","volume":"18","author":"Preti","year":"2026","journal-title":"Cancers (Basel)"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1903427\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:36:37Z","timestamp":1789450597000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1903427\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":20,"alternative-id":["10.3389\/fsurg.2026.1903427"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1903427","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]},"article-number":"1903427"}}