HPV Patients at Increased Risk for Glaucoma

Chronic inflammation, endothelial dysfunction and oxidative stress may be the mechanisms connecting HPV infection to glaucoma, but authors of a recent study suggest further research is needed. Photo: Justin Cole, OD, and Jarett Mazzarella, OD. Click image to enlarge. Previous studies have shown that inflammation plays a role in both glaucoma and human papillomavirus (HPV), but little is known about the relationship between the two. In a recent study, researchers from Taiwan and the US evaluated the association between HPV infection and the risk of developing glaucoma. They found that HPV individuals are at a 34% higher risk In addition to chronic inflammation, oxidative stress and endothelial damage may underlie this association. The findings were reported recently in Ophthalmology.Adults aged 18 and older with a diagnosis of HPV were identified from the TriNetX research network and matched 1:1 to individuals without HPV based on demographics, comorbidities and healthcare usage patterns. Propensity score matching was performed to balance baseline characteristics and Cox proportional hazards models were used to estimate the hazard ratios (HRs) for incident glaucoma.Among 451,288 participants, HPV infection was associated with an increased risk of glaucoma (HR of 1.34), with elevated risks observed for both open-angle and angle-closure glaucoma. The association was more pronounced in older adults, men and people of Asian background, and further amplified by comorbidities such as hypertension, diabetes and myopia.While the exact underlying mechanisms remain unclear, the authors suggest the following hypotheses. They explained in their Ophthalmology paper that HPV infections have been proved to involve chronic inflammation, which may extend to the trabecular meshwork. Also, a previous study found patients with glaucoma had higher bacterial oral counts than controls, and these species might induce axonal degeneration and neuronal loss. “This relationship might explain the association between HPV infection and the development of glaucoma,” the authors wrote in their article.The authors continued in their paper by writing that HPV infection would lead to inflammatory response, causing endothelial damage, and endothelial dysfunction might trigger the impairment of arterial vascular system, which could decrease the perfusion of the optic nerve and cause ischemia. “In the situation of the intraocular ischemia, glial cells were observed to secrete tumor necrosis factor-α (TNF-α) and other noxious agents,” the authors wrote. “In the study, TNF-α was found to induce apoptotic death and loss of retinal ganglion cells, increasing the risk of developing glaucoma.”Additionally, oxidative stress would be induced from the inflammatory mechanism by HPV infection and trigger reactive oxygen species causing mitochondrial DNA damage and apoptosis of retinal ganglion cells.“These findings not only underscore the potential link between HPV infection and the pathogenesis of glaucoma but also identified clinical importance of early ophthalmologic screening for HPV-infected individuals, particularly those with additional risk factors, to prevent glaucoma-related vision loss,” the authors wrote in their Ophthalmology paper.“Although mechanisms such as chronic inflammation, endothelial dysfunction and oxidative stress may underlie this association, (between HPV infection and an increased risk of new-onset glaucoma), further research is needed to clarify these pathways,” the authors concluded.Click here for the journal source. Liao W-C, Su Y-J, Li Y-F, et al. Human papillomavirus infection is associated with increased risk of glaucoma: real-world evidence. Ophthalmology. May 21, 2025. [Epub ahead of print].