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Orzechowska M, Cybulski M, Krajewska-Kulak E, Sobolewski M, Gniadek A, Niczyporuk W. Comparative Analysis of the Incidence of Selected Sexually Transmitted Viral Infections in Poland in 2010-2015: A Retrospective Cohort Study. J Clin Med 2022; 11:3448. [PMID: 35743518 PMCID: PMC9225430 DOI: 10.3390/jcm11123448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
Sexually transmitted infections (STIs) represent a major cause of morbidity in women and men worldwide. The main aim of this study was to perform a comparative analysis of the incidence of sexually transmitted viral infections in 2010-2015 in Poland, taking into account the administrative division of the country into provinces. This was a retrospective study. The analysed data came from the Centre for Health Information Systems of the Ministry of Health and the National Institute of Public Health-National Research Institute and constituted information from the epidemiological surveillance system in Poland. We collected data on the incidence of the following diseases: genital herpes (HSV), genital warts, human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). The key groups with the highest risk of infection were young people between 20 and 29 years of age. The reported data on the incidence of genital herpes in Poland (n = 3378; 1.5/100,000) showed a downward trend, which does not coincide with global trends. Genital warts were the most frequent genital infections in Poland (n = 7980; 3.46/100,000), with significant regional variation. Over the analysed period, the situation of newly detected HIV infections seemed to be stable (n = 7144; 3.1/100,000). The incidence of these infections appeared to be highly correlated with urbanisation rates, which was not confirmed in the case of other analysed infections. The worsening epidemic situation with respect to sexually transmitted infections, the inefficiency of the current surveillance system and the reduction in funding for diagnosis and prevention, combined with inadequate legal solutions, make it necessary to undertake new legal and organisational measures aimed at improving the reproductive health in Poland in terms of sexually transmitted infections.
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Affiliation(s)
- Magda Orzechowska
- Department of Epidemiology of Infectious Diseases and Supervision, National Institute of Public Health/National Research Institute, 00-791 Warsaw, Poland
| | - Mateusz Cybulski
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.C.); (E.K.-K.)
| | - Elzbieta Krajewska-Kulak
- Department of Integrated Medical Care, Faculty of Health Sciences, Medical University of Bialystok, 15-096 Bialystok, Poland; (M.C.); (E.K.-K.)
| | - Marek Sobolewski
- Department of Quantitative Methods, Rzeszow University of Technology, 35-959 Rzeszow, Poland;
| | - Agnieszka Gniadek
- Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, 31-501 Krakow, Poland;
| | - Wiaczeslaw Niczyporuk
- Department of Medical Sciences, Faculty of Health Sciences, Lomza State University of Applied Sciences, 18-400 Lomza, Poland;
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2
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Mestrovic T, Sviben M, Zember S, Drenjancevic D. Topical medication as an initial therapeutic option for protruding and non-protruding condylomata acuminata of the distal urethra. BMJ Case Rep 2021; 14:e243618. [PMID: 34548297 PMCID: PMC8458332 DOI: 10.1136/bcr-2021-243618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/04/2022] Open
Abstract
Genital warts (also known as condylomata acuminata) caused by the human papillomavirus (HPV) represent one of the most common sexually transmitted infections. Although they are usually found in the outer genital region, a small proportion of men can present with (often unrecognised) intraurethral warts, generally limited to the distal urethra and urethral meatus. This poses a treatment challenge not adequately addressed by the current guidelines. Here, we present two cases of low-risk HPV-positive patients with protruding and non-protruding condylomata acuminata of the distal urethra, which were treated successfully by using two different topical regimens (ie, a combination of policresulen and imiquimod for one patient and 5-fluorouracil monotherapy for the other). Although this type of management results in lower rates of tissue destruction and complications and may be given preference as an initial therapeutic option, additional prospective comparative clinical studies are needed to elucidate its potential in similar cases.
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Affiliation(s)
- Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Mario Sviben
- Department of Medical Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia
- Microbiology Service, Croatian National Institute of Public Health, Zagreb, Croatia
| | - Sanja Zember
- Department for Urogenital Infections, University Hospital for Infectious Diseases 'Dr. Fran Mihaljević', Zagreb, Croatia
| | - Domagoj Drenjancevic
- Clinical Microbiology Department, University Hospital Centre Osijek, Osijek, Croatia
- Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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3
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Zizza A, Banchelli F, Guido M, Marotta C, Di Gennaro F, Mazzucco W, Pistotti V, D'Amico R. Efficacy and safety of human papillomavirus vaccination in HIV-infected patients: a systematic review and meta-analysis. Sci Rep 2021; 11:4954. [PMID: 33654181 PMCID: PMC7925667 DOI: 10.1038/s41598-021-83727-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/03/2021] [Indexed: 11/09/2022] Open
Abstract
The prophylactic vaccines available to protect against infections by HPV are well tolerated and highly immunogenic. People with HIV have a higher risk of developing HPV infection and HPV-associated cancers due to a lower immune response, and due to viral interactions. We performed a systematic review of RCTs to assess HPV vaccines efficacy and safety on HIV-infected people compared to placebo or no intervention in terms of seroconversion, infections, neoplasms, adverse events, CD4+ T-cell count and HIV viral load. The vaccine-group showed a seroconversion rate close to 100% for each vaccine and a significantly higher level of antibodies against HPV vaccine types, as compared to the placebo group (MD = 4333.3, 95% CI 2701.4; 5965.1 GMT EL.U./ml for HPV type 16 and MD = 1408.8, 95% CI 414.8; 2394.7 GMT EL.U./ml for HPV type 18). There were also no differences in terms of severe adverse events (RR = 0.6, 95% CI 0.2; 1.6) and no severe adverse events (RR = 0.6, 95% CI 0.9; 1.2) between vaccine and placebo groups. Secondary outcomes, such as CD4 + T-cell count and HIV viral load, did not differ between groups (MD = 14.8, 95% CI - 35.1; 64.6 cells/µl and MD = 0.0, 95% CI - 0.3; 0.3 log10 RNA copies/ml, respectively). Information on the remaining outcomes was scarce and that did not allow us to combine the data. The results support the use of the HPV vaccine in HIV-infected patients and highlight the need of further RCTs assessing the effectiveness of the HPV vaccine on infections and neoplasms.
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Affiliation(s)
- Antonella Zizza
- Institute of Clinical Physiology, National Research Council, 73100, Lecce, Italy
| | - Federico Banchelli
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41100, Modena, Italy
| | - Marcello Guido
- Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, University of Salento, Via Prov.Le Lecce-Monteroni, 165, 73100, Lecce, Italy.
- Inter-University Centre of Research on Influenza and Other Transmissible Infections (CIRI-IT), University of Genoa, 16100, Genoa, Italy.
| | - Claudia Marotta
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90100, Palermo, Italy
- Medical Direction, IRCCS Neuromed, 86170, Pozzilli, IS, Italy
| | - Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90100, Palermo, Italy
- Clinical Epidemiology and Cancer Registry Unit, COVID-19 Sicilian Regional Reference Lab, Palermo University Hospital (AOUP) "P. Giaccone", 90100, Palermo, Italy
- Division of Biostatistics and Epidemiology, Department of Pediatric, Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Roberto D'Amico
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41100, Modena, Italy
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4
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Meliti A, Hawari A, Al-Maghrabi H, Mokhtar G. Condyloma accuminatum of the male urethra: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20904584. [PMID: 32128210 PMCID: PMC7036498 DOI: 10.1177/2050313x20904584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 12/31/2019] [Indexed: 11/16/2022] Open
Abstract
Condyloma acuminatum is an anogenital lesion caused by the human papillomavirus infection. It is a common, sexually transmitted disease. It usually affects the external genitalia, while urethral and bladder involvement is uncommon. Human papillomavirus types are classified into three categories depending on their oncogenic potential: low risk (type 6, 11, 42, 43, 44, 59, 66, 68, and 70), intermediate-risk (type 30, 31, 33, 34, 35, 39, 40, 49, 51, 52, 53, 57, 58, 63, and 64) and high risk (type 16, 18, 45, and 56). High-risk and intermediate-risk human papillomavirus DNA types, together with other co-factors still to be defined, account for over 90% of anogenital pre-malignant and malignant tumours. Herein, we report a unique case of condyloma acuminatum positive for human papillomavirus -6 involving the penile urethra, presents as the primary and only site of the disease in a diabetic type-2 patient.
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Affiliation(s)
- Abdelrazak Meliti
- Department of Anatomic Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia.,Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada
| | - Abdulrahman Hawari
- Department of Anatomic Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Haneen Al-Maghrabi
- Department of Anatomic Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Ghadeer Mokhtar
- Department of Anatomic Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia.,Department of Anatomic Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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5
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Pereira-Caldeira NMV, Pereira-Ávila FMV, Almeida-Cruz MCMD, Reinato LAF, Reis RK, Gir E. Instruments for quality of life assessment in individuals with human papillomavirus. Rev Bras Enferm 2019; 72:1363-1369. [PMID: 31531663 DOI: 10.1590/0034-7167-2017-0394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/10/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To identify scientific evidence on quality of life measurement instruments used in individuals with infections caused by human papillomavirus. METHOD This was an integrative review carried out from April 1995 to March 2017 in the LILACS, SciVerse Scopus, ISI Web of Science, CINAHL, and PubMed databases. The controlled descriptors adopted were: Infecções por Papilomavirus; Qualidade de Vida; Papillomavirus Infections; and Quality of Life. RESULTS Of the 416 articles found, 12 were selected. Thirteen different types of instruments to evaluate the quality of life of individuals with human papillomavirus were identified, in that nine were generic and four specific. CONCLUSION Different generic and specific instruments were used to evaluate the quality of life of individuals with human papillomavirus, which means no consensus or preference among the studies was identified. However, a lack of use of specific instruments to evaluate this construct in this population was observed.
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Affiliation(s)
| | | | | | | | | | - Elucir Gir
- Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil
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6
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Domenech-Viñolas M, León-Maldonado L, Ramírez-Palacios P, Flores YN, Granados-García V, Brown B, Corona E, Liu S, Lazcano-Ponce E, Salmerón J. Incidence, psychosocial burden, and economic impact of genital warts in Mexico. SALUD PUBLICA DE MEXICO 2019; 60:624-632. [PMID: 30699267 DOI: 10.21149/10008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/14/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To estimate the burden of genital warts (GW)in Mexico. MATERIALS AND METHODS We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. RESULTS The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. CONCLUSIONS This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.
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Affiliation(s)
| | - Leith León-Maldonado
- Cátedra Conacyt, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México.,Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México.,Centro de Investigación en Población, Políticas y Salud, Facultad de Medicina, Universidad Autónoma de México. Ciudad de México, México
| | - Paula Ramírez-Palacios
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social. Cuernavaca, Morelos, México
| | - Yvonne N Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social. Cuernavaca, Morelos, México.,Department of Health Policy and Management, and Kaiser Permanente Center for Health Equity, University of California, Los Angeles. Los Angeles, CA, USA.,Cancer Prevention and Control Research Center, Fielding School of Public Health and Jonsson Comprehensive Cancer Center. Los Angeles, CA, USA
| | - Víctor Granados-García
- Unidad de Investigación Epidemiológica y en Servicios de Salud Área Envejecimiento, Centro Médico Nacional Siglo XXI. Ciudad de México, México
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Riverside School of Medicine, University of California. Riverside, California, USA
| | - Edgar Corona
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social. Cuernavaca, Morelos, México.,David Geffen School of Medicine, University of California. Los Angeles, CA, USA
| | - Stephanie Liu
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social. Cuernavaca, Morelos, México.,Department of Epidemiology, School of Public Health, University of Washington. Seattle, WA, USA
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Jorge Salmerón
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México.,Centro de Investigación en Población, Políticas y Salud, Facultad de Medicina, Universidad Autónoma de México. Ciudad de México, México
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7
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Lee TS, Kothari-Talwar S, Singhal PK, Yee K, Kulkarni A, Lara N, Roset M, Giuliano AR, Garland SM, Ju W. Cross-sectional study estimating the psychosocial impact of genital warts and other anogenital diseases in South Korea. BMJ Open 2019; 9:e025035. [PMID: 30898815 PMCID: PMC6475443 DOI: 10.1136/bmjopen-2018-025035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To estimate self-reported human papillomavirus (HPV) disease-related psychosocial impact among male and female patients in South Korea. DESIGN In this multicentre cross-sectional study, psychosocial impacts were estimated using a one-time survey capturing HPV Impact Profile (HIP) results, CuestionarioEspecifico en Condilomas Acuminados (CECA; in Spanish)-'Specific questionnaire for Condylomata Acuminata' and the EuroQol-5 Dimension (EQ-5D) surveys. Student's t-tests or Mann-Whitney U tests were used for continuous comparisons; χ2 or Fisher's exact tests were applied for categorical comparisons. SETTING 5098 clinics throughout Seoul, Busan, Daegu, Kwangju and Daejeon (South Korea). PARTICIPANTS Patients with and without genital warts (GW) (males) and selected HPV diseases (females) visiting primary care physicians, obstetricians/gynaecologists, urologists and dermatologists with 2-30 years experience. RESULTS Of 150 male and 250 female patients, HIP scores showed 85.3% of male patients with GW and 32.0% without reported moderate psychological impact (p<0.0001). In categorised total scores, 88.5% of female patients with and 66.0% without selected HPV-related diseases reported moderate or high psychological impacts (p=0.0004). In the CECA questionnaire, male patients had mean (SD) scores of 10.51 (3.79) in 'emotional health' and 15.90 (6.13) in 'sexual activity'. Female patients with GW reported lower scores in both dimensions with mean scores of 7.18 (4.17) in 'emotional health' and 10.97 (5.80) in 'sexual activity' (p<0.0001), indicating worse health-related quality of life (HRQoL). For the EQ-5D, male patients with GW reported lower mean Visual Analogue Scale (VAS) scores than those without (75.1 vs 81.13, p<0.0135). Mean VAS score and utility values were lower for females with HPV-related diseases than those without (72.18 vs 76.86 and 0.90 vs 0.94, respectively). CONCLUSION In South Korea, GW in men and HPV-related diseases in women negatively impact patient well-being and HRQoL scores. Among women, those with GW suffered a greater psychosocial impact than those with other selected HPV-related diseases.
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Affiliation(s)
- Taek Sang Lee
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | | | | | - Karen Yee
- Cubist Pharmaceuticals Inc, Lexington, Massachusetts, USA
| | | | - Nuria Lara
- Real World Evidence Solutions, IQVIA, Barcelona, Spain
| | | | - Anna R Giuliano
- Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Suzanne M Garland
- Microbiology and Infectious Diseases Department, The Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Woong Ju
- School of Medicine, Ewha Womans University, Seoul, South Korea
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8
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Ong KJ, Checchi M, Burns L, Pavitt C, Postma MJ, Jit M. Systematic review and evidence synthesis of non-cervical human papillomavirus-related disease health system costs and quality of life estimates. Sex Transm Infect 2018; 95:28-35. [PMID: 30674687 DOI: 10.1136/sextrans-2018-053606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/06/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many economic evaluations of human papillomavirus vaccination should ideally consider multiple disease outcomes, including anogenital warts, respiratory papillomatosis and non-cervical cancers (eg, anal, oropharyngeal, penile, vulvar and vaginal cancers). However, published economic evaluations largely relied on estimates from single studies or informal rapid literature reviews. METHODS We conducted a systematic review of articles up to June 2016 to identify costs and utility estimates admissible for an economic evaluation from a single-payer healthcare provider's perspective. Meta-analyses were performed for studies that used same utility elicitation tools for similar diseases. Costs were adjusted to 2016/2017 US$. RESULTS Sixty-one papers (35 costs; 24 utilities; 2 costs and utilities) were selected from 10 742 initial records. Cost per case ranges were US$124-US$883 (anogenital warts), US$6912-US$52 579 (head and neck cancers), US$12 936-US$51 571 (anal cancer), US$17 524-34 258 (vaginal cancer), US$14 686-US$28 502 (vulvar cancer) and US$9975-US$27 629 (penile cancer). The total cost for 14 adult patients with recurrent respiratory papillomatosis was US$137 601 (one paper).Utility per warts episode ranged from 0.651 to 1 (12 papers, various utility elicitation methods), with pooled mean EQ-5D and EQ-VAS of 0.86 (95% CI 0.85 to 0.87) and 0.74 (95% CI 0.74 to 0.75), respectively. Fifteen papers reported utilities in head and neck cancers with range 0.29 (95% CI 0.0 to 0.76) to 0.94 (95% CI 0.3 to 1.0). Mean utility reported ranged from 0.5 (95% CI 0.4 to 0.61) to 0.65 (95% CI 0.45 to 0.75) (anal cancer), 0.59 (95% CI 0.54 to 0.64) (vaginal cancer), 0.65 (95% CI 0.60 to 0.70) (vulvar cancer) and 0.79 (95% CI 0.74 to 0.84) (penile cancer). CONCLUSIONS Differences in values reported from each paper reflect variations in cancer site, disease stages, study population, treatment modality/setting and utility elicitation methods used. As patient management changes over time, corresponding effects on both costs and utility need to be considered to ensure health economic assumptions are up-to-date and closely reflect the case mix of patients.
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Affiliation(s)
- Koh Jun Ong
- National Infection Service, Public Health England, London, UK
| | - Marta Checchi
- National Infection Service, Public Health England, London, UK
| | - Lorna Burns
- Faculty of Medicine and Dentistry, University of Plymouth, Devon, UK
| | | | - Maarten J Postma
- Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Groningen, The Netherlands
| | - Mark Jit
- National Infection Service, Public Health England, London, UK .,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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9
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Pańczyszyn A, Boniewska-Bernacka E, Głąb G. Telomeres and Telomerase During Human Papillomavirus-Induced Carcinogenesis. Mol Diagn Ther 2018; 22:421-430. [PMID: 29777397 PMCID: PMC6061425 DOI: 10.1007/s40291-018-0336-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Human papillomaviruses (HPVs) belong to a small spherical virus family and are transmitted through direct contact, most often through sexual behavior. More than 200 types of HPV are known, a dozen or so of which are classified as high-risk viruses (HR HPV) and may contribute to the development of cervical cancer. HPV is a small virus with a capsid composed of L1 and L2 proteins, which are crucial for entry to the cell. The infection begins at the basal cell layer and progresses to involve cells from higher layers of the cervical epithelium. E6 and E7 viral proteins are involved in the process of carcinogenesis. They interact with suppressors of oncogenesis, including p53 and Rb proteins. This leads to DNA replication and intensive cell divisions. The persistent HR HPV infection leads to the development of dysplasia and these changes may progress to invasive cancer. During the initial stage of carcinogenesis, telomeres shorten until telomerase activates. The activation of telomerase, the enzyme necessary to extend chromosome ends (telomeres) is the key step in cell immortalization. Analyzing the expression level of hTERT and hTERC genes encoding telomerase and telomere length measurement may constitute new markers of the early carcinogenesis.
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Affiliation(s)
- Anna Pańczyszyn
- Department of Biotechnology and Molecular Biology, University of Opole, ul. Kominka 6, 45-035, Opole, Poland.
| | - Ewa Boniewska-Bernacka
- Department of Biotechnology and Molecular Biology, University of Opole, ul. Kominka 6, 45-035, Opole, Poland
| | - Grzegorz Głąb
- Public Higher Medical Professional School in Opole, Opole, Poland
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10
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Tejada RA, Vargas KG, Benites-Zapata V, Mezones-Holguín E, Bolaños-Díaz R, Hernandez AV. Human papillomavirus vaccine efficacy in the prevention of anogenital warts: systematic review and meta-analysis. SALUD PUBLICA DE MEXICO 2018; 59:84-94. [PMID: 28423114 DOI: 10.21149/7824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/10/2016] [Indexed: 11/06/2022] Open
Abstract
Objective: To review evidence on the efficacy of HPV vaccines in the prevention of non-cancer lesions (anogenital warts [AGW], recurrent laryngeal papillomatosis and oral papillomatosis). Materials and methods: We conducted a systematic review of randomized trials. We performed random effect models and effects were reported as relative risks (RR) and their confidence intervals (95%CI) following both intention to treat (ITT) and per protocol (PP) analyses. Results: We included six studies (n=27 078). One study was rated as high risk of bias. One study could not be included in the meta-analysis because it provided combined results. We found that quadrivalent vaccine reduced the risk of AGW by 62% (RR: 0.38, 95%CI:0.32-0.45, I2:0%) in the ITT analysis and by 95% (RR: 0.05, 95%CI:0.01-0.25, I2:66%) in the PP analysis. Subgroup analyses of studies in women or with low-risk of bias provided similar results. Conclusion: HPV quadrivalent vaccine is efficacious in preventing AGW in men and women.
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Affiliation(s)
- Romina A Tejada
- Unidad de Análisis y Generación de Evidencias en Salud Pública, Centro Nacional de Salud Pública, Instituto Nacional de Salud. Lima, Perú
| | - Kris G Vargas
- Department of Epidemiology, Erasmus MC. Rotterdam. Netherlands
| | - Vicente Benites-Zapata
- Centro de Investigación de Salud Pública, Instituto de Investigación, Facultad de Medicina Humana, Universidad de San Martín de Porres. Lima, Perú
| | - Edward Mezones-Holguín
- Intendencia de Investigación y Desarrollo, Superintendencia Nacional de Salud. Lima, Perú.,School of Medicine, Universidad Peruana de Ciencias Aplicadas. Lima, Perú
| | - Rafael Bolaños-Díaz
- Unidad de Análisis y Generación de Evidencias en Salud Pública, Centro Nacional de Salud Pública, Instituto Nacional de Salud. Lima, Perú.,Organización médica para el desarrollo de la salud. Lima, Perú
| | - Adrián V Hernandez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas. Lima, Perú.,Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic. Ohio, USA
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11
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The human papillomavirus replication cycle, and its links to cancer progression: a comprehensive review. Clin Sci (Lond) 2017; 131:2201-2221. [DOI: 10.1042/cs20160786] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022]
Abstract
HPVs (human papillomaviruses) infect epithelial cells and their replication cycle is intimately linked to epithelial differentiation. There are over 200 different HPV genotypes identified to date and each displays a strict tissue specificity for infection. HPV infection can result in a range of benign lesions, for example verrucas on the feet, common warts on the hands, or genital warts. HPV infects dividing basal epithelial cells where its dsDNA episomal genome enters the nuclei. Upon basal cell division, an infected daughter cell begins the process of keratinocyte differentiation that triggers a tightly orchestrated pattern of viral gene expression to accomplish a productive infection. A subset of mucosal-infective HPVs, the so-called ‘high risk’ (HR) HPVs, cause cervical disease, categorized as low or high grade. Most individuals will experience transient HR-HPV infection during their lifetime but these infections will not progress to clinically significant cervical disease or cancer because the immune system eventually recognizes and clears the virus. Cancer progression is due to persistent infection with an HR-HPV. HR-HPV infection is the cause of >99.7% cervical cancers in women, and a subset of oropharyngeal cancers, predominantly in men. HPV16 (HR-HPV genotype 16) is the most prevalent worldwide and the major cause of HPV-associated cancers. At the molecular level, cancer progression is due to increased expression of the viral oncoproteins E6 and E7, which activate the cell cycle, inhibit apoptosis, and allow accumulation of DNA damage. This review aims to describe the productive life cycle of HPV and discuss the roles of the viral proteins in HPV replication. Routes to viral persistence and cancer progression are also discussed.
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Bardach AE, Garay OU, Calderón M, Pichón-Riviére A, Augustovski F, Martí SG, Cortiñas P, Gonzalez M, Naranjo LT, Gomez JA, Caporale JE. Health economic evaluation of Human Papillomavirus vaccines in women from Venezuela by a lifetime Markov cohort model. BMC Public Health 2017; 17:152. [PMID: 28148228 PMCID: PMC5289055 DOI: 10.1186/s12889-017-4064-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 01/24/2017] [Indexed: 12/16/2022] Open
Abstract
Background Cervical cancer (CC) and genital warts (GW) are a significant public health issue in Venezuela. Our objective was to assess the cost-effectiveness of the two available vaccines, bivalent and quadrivalent, against Human Papillomavirus (HPV) in Venezuelan girls in order to inform decision-makers. Methods A previously published Markov cohort model, informed by the best available evidence, was adapted to the Venezuelan context to evaluate the effects of vaccination on health and healthcare costs from the perspective of the healthcare payer in an 11-year-old girls cohort of 264,489. Costs and quality-adjusted life years (QALYs) were discounted at 5%. Eight scenarios were analyzed to depict the cost-effectiveness under alternative vaccine prices, exchange rates and dosing schemes. Deterministic and probabilistic sensitivity analyses were performed. Results Compared to screening only, the bivalent and quadrivalent vaccines were cost-saving in all scenarios, avoiding 2,310 and 2,143 deaths, 4,781 and 4,431 CCs up to 18,459 GW for the quadrivalent vaccine and gaining 4,486 and 4,395 discounted QALYs respectively. For both vaccines, the main determinants of variations in the incremental costs-effectiveness ratio after running deterministic and probabilistic sensitivity analyses were transition probabilities, vaccine and cancer-treatment costs and HPV 16 and 18 distribution in CC cases. When comparing vaccines, none of them was consistently more cost-effective than the other. In sensitivity analyses, for these comparisons, the main determinants were GW incidence, the level of cross-protection and, for some scenarios, vaccines costs. Conclusions Immunization with the bivalent or quadrivalent HPV vaccines showed to be cost-saving or cost-effective in Venezuela, falling below the threshold of one Gross Domestic Product (GDP) per capita (104,404 VEF) per QALY gained. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these results. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4064-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariel Esteban Bardach
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina.
| | - Osvaldo Ulises Garay
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - María Calderón
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Andrés Pichón-Riviére
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Federico Augustovski
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Sebastián García Martí
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
| | - Paula Cortiñas
- Salud Chacao, Final Av. Ávila, Edif. Salud Chacao. Urb. Bello Campo. Chacao, 1060, Caracas, D.C, Venezuela
| | - Marino Gonzalez
- Unit of Public Policy, Simon Bolivar University, Edificio Física y Electrónica I, Planta Baja. Valle de Sartenejas, Estado Miranda, Caracas, Venezuela
| | - Laura T Naranjo
- GlaxoSmithKline Biologicals, Clayton, Ciudad del Saber Edificio 230, Panama City, Panama
| | - Jorge Alberto Gomez
- GSK Vaccines Latin America, Carlos Casares 3690, B1644 BCD, Victoria, Buenos Aires, Argentina
| | - Joaquín Enzo Caporale
- IECS Instituto de Efectividad Clínica y Sanitaria, Dr. Emilio Ravignani 2024 (C1014CPV), 1014, Buenos Aires, Argentina
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Squiquera L, Taxman DJ, Brendle SA, Torres R, Sulley J, Hodge T, Christensen N, Sidransky D. Ranpirnase eradicates human papillomavirus in cultured cells and heals anogenital warts in a Phase I study. Antivir Ther 2017; 22:247-255. [PMID: 28121292 DOI: 10.3851/imp3133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Human papillomaviruses (HPV), the causative agents of anogenital warts, are the most prevalent sexually transmitted infectious agents, and wart treatment poses a persistent challenge. We assessed the safety and efficacy of treating HPV with ranpirnase, an endoribonuclease from the northern leopard frog that has been used extensively in Phase III oncology trials. METHODS As initial verification of ranpirnase antiviral activity, we assessed its ability to eliminate papillomaviruses in cultured cells. To further assess its feasibility for treating anogenital warts in humans, we performed a Phase I study. Forty-two male volunteers with genital/perianal warts were treated topically with three different formulations of 1 mg/ml ranpirnase. Patients were monitored for 8 weeks or until healing. Four patients with HIV were treated in accordance with the compassionate programme but were not evaluated. RESULTS In cultured cells, ranpirnase showed specific activity against HPV-11 with low toxicity (selectivity index >88). The broad applicability of ranpirnase for treating papillomaviruses was verified using the cottontail rabbit papillomavirus. In the clinical study, eight participants were lost-to-follow-up or discontinued due to protocol violation or non-compliance. Among 30 evaluable participants, topical ranpirnase was moderately well-tolerated, with discontinuation by 5 (16.7%) due to adverse reactions. Clinical healing was achieved by 25 participants (83.3%) and 50% improvement by the 5 discontinued participants (16.7%). The median time to clinical healing was 30 days. CONCLUSIONS This study provides the first in vitro and clinical evidence of the antiviral efficacy of ranpirnase against HPV and supports assessment of ranpirnase in expanded clinical studies.
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Affiliation(s)
- Luis Squiquera
- Tamir Biotechnology, Inc., Clinical Development, San Diego, CA, USA
| | - Debra J Taxman
- Tamir Biotechnology, Inc., Clinical Development, San Diego, CA, USA
| | - Sarah A Brendle
- Department of Pathology and Microbiology and Immunology, Penn State University, Hershey, PA, USA
| | - Roberto Torres
- Tamir Biotechnology, Inc., Clinical Development, San Diego, CA, USA
| | - Jamie Sulley
- Tamir Biotechnology, Inc., Clinical Development, San Diego, CA, USA
| | - Thomas Hodge
- Tamir Biotechnology, Inc., Clinical Development, San Diego, CA, USA
| | - Neil Christensen
- Department of Pathology and Microbiology and Immunology, Penn State University, Hershey, PA, USA
| | - David Sidransky
- Tamir Biotechnology, Inc., Clinical Development, San Diego, CA, USA
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Thurgar E, Barton S, Karner C, Edwards SJ. Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation. Health Technol Assess 2017; 20:v-vi, 1-486. [PMID: 27034016 DOI: 10.3310/hta20240] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Typically occurring on the external genitalia, anogenital warts (AGWs) are benign epithelial skin lesions caused by human papillomavirus infection. AGWs are usually painless but can be unsightly and physically uncomfortable, and affected people might experience psychological distress. The evidence base on the clinical effectiveness and cost-effectiveness of treatments for AGWs is limited. OBJECTIVES To systematically review the evidence on the clinical effectiveness of medical and surgical treatments for AGWs and to develop an economic model to estimate the cost-effectiveness of the treatments. DATA SOURCES Electronic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases and Web of Science) were searched from inception (or January 2000 for Web of Science) to September 2014. Bibliographies of relevant systematic reviews were hand-searched to identify potentially relevant studies. The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov were searched for ongoing and planned studies. REVIEW METHODS A systematic review of the clinical effectiveness literature was carried out according to standard methods and a mixed-treatment comparison (MTC) undertaken. The model implemented for each outcome was that with the lowest deviance information criterion. A de novo economic model was developed to assess cost-effectiveness from the perspective of the UK NHS. The model structure was informed through a systematic review of the economic literature and in consultation with clinical experts. Effectiveness data were obtained from the MTC. Costs were obtained from the literature and standard UK sources. RESULTS Of 4232 titles and abstracts screened for inclusion in the review of clinical effectiveness, 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by MTC indicated that ablative techniques were typically more effective than topical interventions at completely clearing AGWs at the end of treatment. Podophyllotoxin 0.5% solution (Condyline(®), Takeda Pharmaceutical Company Ltd; Warticon(®) solution, Stiefel Laboratories Ltd) was found to be the most effective topical treatment evaluated. Networks for other outcomes included fewer treatments, which restrict conclusions on the comparative effectiveness of interventions. In total, 84 treatment strategies were assessed using the economic model. Podophyllotoxin 0.5% solution first line followed by carbon dioxide (CO2) laser therapy second line if AGWs did not clear was most likely to be considered a cost-effective use of resources at a willingness to pay of £20,000-30,000 per additional quality-adjusted life-year gained. The result was robust to most sensitivity analyses conducted. LIMITATIONS Limited reporting in identified studies of baseline characteristics for the enrolled population generates uncertainty around the comparability of the study populations and therefore the generalisability of the results to clinical practice. Subgroup analyses were planned based on type, number and size of AGWs, all of which are factors thought to influence treatment effect. Lack of data on clinical effectiveness based on these characteristics precluded analysis of the differential effects of treatments in the subgroups of interest. Despite identification of 60 studies, most comparisons in the MTC are informed by only one RCT. Additionally, lack of head-to-head RCTs comparing key treatments, together with minimal reporting of results in some studies, precluded comprehensive analysis of all treatments for AGWs. CONCLUSIONS The results generated by the MTC are in agreement with consensus opinion that ablative techniques are clinically more effective at completely clearing AGWs after treatment. However, the evidence base informing the MTC is limited. A head-to-head RCT that evaluates the comparative effectiveness of interventions used in clinical practice would help to discern the potential advantages and disadvantages of the individual treatments. The results of the economic analysis suggest that podophyllotoxin 0.5% solution is likely to represent a cost-effective first-line treatment option. More expensive effective treatments, such as CO2 laser therapy or surgery, may represent cost-effective second-line treatment options. No treatment and podophyllin are unlikely to be considered cost-effective treatment options. There is uncertainty around the cost-effectiveness of treatment with imiquimod, trichloroacetic acid and cryotherapy. STUDY REGISTRATION This study is registered as PROSPERO CRD42013005457. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Abstract
The human papillomavirus (HPV) may be associated with various oral, genital, and cutaneous conditions, both benign and malignant. The association between sexually transmitted α-HPV types is the strongest with cervical cancer because almost all such malignancies contain viral DNA, notably HPV types 16 and 18. The contribution of cancer causing HPV types in other anogenital, oral, and oropharyngeal malignancies, plus benign disorders, is lower and with a less significant public health concern. Cervical cytologic screening is a well-established preventive measure that allows early detection and successful treatment of precancerous cervical lesions. In cases of all other HPV-associated disorders, early detection of a precancerous lesion is either difficult or almost impossible. HPV vaccination remains the only preventive measure against most HPV-related diseases.
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Incidence of Genital Warts in Adolescents and Young Adults in an Integrated Health Care Delivery System in the United States Before Human Papillomavirus Vaccine Recommendations. Sex Transm Dis 2013; 40:534-8. [DOI: 10.1097/olq.0b013e3182953ce0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Danielewski JA, Garland SM, McCloskey J, Hillman RJ, Tabrizi SN. Human papillomavirus type 6 and 11 genetic variants found in 71 oral and anogenital epithelial samples from Australia. PLoS One 2013; 8:e63892. [PMID: 23691108 PMCID: PMC3656832 DOI: 10.1371/journal.pone.0063892] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 04/07/2013] [Indexed: 11/18/2022] Open
Abstract
Genetic variation of 49 human papillomavirus (HPV) 6 and 22 HPV11 isolates from recurrent respiratory papillomatosis (RRP) (n = 17), genital warts (n = 43), anal cancer (n = 6) and cervical neoplasia cells (n = 5), was determined by sequencing the long control region (LCR) and the E6 and E7 genes. Comparative analysis of genetic variability was examined to determine whether different disease states resulting from HPV6 or HPV11 infection cluster into distinct variant groups. Sequence variation analysis of HPV6 revealed that isolates cluster into variants within previously described HPV6 lineages, with the majority (65%) clustering to HPV6 sublineage B1 across the three genomic regions examined. Overall 72 HPV6 and 25 HPV11 single nucleotide variations, insertions and deletions were observed within samples examined. In addition, missense alterations were observed in the E6/E7 genes for 6 HPV6 and 5 HPV11 variants. No nucleotide variations were identified in any isolates at the four E2 binding sites for HPV6 or HPV11, nor were any isolates found to be identical to the HPV6 lineage A or HPV11 sublineage A1 reference genomes. Overall, a high degree of sequence conservation was observed between isolates across each of the regions investigated for both HPV6 and HPV11. Genetic variants identified a slight association with HPV6 and anogenital lesions (p = 0.04). This study provides important information on the genetic diversity of circulating HPV 6 and HPV11 variants within the Australian population and supports the observation that the majority of HPV6 isolates cluster to the HPV6 sublineage B1 with anogenital lesions demonstrating an association with this sublineage (p = 0.02). Comparative analysis of Australian isolates for both HPV6 and HPV11 to those from other geographical regions based on the LCR revealed a high degree of sequence similarity throughout the world, confirming previous observations that there are no geographically specific variants for these HPV types.
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Affiliation(s)
- Jennifer A. Danielewski
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne, Australia
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Suzanne M. Garland
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne, Australia
- Murdoch Childrens Research Institute, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Jenny McCloskey
- Sexual Health Services, Royal Perth Hospital, Perth, Australia
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia
| | - Richard J. Hillman
- Western Sydney Sexual Health Centre, University of Sydney, Sydney, Australia
| | - Sepehr N. Tabrizi
- Department of Microbiology and Infectious Diseases, Royal Women’s Hospital, Melbourne, Australia
- Murdoch Childrens Research Institute, Melbourne, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- * E-mail:
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Monteiro DL, Sodré DC, Russomano FB, Trajano AJ, Silva KS. Incidence of genital warts in adolescents and their association with cervical intraepithelial lesions. Eur J Obstet Gynecol Reprod Biol 2013; 168:80-2. [DOI: 10.1016/j.ejogrb.2012.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/23/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
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Patel H, Wagner M, Singhal P, Kothari S. Systematic review of the incidence and prevalence of genital warts. BMC Infect Dis 2013; 13:39. [PMID: 23347441 PMCID: PMC3618302 DOI: 10.1186/1471-2334-13-39] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 01/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anogenital warts (AGWs) are a common, highly infectious disease caused by the human papillomavirus (HPV), whose high recurrence rates contribute to direct medical costs, productivity loss and increased psychosocial impact. Because of the lack of a systematic review of the epidemiology of AGWs in the literature, this study reviewed the published medical literature on the incidence and prevalence of AGWs. METHODS A comprehensive literature search was performed on the worldwide incidence and prevalence of AGWs between 2001 and 2012 using the PubMed and EMBASE databases. An additional screening of abstracts from relevant sexual health and infectious disease conferences from 2009 to 2011 was also conducted. Only original studies with general adult populations (i.e., at least including ages 20 through 40 years) were included. RESULTS The overall (females and males combined) reported annual incidence of any AGWs (including new and recurrent) ranged from 160 to 289 per 100,000, with a median of 194.5 per 100,000. New AGW incidence rates among males ranged from 103 to 168 per 100,000, with a median of 137 per 100,000 and among females from 76 to 191 per 100,000, with a median of 120.5 per 100,000 per annum. The reported incidence of recurrent AGWs was as high as 110 per 100,000 among females and 163 per 100,000 among males. Incidence peaked before 24 years of age in females and between 25 and 29 years of age among males. The overall prevalence of AGWs based on retrospective administrative databases or medical chart reviews or prospectively collected physician reports ranged from 0.13% to 0.56%, whereas it ranged from 0.2% to 5.1% based on genital examinations. CONCLUSIONS The literature suggests that AGWs are widespread and the prevalence depends on study methodology as suggested by higher rates reported from routine genital examinations versus those from treatment records. However, there remains a need for more population-based studies from certain regions including Africa, Latin America and Southern Asia to further elucidate the global epidemiology of this disease.
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Affiliation(s)
- Harshila Patel
- LA-SER Analytics, 1405 TransCanada Highway, Suite 310, Montréal, Quebec H9P 2V9, Canada
| | - Monika Wagner
- LA-SER Analytics, 1405 TransCanada Highway, Suite 310, Montréal, Quebec H9P 2V9, Canada
| | - Puneet Singhal
- Merck & Co., Inc. Global Health Outcomes, Whitehouse Station, NJ, USA
| | - Smita Kothari
- Merck & Co., Inc. Global Health Outcomes, Whitehouse Station, NJ, USA
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Kawai K, de Araujo GTB, Fonseca M, Pillsbury M, Singhal PK. Estimated health and economic impact of quadrivalent HPV (types 6/11/16/18) vaccination in Brazil using a transmission dynamic model. BMC Infect Dis 2012; 12:250. [PMID: 23046886 PMCID: PMC3517904 DOI: 10.1186/1471-2334-12-250] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 10/01/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cervical cancer is the second most common cancer among women in Brazil. We examined the health and economic impacts of quadrivalent HPV vaccination in Brazil. METHODS We adapted a previously developed transmission dynamic model to estimate the effectiveness of HPV vaccination on cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3), CIN1, and genital warts. We evaluated following vaccination strategies: routine vaccination of 12-year-old girls and routine vaccination in combination with a catch-up vaccination of 12 to 26-year-old women. RESULTS The model projected that the vaccination would reduce the incidence rates of HPV 6/11/16/18-related cervical cancer, CIN2/3, CIN1, and female genital warts by 94% to 98% at year 100. Routine vaccination in combination with a catch-up vaccination could prevent approximately 163,000 cases of cervical cancer, 48,000 deaths from cervical cancer, 2.3 million cases of CIN2/3, and 11.4 million genital warts in the next 50 years. The incremental cost-effectiveness ratios for female vaccination strategies ranged from R$350 to R$720 (US$219 to US$450) per quality-adjusted life year (QALY) gained. CONCLUSIONS Our study demonstrates that quadrivalent HPV female vaccination can be a cost-effective public health intervention that can substantially reduce the burden of cervical diseases and genital warts in Brazil.
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Affiliation(s)
- Kosuke Kawai
- Temple University, 3307 N, Broad Street, Philadelphia, PA 19140, USA.
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Garland S, Pirotta M, Donovan B. Genital warts are more than an inconvenience! Public Health 2012; 126:546-7. [DOI: 10.1016/j.puhe.2012.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
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Response to: "The use of an “old-fashioned method” to assess the clinical and economic impact of a HPV vaccination program". Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2011.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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