Reply to the editor

We thank Jayaraj and Kumarasamy for their response to our systematic review and meta-analysis of the prevalence of cervical human papilloma virus (HPV) infection in women with systemic lupus erythematosus (SLE) [1], whose main objective was to evaluate the prevalence of cervical HPV in SLE pacientes compared with healthy controls and, secondarily, to determine whether risk factors were more frequent in SLE patients with cervical HPV infection. In almost all the original studies included also had the main objective of comparing cervical HPV infection prevalences between SLE patients and controls and some also analyzed possible associated risk factors, both traditional and SLE-related factors (particularly immunosuppresive therapy). It is established that the major risk factors for HPV infection are behaviors related to sexual activity [2], but factors unrelated to sexual behavior have been identified such as the first sexual intercourse at an early age, long-term oral contraceptive use [3], ethnicity [4], etc. Although, we placed no restriction on risk factors the lack of evidence in original studies, or a low level of evaluation of some traditional risk factors and differing definitions limited the inclusion of risk factors such as early age at the first sexual intercourse or contraceptive use, etc. Despite these shortcommings, we extracted data from four studies [[5], [6], [7], [8]] that analyzed multiple sexual partners as a classical risk factor for genital HPV, without finding it was significant.