Genital human papillomavirus infections in Taiwan

Estimating the burden of genital warts in Taiwan

Background This study aimed to estimate the prevalence of genital warts in Taiwan among those seeking healthcare, as well as genital-warts-related healthcare resource use and costs, and self-reported genital-warts-related psychosocial impact.

METHODS

Genital warts prevalence estimates were extracted from a daily record of patients examined from 31 October 2011 to 4 May 2012 by 67 physicians in Taiwan. Physicians recorded the total number of patients and genital warts patients seen daily for 2 weeks. These physicians also completed a survey regarding healthcare resource use, treatment, follow-up care, and referral patterns. Patient psychosocial impact was estimated using a self-administered survey.

RESULTS

The overall prevalence of genital warts in Taiwan was estimated at 1.1%, with a higher prevalence among men. A total of 146 genital warts case patients were included in the study (76 men, 70 women). Median costs for diagnosis and treatment were US$222 for male and US$351.8 for female patients. Male genital warts subjects reported a negative psychosocial impact on their well-being and health-related quality of life - psychosocial impact results are reported in the Supplementary Material file.

CONCLUSIONS

Genital warts prevalence was higher among male patients; female patients incurred higher costs. Among men, genital warts had a negative psychosocial impact on well-being and health-related quality of life.

Cost and effectiveness evaluation of prophylactic HPV vaccine in developing countries

BACKGROUND

Approximately 80% of cervical cancer cases occur in developing countries. In Thailand, cervical cancer has been the leading cancer in females, with an incidence of 24.7 cases per 100,000 individuals per year.

OBJECTIVES

We constructed a decision model to simulate the lifetime economic impact for women in the context of human papillomavirus (HPV) infection prevention. HPV-related diseases were of interest: cervical cancer, cervical intraepithelial neoplasia, and genital warts. The two strategies used were 1) current practice and 2) prophylactic quadrivalent vaccine against HPV types 6, 11, 16, and 18.

METHODS

We developed a Markov simulation model to evaluate the incremental cost-effectiveness ratio of prophylactic HPV vaccine. Women transition through a model either healthy or developing HPV or its related diseases, or die from cervical cancer or from other causes according to transitional probabilities under the Thai health-care context. Costs from a provider perspective were obtained from King Chulalongkorn Memorial Hospital. Costs and benefits were discounted at 3% annually.

RESULTS

Compared with no prophylactic HPV vaccine, the incremental cost-effectiveness ratio was 160,649.50 baht per quality-adjusted life-year. The mortality rate was reduced by 54.8%. The incidence of cervical cancer, cervical intraepithelial neoplasia grade 1, cervical intraepithelial neoplasia grade 2/3, and genital warts was reduced by up to 55.1%.

CONCLUSION

Compared with commonly accepted standard thresholds recommended by the World Health Organization Commission on Macroeconomics and Health, the nationwide coverage of HPV vaccination in girls is likely to be cost-effective in Thailand.

The impact of HIV infection and immunodeficiency on human papillomavirus type 6 or 11 infection and on genital warts

BACKGROUND

HIV infection and associated immunodeficiency are known to alter the course of human papillomavirus (HPV) infections and of associated diseases.

GOAL

This study investigated the association between HIV and HPV and genital warts.

STUDY DESIGN

HPV testing and physical examinations were performed in two large prospective studies: the Women's Interagency HIV Study (WIHS) and the HIV Epidemiology Research Study (HERS). Statistical methods incorporating dependencies of longitudinal data were used to examine the relationship between HIV and HPV and genital warts.

RESULTS

A total of 1008 HIV-seronegative and 2930 HIV-seropositive women were enrolled in the two studies. The prevalence of HPV 6 or 11 was 5.6 times higher in HIV-seropositive women in the WIHS and 3.6 times higher in the HERS. Genital wart prevalence increased by a factor of 3.2 in the WIHS and 2.7 in the HERS in HIV-seropositive women. In the WIHS, infection with HPV type 6 or 11, in comparison with no HPV infection, was associated with odds of genital wart prevalence of 5.1 (95% CI: 2.9-8.8), 8.8 (95% CI: 6.1-12.8), and 12.8 (95% CI: 8.8-18.8) in HIV-seronegative women, HIV-seropositive women with > or =201 CD4 cells/microl, and HIV-seropositive women with < or =200 CD4 cells/microl, respectively. In the HERS, infection with HPV type 6 or 11 was associated with odds of 2.7 (95% CI: 1.6-4.6), 4.9 (95% CI: 3.2-7.7), and 5.3 (95% CI: 3.3-8.5) in these same groups. Other HPV types showed a similar dose-response relation, but of substantially lower magnitude and statistical significance.

CONCLUSIONS

HIV infection and immunodeficiency synergistically modified the relation between HPV 6 or 11 infection and genital wart prevalence.

Overexpression of the proto-oncogene c-jun in association with low-risk type specific human papillomavirus infection in condyloma acuminata

Infection with different types of human papillomavirus (HPV) is associated with neoplasia at different anatomic sites. The "low-risk" HPVs (LR-HPV) are responsible for benign genital lesions such as condyloma acuminata. In order to clarify the tumorigenic mechanism of LR-HPV, the HPV infection status was investigated and the expression of the c-jun proto-oncogene in different HPV-related skin and genital lesions analyzed. Of the 17 condyloma specimens analyzed by Western blotting, 13 cases (76.5%) exhibited overexpression of the c-jun gene. All 13 cases harbored high copy numbers of the LR-HPV genome with an average of 926 copies per cell, whereas the other four cases had an average of 12 copies of LR-HPV per cell (P < 0.001). Further typing of HPV by Southern blotting revealed that HPV-6 and HPV-11 infections predominated in c-jun positive cases. The c-jun protein was detected much less frequently in cervical cancers (three of 29, or 10.3%) and skin warts (one of 10), and was not detected in five genital polyps or in five normal cervical tissues. These findings suggest a type 6/11-specific induction of c-jun gene expression in HPV-related neoplastic lesions.