Association of Infection with Human Papillomavirus and Development of End-Stage Kidney Disease in Taiwan

Abstract

Importance: The association between human papillomavirus (HPV) infection status and the natural process of kidney diseases has been neglected as an area of research. Further studies are needed to clarify factors that may alter the progression of end-stage kidney disease (ESKD). Objective: To describe the rates of ESKD among patients with and without HPV infection. Design, Setting, and Participants: In this nationwide, population-based retrospective cohort study, data were collected from the National Health Insurance Research Database of Taiwan. A total of 76088 individuals with HPV infection were enrolled from January 1, 2000, to December 31, 2012, and compared with a control group of 76088 individuals who had never been diagnosed with HPV infection (at a 1:1 ratio propensity-score matched by age, sex, index year, and comorbidities) in the context of the risk of developing ESKD. Statistical analysis was performed between November 2019 and July 2020. Exposures: HPV infection was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Main Outcomes and Measures: The main outcome was ESKD, as recorded in the Catastrophic Illness Patients database. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs, with the control group as a reference. Results: Of 152176 individuals (79652 [52.3%] women; mean [SD] age, 34.4 [19.1] years), 76088 individuals (50.0%) had HPV and 463 individuals (0.3%) developed ESKD. Incidence of ESKD was lower in individuals with HPV history than in those without HPV history (3.64 per 10000 person-years vs 4.80 per 10000 person-years). In the fully adjusted multivariate Cox proportional hazards regression model, individuals with a history of HPV infection had a significant decrease in risk of ESKD (adjusted HR, 0.72; 95% CI, 0.60-0.87) after adjusting for demographic characteristics, comorbidities, and comedications. In the subgroup analysis, individuals ages 50 to 64 years with HPV infection had a statistically significantly lower risk of ESKD compared with individuals ages 50 to 64 years with no HPV infection (adjusted HR, 0.48; 95% CI, 0.34-0.68; P