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Between November 2019 and July 2021, 201 women were enrolled in the study. These included 98 kidney transplant recipients, 93 liver transplant recipients, and ten patients who received simultaneous kidney and liver transplantation. 65.2% of patients knew they were at increased risk for genitoanal cancers, and 77.6% knew cervical screening could reduce cancer risk. In addition, most patients (92.5%) reported regularly taking advantage of the cervical screening offer.

HrHPV prevalence

The baseline characteristics of the participants are shown in Table 1, which compares hrHPV positive and negative patients. Overall, 32 out of 201 (15.9%) patients tested positive for hrHPV at the cervical site. The anal hrHPV prevalence was 20.3% (40/197). No significant difference in cervical hrHPV prevalence was found between kidney and liver transplanted patients (see Table 2). The median age was 52 years (median 18–78), with cervical hrHPV-positive patients being, on average, eight years younger (p = 0.029). HrHPV prevalence declined with increasing age as shown in Fig. 1. However, the differences in cervical hrHPV prevalence across age groups were not statistically significant (p = 0.068), whereas anal hrHPV prevalence did show a significant difference across age groups (p = 0.038). When comparing individuals aged ≤ 45 years to those > 45 years, anal hrHPV prevalence was significantly higher in the younger age group (p = 0.020). In contrast, cervical hrHPV prevalence showed a non-significant trend towards higher rates in the younger group (p = 0.078).The median body mass index (BMI) was 23.4 in the cervical hrHPV-negative group and 21.4 in the cervical hrHPV-positive group (p = 0.030).

Immunosuppressive treatment

Overall, 97.5% of the patients were currently taking immunosuppressants, with most (75%) being on a calcineurin inhibitor (CNI) based immunosuppressive regimen consisting of more than two drugs. A comparison of immunosuppression and HPV risk factors is shown in Table 1. Neither the number of immunosuppressants nor the type of immunosuppression was significantly associated with hrHPV infection. Other transplant-specific variables, such as duration of immunosuppressive treatment, pretransplant immunosuppressant use, or graft rejections, did not correlate with hrHPV infection. A comparison of kidney and liver transplant recipients showed differences in immunosuppressive therapy (see Table 2). Compared to liver transplants, more kidney recipients took at least two immunosuppressants and had higher induction therapy rates (85.5% vs. 37%). However, cervical hrHPV prevalence showed no significant difference. Additionally, risk factors like sexual partners and age at first intercourse didn’t differ between kidney and liver recipients.

Risk factors associated with increased HPV prevalence in the general population, i.e. sexual behaviour and younger age, are confirmed in transplanted patients in a multivariable logistic regression model, with adjusting for transplantation, nicotine use and age of first intercourse (see Table 3). HrHPV-positive women were, on average, one year younger at the time of first sexual intercourse (p = 0.025) and had more than twice as many sexual partners as HPV- negative patients (p < 0.001). Likewise, the number of sexual partners since the first transplant was significantly higher among hrHPV-positive patients (p < 0.001).

HPV vaccination

In total, 12.4% (25/201) of patients had prior HPV vaccination. Among them, 80% (20/25) were under 30, while only 2.9% (5/173) of those over 30 were vaccinated (p < 0.0001). Most patients were vaccinated before their first sexual intercourse (17/25), and six were vaccinated before transplantation. The number of vaccinated patients was higher among HPV-positive patients compared with HPV-negative patients (see Table 1). Three HPV-positive women were vaccinated after their first sexual intercourse and six after their transplantation.

Follow-up

The participation rate in the follow-up offered 6 to 18 months after the initial HPV test for cervical hr-HPV positive patients was 91%, with 29 out of 32 patients returning. The positive hr-HPV result was confirmed in 25 cases. In 52% (13/25), more than one HPV type was determined by genotyping. A total of 14 different HPV-Types with oncogenic potential were detected in the cervical site (HPV 16, 18, 31, 33, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73). High-grade squamous intraepithelial lesion (HSIL) was detected in four patients during follow-up in the dysplasia unit (1x CIN2, 2x CIN3, 1x VaIN3). Three out of four patients with precancerous lesions had normal pap smears (NILM).

In anal swab specimens more than one HPV genotype was detected in 52.5% of patients, and 11 different high-risk oncogenic genotypes were identified (HPV 16, 18, 31, 39, 45, 51, 52, 56, 58, 59, 68). The most common HPV-types are shown in Fig. 2.

* This refers to the number of tested patients; multiple HPV types can occur in a single patient. HPV = Human papillomavirus

Anal and cervical co-infection

For further investigation of co-infection in cervical hrHPV-positive patients, genotyping was performed at follow-up, whereas anal HPV testing involved genotyping at baseline and follow-up, and one positive test was considered sufficient for hrHPV positivity. All detected HPV types were included in the evaluation of co-infection, regardless of the time of examination. In patients with cervical hrHPV positivity, anal co-infection was detected in 68,8% (22/32), whereas in cervical HPV-negative patients, only 10.9% (18/165) had an anal hrHPV infection. In 18 of 23 patients, cervical and anal genotyping was available to compare HPV genotypes. Fifteen of these 18 patients were positive for more than one HPV type. There was a strong association at the HPV-specific level: 78% (14/18) of patients exhibited at least one concordant hrHPV type, while 22% (4/18) displayed different hrHPV genotypes. The highest concordance rate was found for HPV 16, with all 6 out of 6 patients (100%) showing a coinfection in the anal swab specimens.

Former world-class rowers have an elevated risk for atrial fibrillation (AF) in the years after retirement, according to an observational case-control study.

Researchers found 1 in 5 former Olympic, world, or national-level Australian rowers aged 45-80 years had the heart rhythm anomaly. The ex-rowers, who had competed for at least 10 years, were nearly seven times more likely to have been diagnosed with AF compared to a control group. During a follow-up period of around 4 years, new cases of AF were also higher among the ex-rowers (6.3% vs 2.3%), according to the researchers, who published their findings last month in the European Heart Journal.

“As a clinician, I was not surprised that rowers experienced more AF,” said André La Gerche, PhD, MD, a cardiologist and head of the Heart Exercise And Research Trials Lab at the Victor Chang Cardiac Research Institute and St Vincent’s Hospital in Melbourne, Australia, and senior author of the study. “However, I was very surprised by the magnitude of the difference. Furthermore, I learnt that the risk persists years after retirement and is not just due to genetic factors.”

The findings are “consistent with prior research demonstrating that endurance athletes — especially highly trained endurance athletes — seem to have this higher risk of AF,” said Gregory Marcus, MD, MAS, a cardiac electrophysiologist and the inaugural Endowed Professor of Atrial Fibrillation Research at the University of California, San Francisco.

“These numbers nudge me in the direction of more aggressively screening for AF specifically in masters-aged rowers, such as with the use of Holter monitors or wearable devices approved to detect AF,” said Jeffrey Hsu, MD, an assistant professor of medicine in the Division of Cardiology at the David Geffen School of Medicine at the University of California, Los Angeles.

La Gerche and his team captured data from 121 former rowers — 75% men, all White, with a median age of 62 years — who were matched with more than 11,000 control individuals from the UK Biobank who had never rowed and had varying fitness levels. The ex-rowers had similar rates of ischemic heart disease and diabetes as did the control individuals, but lower blood pressure. They also were less likely to have ever smoked.

The athletes showed persistent changes in cardiac function after retirement. Ex-rowers had larger left ventricles, lower heart rates, longer PQ intervals, and longer QT intervals compared to control individuals.

The research, “raises the question of whether certain types of intensive exercise — like elite-level competitive rowing — leads to long-lasting, perhaps even irreversible, enlargement of the cardiac chambers,” Hsu said.

Genetics factored into the risk for AF among both groups. While the prevalence of rare variants in genes associated with cardiomyopathy was low across the study, the combined risk for individual genes associated with AF was a strong predictor of the disease in both athletes (odds ratio [OR], 3.7) and nonathletes (OR, 2.0). The proportions were similar between them (P = .37), indicating genetics did not fully account for the increased risk in the ex-rowers, La Gerche said.

Marcus flagged a few factors that may have skewed the results. The former athletes tended to be tall, White, and in many cases, drank more alcohol than control individuals — all of these factors increase the risk for AF.

Because the ex-rowers volunteered for a cardiovascular study, selection bias could have skewed prevalence higher, Marcus said. After a sensitivity analysis, ex-rowers still had a 2.5-fold higher risk for AF in the case of a 100% selection bias.

La Gerche emphasized the findings shouldn’t dissuade clinicians from encouraging regular exercise or high-level sports training.

“The overall health outcomes of these rowers are generally superb,” La Gerche said. “Rather, this highlights an important ‘Achilles heel’ that requires attention and, ideally, effective prevention strategies so that sports can be enjoyed by more people, more often.”

The study was funded by the National Health and Medical Research Council. La Gerche, Hsu, and Marcus reported having no relevant financial conflicts of interest.

Brittany Vargas is a journalist covering medicine, mental health, and wellness.