HPV Infection May Increase Risk of Developing CRS With Nasal Polyps

Presence of human papillomavirus (HPV) was significantly associated with incidence of chronic rhinosinusitis with nasal polyps (CRSwNP), although no differences in disease severity were observed among HPV-positive and HPV-negative patients with CRSwNP.

Human papillomavirus (HPV) may be associated with the development of chronic rhinosinusitis with nasal polyps (CRSwNP), according to study findings published in the American Journal of Otolaryngology–Head and Neck Medicine and Surgery.

In exploring the etiology and pathogenesis of CRSwNP, researchers noted that the syndrome is currently linked with multifactorial causations resulting from a dysfunctional interaction between environmental and host immune systems. The influence of individual factors have also been cited at the population level, in which the role of viruses, namely HPV, has garnered conflicting results.

“​​Viruses have long been postulated to be the inciting factor for starting the chain of events leading to CRSwNP,” said the study authors. “HPV are double-stranded DNA viruses with a capacity to incorporate into host DNA, to establish lifelong latent infections in the upper respiratory mucosa, and to reactivate in immunocompromised conditions.”

They conducted a prospective cohort study of consecutive patients with CRSwNP undergoing surgical management at the Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Science, in New Delhi, India, from May 2017 to May 2019, to investigate the potential role of HPV on the etiopathogenesis of CRSwNP.

In the study, nasal tissue samples of patients with CRSwNP (n = 60) and healthy controls (n = 20) were evaluated and compared, using the the nucleic acid hybridization assay, on the prevalence of high-risk HPV types (HR-HPV; subtypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and low-risk HPV types (LR-HPV; subtypes 6, 11). Potential correlations regarding severity of CRSwNP and HPV infection were also examined.

“All patients underwent preoperative endoscopic evaluation and radiological assessment using non-contrast computed tomography (NCCT) of the nose and paranasal sinuses. The severity of the disease was graded using the Lund-Mackay score on NCCT. All patients underwent endoscopic polypectomy and the sample of tissues was sent for HPV DNA detection using Hybrid Capture II technique,” explained researchers.

Of the study cohort, all healthy controls were negative for HPV DNA, whereas 27 patients with CRSwNP (45%) had the presence of HPV DNA—23 had only LR-HPV, 1 had only HR-HPV types, and 3 patients had both HR-HPV and LR-HPV subtypes. The patients were followed up for a median duration of 28 months (range, 20-38 months)

A significant difference between healthy controls and patients with CRSwNP was observed regarding the presence of HPV DNA (P < .001). However, the patients with HPV-positive DNA in the nasal specimen were not shown to differ significantly from HPV-negative patients in age, gender, or severity of the disease.

Speaking on the study findings, researchers said that although HPV may play a significant role in the etiopathogenesis of CRSwNP, it appears to have no impact on the degree of sinus involvement.

“Further studies are required to know whether antivirals directed against HPV prove beneficial in changing the course of disease or not,” they added.

Limitations of the study were the lack of testing for the functional and replicating virus in the nasal specimen and that the short follow-up could not establish the need for repeat surgery among participants.

Reference

Jaiswal AS, Tanwar P, Irugu DVK, et al. Human papilloma virus in the etiopathogenesis of allergic nasal polyposis: a prospective study. Am J Otolaryngol. 2022;43(1):103273. doi:10.1016/j.amjoto.2021.103273