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Infection of the anogenital tract with human papillomavirus (HPV) is very common. Approximately 15–20 anogenital HPV types are oncogenic or “high-risk” and are associated with 99.9% of cervical cancers, 90% of anal cancers, 70% of oropharyngeal cancers, and a high proportion of vaginal, penile, and vulvar cancers. Defects in cellular immunity make solid organ transplant (SOT) recipients particularly susceptible to persistent high-risk HPV infection, development of the cancer precursor lesion, high-grade squamous intraepithelial lesion (HSIL), and, in some cases, progression to malignancy. Hematopoietic stem cell transplant (HSCT) recipients may also be at risk for HPV-related malignancies, particularly those who require long-term immunosuppression for graft-versus-host disease. This highlights the need for cancer screening programs to detect and eliminate HSIL prior to progression to malignancy. While clear evidence exists to support the effectiveness of cervical cancer screening, the role for anal cancer screening is less clear. Anal cancer screening is recommended in high-risk SOT recipients like men who have sex with men (MSM) and can be considered in high-risk HSCT recipients. While HPV vaccines are highly effective at preventing initial HPV infection and HSIL in the general population, studies on their efficacy in SOT and HSCT recipients are limited. Ongoing work to optimize both screening and vaccination programs is currently the best option to decrease HPV-related complications in SOT and HSCT recipients.

DOI: 10.1007/978-3-030-01751-4_70-1