Current data suggest that the clinical expression and progression of humanpapillomavirus (HPV)-associated disease occurs more rapidly in immunosuppressed patients, and it is feasible to study genital HPV infections at the clinical, pathologic, and molecular level in this population. Bone Marrow Transplant (BMT) recipients represent a growing number of immunosuppressed patients who are known to have a pronounced susceptibility to viral infections as a consequence of impaired T-cell mediated cytotoxicity. Given that 40-70 percent of sexually active people are infected with one or more genital HPV types, it is plausible that female BMT recipients may have reactivation of latent infections. To date, female BMT recipients have not been evaluated for genital HPV nor do guidelines for cervical cancer screening exist in this immunosuppressed population. The purpose of this study is to describe the molecular epidemiology of cervicovaginal HPV infection in women who are undergoing BMT and to determine the effect of specific HPV types on the clinical and pathologic course of genital infection. This study will also determine the correlation of dynamic HPV gene expression, DNA replication, and host responses to infection and their relation to changes in clinical, pathologic, and histopathologic features of genital HPV and the degree of BMT-related immunosuppression and subsequent immune reconstitution. All female BMT patients 18 years or older will be eligible. Patients will be followed prospectively and receive evaluations prior to BMT, and at important follow-up visits. HPV viral pathogenic events will be assessed through the use of both routine and innovative techniques to detect not only the presence of HPV, but also measure early markers of viral expression that may correlate with disease progression leading to cervical neoplasia.
