1
|
Beltrami S, Rizzo S, Schiuma G, Speltri G, Di Luca D, Rizzo R, Bortolotti D. Gestational Viral Infections: Role of Host Immune System. Microorganisms 2023; 11:1637. [PMID: 37512810 PMCID: PMC10383666 DOI: 10.3390/microorganisms11071637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Viral infections in pregnancy are major causes of maternal and fetal morbidity and mortality. Infections can develop in the neonate transplacentally, perinatally, or postnatally (from breast milk or other sources) and lead to different clinical manifestations, depending on the viral agent and the gestational age at exposure. Viewing the peculiar tolerogenic status which characterizes pregnancy, viruses could exploit this peculiar immunological status to spread or affect the maternal immune system, adopting several evasion strategies. In fact, both DNA and RNA virus might have a deep impact on both innate and acquired immune systems. For this reason, investigating the interaction with these pathogens and the host's immune system during pregnancy is crucial not only for the development of most effective therapies and diagnosis but mostly for prevention. In this review, we will analyze some of the most important DNA and RNA viruses related to gestational infections.
Collapse
Affiliation(s)
- Silvia Beltrami
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| | - Sabrina Rizzo
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| | - Giovanna Schiuma
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| | - Giorgia Speltri
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| | - Dario Di Luca
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Roberta Rizzo
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| | - Daria Bortolotti
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| |
Collapse
|
2
|
Wells J, Klosky JL, Liu Y, Gillespie TW. An overview of implementing an evidence based program to increase HPV vaccination in HIV community clinics. BMC Public Health 2022; 22:1696. [PMID: 36071389 PMCID: PMC9450352 DOI: 10.1186/s12889-022-14100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HPV-related anal cancer occurs in excess rates among people living with HIV (PLWH) and has been increasing in incidence. The HPV vaccine is an effective and safe approach to prevent and reduce the risk of HPV-related disease. Yet, HPV vaccine programs tailored and implemented in the HIV population are lagging for this high-risk group. METHODS A pre-post intervention study design will be used to tailor, refine, and implement the 4 Pillars™ Practice Transformation Program to increase HPV vaccination among PLWH. Guided by the RE-AIM framework, the CHAMPS study will provide training and motivation to HIV providers and clinic staff to recommend and administer the HPV vaccination within three HIV clinics in Georgia. We plan to enroll 365 HIV participants to receive HPV education, resources, and reminders for HPV vaccination. Sociodemographic, HPV knowledge, and vaccine hesitancy will be assessed as mediators and moderators for HPV vaccination. The primary outcome will be measured as an increase in uptake rate in initiation of the HPV vaccine and vaccine completion (secondary outcome) compared to historical baseline vaccination rate (control). DISCUSSION The proposed study is a novel approach to address a serious and preventable public health problem by using an efficacious, evidence-based intervention on a new target population. The findings are anticipated to have a significant impact in the field of improving cancer outcomes in a high-risk and aging HIV population. TRIAL REGISTRATION NCT05065840; October 4, 2021.
Collapse
Affiliation(s)
- Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, NE, RM. 230, Atlanta, GA, 30324, USA.
| | - James L Klosky
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Theresa Wicklin Gillespie
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Surgery, Division of Surgical Oncology, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
3
|
Zayats R, Murooka TT, McKinnon LR. HPV and the Risk of HIV Acquisition in Women. Front Cell Infect Microbiol 2022; 12:814948. [PMID: 35223546 PMCID: PMC8867608 DOI: 10.3389/fcimb.2022.814948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/03/2022] [Indexed: 01/08/2023] Open
Abstract
The risk of HIV acquisition is low on a per-contact basis but increased by transmission co-factors such as other sexually transmitted infections (STIs). Human papillomavirus (HPV) is a prevalent STI that most individuals will acquire HPV in their lifetime. Current HPV vaccines can prevent newly acquired infections, but are largely ineffective against established HPV, complicating worldwide eradication efforts. In addition to being the causative agent of cervical cancer, accumulating evidence suggests that HPV infection and/or accompanying cervical inflammation increase the risk of HIV infection in men and women. The fact that immunological features observed during HPV infection overlap with cellular and molecular pathways known to enhance HIV susceptibility underscore the potential interplay between these two viral infections that fuel their mutual spread. Here we review current insights into how HPV infection and the generation of anti-HPV immunity contribute to higher HIV transmission rates, and the impact of HPV on mucosal inflammation, immune cell trafficking, and epithelial barrier function.
Collapse
Affiliation(s)
- Romaniya Zayats
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas T. Murooka
- Department of Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- *Correspondence: Thomas T. Murooka, ; Lyle R. McKinnon,
| | - Lyle R. McKinnon
- Department of Medical Microbiology and Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- *Correspondence: Thomas T. Murooka, ; Lyle R. McKinnon,
| |
Collapse
|
4
|
Jones A, Kawesa-Newell N. Using branded behaviour change communication to create demand for the HPV vaccine among girls in Malawi: An evaluation of Girl Effect's Zathu mini magazine. Vaccine 2021; 40 Suppl 1:A107-A115. [PMID: 34340857 DOI: 10.1016/j.vaccine.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/14/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
The HPV vaccine was introduced nationally in Malawi in 2019 and administered to 9-year-old girls. In order to drive uptake of the HPV vaccine Girl Effect utilised their youth brand, Zathu, to deliver messaging on the HPV vaccine. A Zathu 'mini magazine' was created specifically for 9-year-old girls to provide information, prompt household conversations and build empowerment around the HPV vaccine. This evaluation assessed the effectiveness of the Zathu mini magazine against two outcomes: (1) Girls are more informed & motivated to receive the HPV vaccine and (2) Girls talk to their caregivers about the HPV vaccine.A quasi-experimental approach was adopted using both qualitative and quantitative data collection to measure the results against these outcomes. The study found positive correlations between consumption of the Zathu mini magazine and awareness of cervical cancer, and positive attitudes towards the HPV vaccine among girls and parents in the exposed group compared to the non-exposed group. The Zathu mini magazine also encouraged household discussions on the HPV vaccine. Most significantly, consumption of the mini magazine was also positively correlated with uptake of the HPV vaccine among girls. This study highlights the value of girl-centred communications in demand generation for the HPV vaccine. There is potential to learn from and replicate this approach in other comparable settings.
Collapse
|
5
|
Infante V, Miyaji KT, Soarez PC, Sartori AMC. Systematic review and meta-analysis of HPV vaccination in women with systemic lupus erythematosus (SLE). Expert Rev Vaccines 2021; 20:309-318. [PMID: 33573404 DOI: 10.1080/14760584.2021.1889375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to access HPV vaccines' safety and immunogenicity in Systemic Lupus Erythematosus (SLE) women. METHODS The search was conducted in the most relevant databases. Meta-analyses to evaluate seroconversion rates for each HPV vaccine type and SLE flare rates after vaccination were performed. RESULTS We identified 3,467 articles; six papers referring to SLE population were included. Five articles that evaluated vaccine immunogenicity at 7th month after enrollment were included in the meta-analysis. Overall seroconversion rates among SLE participants were 89.3% (95%CI, 0.76-1.00) for HPV6; 92.4% (95%CI, 0.82-1.00) for HPV11; 96.4% (95%CI, 0.93-1.00) for HPV16; and 91.8% (95%CI, 0.85-1.00) for HPV18. Five studies were included in the qualitative analysis of vaccines safety. Pain at the injection site was the most common adverse event (AE). Just one study reported serious AE not related to the vaccine. Flare rate after HPV vaccination was 12,6% (95% CI, 0.04-0.21). CONCLUSION Few studies, small sample size, evaluated HPV vaccines in SLE women. Seroconversion rates in SLE women were like healthy women, but anti-HPV geometric mean titers (GMT) were slightly lower in SLE women. HPV vaccines were safe in this population.
Collapse
Affiliation(s)
- Vanessa Infante
- Departamento De Molestias Infecciosas E Parasitarias, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| | - Karina Takesaki Miyaji
- Departamento De Molestias Infecciosas E Parasitarias, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| | - Patricia Coelhode Soarez
- Departamento De Medicina Preventiva, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| | - Ana Marli Christovam Sartori
- Departamento De Molestias Infecciosas E Parasitarias, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| |
Collapse
|
6
|
Roy Moulik N, Singh Arora R. Immunisation in children with cancer treated with standard dose chemotherapy- review of evidence. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
7
|
Saeed M, Faisal SM, Akhtar F, Ahmad S, Alreshidi MM, Kausar MA, Kazmi S, Saeed A, Adnan M, Ashraf GM. Human Papillomavirus Induced Cervical and Oropharyngeal Cancers: From Mechanisms to Potential Immuno-therapeutic Strategies. Curr Drug Metab 2020; 21:167-177. [DOI: 10.2174/1389200221666200421121228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/04/2019] [Accepted: 01/30/2020] [Indexed: 01/09/2023]
Abstract
The human papillomavirus (HPV) associated infections are the hallmark of cervical and neck cancer.
Almost all the cases of cervical cancer (CC) and 70% of oropharyngeal cancer (OC) are, more or less, caused by the
persistent infection of HPV. CC is the fourth most common cancer globally, and is commenced by the persistent
infection with human papillomaviruses (HPVs), predominantly HPV types; 16 and 18. In the light of the above facts,
there is an immediate requirement to develop novel preventive and innovative therapeutic strategies that may help in
lower occurrences of HPV mediated cancers. Currently, only radiation and chemical-based therapies are the treatment
for HPV mediated neck cancer (NC) and CC. Recent advances in the field of immunotherapy are underway,
which are expected to unravel the optimal treatment strategies for the growing HPV mediated cancers. In this review,
we decipher the mechanism of pathogenesis with current immunotherapeutic advances in regressing the NC and CC,
with an emphasis on immune-therapeutic strategies being tested in clinical trials and predominantly focus on defining
the efficacy and limitations. Taken together, these immunological advances have enhanced the effectiveness of immunotherapy
and promises better treatment results in coming future.
Collapse
Affiliation(s)
- Mohd. Saeed
- Department of Biology, College of Science, University of Hail, Hail, Saudi Arabia
| | - Syed Mohd Faisal
- Molecular Immunology Laboratory, Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | - Firoz Akhtar
- Department of Pharmacology and Toxicology, Higuchi Biosciences Center, University of Kansas, Lawrence, KS 2099, United States
| | - Saheem Ahmad
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Mousa M. Alreshidi
- Department of Biology, College of Science, University of Hail, Hail, Saudi Arabia
| | - Mohd. Adnan Kausar
- Department of Biochemistry, College of Medicine University of Hail, Hail, Saudi Arabia
| | - Shadab Kazmi
- Molecular Immunology Laboratory, Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, India
| | - Amir Saeed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Mohd. Adnan
- Department of Biology, College of Science, University of Hail, Hail, Saudi Arabia
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
8
|
Immunization of Children with Cancer in India Treated with Chemotherapy — Consensus Guideline from the Pediatric Hematology-Oncology Chapter and the Advisory Committee on Vaccination and Immunization Practices of the Indian Academy of Pediatrics. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1678-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Vinkenes E, Nielsen MA, Blaakaer J. Is there evidence for efficacy of human papillomavirus vaccination in solid organ transplant recipients? Eur J Obstet Gynecol Reprod Biol X 2019; 4:100015. [PMID: 31673683 PMCID: PMC6817653 DOI: 10.1016/j.eurox.2019.100015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 11/25/2022] Open
Abstract
Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide and is associated with precancerous lesions and cancers of the cervix, vulva, vagina, penis, anus, tonsils and base of the tongue. Several studies show an increased risk of HPV-associated cancers in solid organ transplant recipients (SOTR). The aims of this review are to investigate the evidence of efficacy for the HPV vaccination in transplant recipients and to discuss the known national guidelines. A systematic literature search has been conducted to identify studies where SOTR received the HPV vaccination to evaluate the efficacy of the HPV vaccine on this population. The primary outcome was antibody response against the HPV genotypes included in the vaccines and the secondary outcome was national guidelines recommending HPV vaccination of SOTR. Three cohort studies evaluated immunogenicity. Two studies found suboptimal effect of the HPV vaccine, while an early terminated study detected 100% seropositivity. We have identified four national guidelines in the following countries; United States of America, Canada, Australia and Ireland, along with a recommendation from the World Health Organization (WHO). The results from the three studies were inconclusive due to the small sample sizes and the diverging results. Recommendations of HPV vaccination of SOTR is based on the knowledge about safety and efficiency in the general population and the safety of other inactivated (not live) vaccines in SOTR. Theoretically, the nonavalent vaccine should be recommended as the first choice in SOTR without age- or sex restrictions.
Collapse
Affiliation(s)
- Emeline Vinkenes
- Odense University Hospital, Dept. of Obstetrics. & Gyn, Sdr. Boulevard 29, Odense 5000 C, Denmark
| | - Martine A Nielsen
- Odense University Hospital, Dept. of Obstetrics. & Gyn, Sdr. Boulevard 29, Odense 5000 C, Denmark
| | - Jan Blaakaer
- Odense University Hospital, Dept. of Obstetrics. & Gyn, Sdr. Boulevard 29, Odense 5000 C, Denmark
| |
Collapse
|
10
|
Sarr EHM, Mayrand MH, Coutlée F, Niyibizi J, Laporte L, Monnier P, Carceller AM, Lacroix J, Audibert F, Bédard MJ, Girard I, Brassard P, Fraser WD, Trottier H. Exploration of the effect of human papillomavirus (HPV) vaccination in a cohort of pregnant women in Montreal, 2010-2016. Heliyon 2019; 5:e02150. [PMID: 31453391 PMCID: PMC6704337 DOI: 10.1016/j.heliyon.2019.e02150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/10/2019] [Accepted: 07/22/2019] [Indexed: 01/04/2023] Open
Abstract
HPV vaccination efficacy has been shown in clinical trials but it is important to verify population level vaccine effectiveness (VE). We aimed to explore VE and herd effect using HPV infection data from a cohort study of Canadian pregnant women. We analyzed the baseline data of the HERITAGE study, which includes pregnant women recruited in Montreal between 2010-2012 and 2015–2016. Cervicovaginal samples self-collected in the first trimester were tested for 36 HPV types. Vaccination status was self-reported. VE and 95% confidence intervals (CI) were estimated by comparing the prevalence of HPV between vaccinated and unvaccinated women. Herd effect was explored by comparing HPV prevalence in unvaccinated women between the 2 recruitment periods. Adjusted ORs (95%CI) were estimated using exact logistic regression. The proportion of vaccinated women with at least one dose of 4vHPV was 7.5%. Although most of them were vaccinated after the onset of sexual activity, a high VE was found for HPV-16/18 (86.1% (95%CI: 15.0–99.7)). For HPV-6/11/16/18 and for HPV-31/33/45, VE was 61.9% (-23.5–92.6) and 57.0% (-47.7–92.0%), respectively. We also observed a non-statistically significant reduction in the prevalence of HPV-6/11/16/18 and HPV-31/33/45 among unvaccinated women recruited during the second recruitment period (adjusted OR: 0.8 (0.4–1.8) and 0.8 (0.3–1.7), respectively).
Collapse
Affiliation(s)
- El Hadji Malick Sarr
- Department of Social and Preventive Medicine, Université de Montréal, Sainte-Justine University Hospital Centre, Montreal, Canada
| | - Marie-Hélène Mayrand
- Department of Obstetrics and Gynecology, Université de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.,Department of Social and Preventive Medicine, Université de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - François Coutlée
- Department of Microbiology, Université de Montréal and CRCHUM, Montreal, Canada
| | - Joseph Niyibizi
- Department of Social and Preventive Medicine, Université de Montréal, Sainte-Justine University Hospital Centre, Montreal, Canada
| | - Louise Laporte
- Sainte-Justine University Hospital Centre, Montreal, Canada
| | - Patricia Monnier
- Department of Obstetrics and Gynecology and the Research Institute of the McGill University Health Centre [RI-MUHC), McGill University, Royal Victoria Hospital, Montreal, Canada
| | - Ana Maria Carceller
- Department of Pediatrics, Université de Montréal, Sainte-Justine University Hospital Centre, Montreal, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Division of Pediatric, Intensive Care Medicine, Sainte-Justine University Hospital Centre, Université de Montréal, Canada
| | - François Audibert
- Department of Obstetrics and Gynecology, Sainte-Justine University Hospital Centre, Montreal, Canada
| | - Marie-Josée Bédard
- Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
| | - Isabelle Girard
- Department of Obstetrics and Gynecology, St-Mary's Hospital Center, Montreal, Canada
| | - Paul Brassard
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, Canada
| | - William D Fraser
- Department of Obstetrics and Gynecology, Université de Sherbrooke, Centre de recherche du CHUS
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montréal, Sainte-Justine University Hospital Centre, Montreal, Canada
| | | |
Collapse
|
11
|
Portillo-Romero AJ, León-Maldonado L, Allen-Leigh B, Brown B, Magis C, García-Fuentes NB, Salmerón J, Hurtado E, Torres-Ibarra L, Rivera-Paredez B, Hernández-López R, Yunes-Díaz E, Lazcano-Ponce E. HPV vaccine acceptance is high among adults in Mexico, particularly in people living with HIV. SALUD PUBLICA DE MEXICO 2019; 60:658-665. [PMID: 30699271 DOI: 10.21149/10182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/23/2018] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To measure HPV vaccine acceptance in diverse Mexican adult popula-tions, taking into account HIV status. MATERIALS AND METHODS A total of 1 329 men and women, with and without HIV, participated in one of three intervention studies, offering HPV vaccination, carried out in the states of Morelos, Tlaxcala and Mexico City; either the bivalent (Morelos n=103, Tlaxcala n=127) or quadrivalent HPV-vaccine (Mexico City n=1 099) was offered. RESULTS HPV vaccine was accepted by 80.3% of participants; acceptance was higher in people living with HIV than those without (84.4 vs. 78%, p=0.004). Women had greater HPV infection knowledge (p<0.0001) than men and slightly higher (p=0.4) vaccine acceptance. The main reason for vaccine non-acceptance among HIV-positive participants was their doctor recommended they not get vaccinated. CONCLUSIONS Acceptance of HPV-vaccine was high in men and women regardless of HIV status. Even higher rates of acceptability may be achieved by educating healthcare providers to recommend HPV vaccine to their patients.
Collapse
Affiliation(s)
| | - Leith León-Maldonado
- Conacyt- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Betania Allen-Leigh
- Dirección de Salud Reproductiva, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Brandon Brown
- School of Medicine, University of California. Riverside, California, United States of America
| | - Carlos Magis
- Atención Integral, Centro Nacional para la Prevención y Control del VIH/SIDA (Censida). Mexico City, Mexico
| | - Norma Beatriz García-Fuentes
- Coordinación Estatal del Programa de VIH, SIDA e ITS, Servicios de Salud de Morelos. Cuernavaca, Morelos, Mexico
| | - Jorge Salmerón
- Centro de Investigación de Políticas de Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México. Mexico City, Mexico.,Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Erika Hurtado
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Leticia Torres-Ibarra
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Berenice Rivera-Paredez
- Centro de Investigación de Políticas de Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México. Mexico City, Mexico.,Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Rubí Hernández-López
- Centro de Investigación de Políticas de Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México. Mexico City, Mexico.,Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Elsa Yunes-Díaz
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| |
Collapse
|
12
|
Martínez-Gómez X, Curran A, Campins M, Alemany L, Rodrigo-Pendás JÁ, Borruel N, Castellsagué X, Díaz-de-Heredia C, Moraga-Llop FA, Del Pino M, Torné A. Multidisciplinary, evidence-based consensus guidelines for human papillomavirus (HPV) vaccination in high-risk populations, Spain, 2016. Euro Surveill 2019; 24:1700857. [PMID: 30782268 PMCID: PMC6381660 DOI: 10.2807/1560-7917.es.2019.24.7.1700857] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/15/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Although human papillomavirus (HPV) routine vaccination programmes have been implemented around the world and recommendations have been expanded to include other high-risk individuals, current recommendations often differ between countries in Europe, as well as worldwide. AIM To find and summarise the best available evidence of HPV vaccination in high-risk patients aiding clinicians and public health workers in the day-to-day vaccine decisions relating to HPV in Spain. METHODS We conducted a systematic review of the immunogenicity, safety and efficacy/effectiveness of HPV vaccination in high-risk populations between January 2006 and June 2016. HPV vaccination recommendations were established with levels of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS A strong recommendation about HPV vaccination was made in the following groups: HIV infected patients aged 9-26 years; men who have sex with men aged 9-26 years; women with precancerous cervical lesions; patients with congenital bone marrow failure syndrome; women who have received a solid organ transplant or hematopoietic stem cell transplantation aged 9-26 years; and patients diagnosed with recurrent respiratory papillomatosis. CONCLUSIONS Data concerning non-routine HPV vaccination in populations with a high risk of HPV infection and associated lesions were scarce. We have developed a document to evaluate and establish evidence-based guidelines on HPV vaccination in high-risk populations in Spain, based on best available scientific evidence.
Collapse
Affiliation(s)
- Xavier Martínez-Gómez
- Servei de Medicina Preventiva i Epidemiologia, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Adrian Curran
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Magda Campins
- Servei de Medicina Preventiva i Epidemiologia, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Laia Alemany
- Programa de Recerca en Epidemiologia del Càncer, Institut Català d'Oncologia - IDIBELL CIBER Epidemiología y Salud Pública, Barcelona, España
| | - José Ángel Rodrigo-Pendás
- Servei de Medicina Preventiva i Epidemiologia, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Natalia Borruel
- Unitat d'Atenció Crohn-Colitis, Servei d'Aparell Digestiu; Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Castellsagué
- Programa de Recerca en Epidemiologia del Càncer, Institut Català d'Oncologia - IDIBELL CIBER Epidemiología y Salud Pública, Barcelona, España
| | - Cristina Díaz-de-Heredia
- Servei d'Oncologia i Hematologia Pediàtrica, Hospital Universitari Vall d'Hebron - Universitat Autònoma de Barcelona, Barcelona, España
| | | | - Marta Del Pino
- Unidad de Ginecología Oncológica, Instituto Clínico de Ginecología y Obstetricia y Neonatología (ICGON), Hospital Clínic de Barcelona, Barcelona, España
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - Aureli Torné
- Unidad de Ginecología Oncológica, Instituto Clínico de Ginecología y Obstetricia y Neonatología (ICGON), Hospital Clínic de Barcelona, Barcelona, España
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| |
Collapse
|
13
|
Awareness of cervical cancer and willingness to be vaccinated against human papillomavirus in Mozambican adolescent girls. PAPILLOMAVIRUS RESEARCH 2018; 5:156-162. [PMID: 29665430 PMCID: PMC6046684 DOI: 10.1016/j.pvr.2018.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/27/2023]
Abstract
Sub-Saharan Africa concentrates the largest burden of cervical cancer worldwide. The introduction of the HPV vaccination in this region is urgent and strategic to meet global health targets. This was a cross-sectional study conducted in Mozambique prior to the first round of the HPV vaccine demonstration programme. It targeted girls aged 10–19 years old identified from schools and households. Face-to-face structured interviews were conducted. A total of 1147 adolescents were enrolled in three selected districts of the country. Most girls [84% (967/1147)] had heard of cervical cancer, while 76% believed that cervical cancer could be prevented. However only 33% (373/1144) of girls recognized having ever heard of HPV. When girls were asked whether they would accept to be vaccinated if a vaccine was available in Mozambique, 91% (1025/1130) answered positively. Girls from the HPV demonstration districts showed higher awareness on HPV and cervical cancer, and willingness to be vaccinated. This study anticipates high acceptability of the HPV vaccine in Mozambique and high awareness about cervical cancer, despite low HPV knowledge. These results highlight that targeted health education programmes are critical for acceptance of new tools, and are encouraging for the reduction of cervical cancer related mortality and morbidity in Mozambique. Cervical cancer incidence rates in Mozambique are among the highest in the world. Introduction of HPV vaccination in Mozambique is an urgent and necessary strategy to meet global targets on women´s health. The awareness on cervical cancer, and anticipated acceptance of HPV vaccination was assessed in Mozambican adolescent girls. The study anticipates high acceptability of HPV vaccine and adequate awareness about cervical cancer. These results are timely in the context towards the implementation of the HPV vaccine at a national scale in Mozambique.
Collapse
|
14
|
Abstract
Survival with human immunodeficiency virus (HIV) infection has greatly improved due to effective antiretroviral therapy (ART). As infectious complications have declined, malignancy now accounts for over one-third of deaths among people living with HIV (PLWH). Based on practices in the general population, cancer screening of PLWH can decrease both morbidity and mortality. In this article, we review and consider directed approaches for colorectal, breast, cervical and lung cancer screening. Furthermore, routine physical examinations may detect lymphomas and skin, anal and oral cancers. Comprehensive cancer prevention in PLWH should also include ART adherence, vaccination against oncogenic viruses, treatment of hepatitis viruses and smoking cessation. Cancer screening for PLWH warrants further research on safety and efficacy as well as targeted efforts to increase adherence.
Collapse
|
15
|
Rantshabeng PS, Moyo S, Moraka NO, Ndlovu A, MacLeod IJ, Gaseitsiwe S, Kasvosve I. Prevalence of oncogenic human papillomavirus genotypes in patients diagnosed with anogenital malignancies in Botswana. BMC Infect Dis 2017; 17:731. [PMID: 29178840 PMCID: PMC5702116 DOI: 10.1186/s12879-017-2832-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) associated malignancies are the leading cause of cancer death in Botswana. We sought to determine causative HPV types in patients with anogenital malignancies in Botswana to inform vaccine strategy. METHODS We used formalin-fixed and paraffin-embedded (FFPE) tissue blocks from patients diagnosed with anal, penile and vulvar squamous cell carcinomas between the years, 2014 and 2016. Presence of HPV 16, 18, or other high-risk (HR) types was detected using Abbott m2000 real-time PCR platform. Tissues with other high-risk types were subsequently analysed using a multiplex qPCR assay that includes 15 validated fluorophore probes. RESULTS A total of 126 tissue specimens, comprising of 21 anal (9 males, 12 females), 31 penile and 74 vulvar were studied. Ninety-three (73.8%) patients had their HIV status documented in the records while the rest did not. Eighty-three (83) out of 93 were HIV positive, a prevalence of 89.4% (95% CI: 81-94). HPV was detected in 68/126 (54%) tissues, of which 69% (95% CI: 54-79) had HPV 16 only, 28% (95% CI: 19-40) had other hr.-HPV types and 2.9% (95% CI, 3.5-10.1) were co-infected with HPV 16 and other hr.-types. Other high-risk types detected included HPV 26, 31, 33, 35, 39, 45, 51, 52, 66 and 68. HPV 18 was not detected. Multiple-type HPV infection was detected in 44 of 47 (93.6%) HIV positive participants co-infected with HPV. In HIV-negative individuals, only HPV 16 was detected. CONCLUSION In our study, anogenital carcinomas were associated with HPV 16 and other hr.-HPV types besides HPV 16 and 18. HIV co-infected patients had multiple hr.-HPV types detected whereas in HIV-negative patients only HPV 16 was detected. Our study suggests that multivalent vaccines may be more suitable in this setting, especially for HIV-infected individuals.
Collapse
Affiliation(s)
- Patricia S Rantshabeng
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Private Bag UB072, 4775 Notwane Rd., Gaborone, Botswana. .,Department of Pathology, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
| | - Sikhulile Moyo
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Private Bag UB072, 4775 Notwane Rd., Gaborone, Botswana.,Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, MA, USA
| | | | - Andrew Ndlovu
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Private Bag UB072, 4775 Notwane Rd., Gaborone, Botswana
| | - Iain J MacLeod
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, MA, USA
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard T. H. Chan School of Public Health, Department of Immunology and Infectious Diseases, Boston, MA, USA
| | - Ishmael Kasvosve
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Botswana, Private Bag UB072, 4775 Notwane Rd., Gaborone, Botswana
| |
Collapse
|
16
|
Murall CL, Bauch CT, Day T. Could the human papillomavirus vaccines drive virulence evolution? Proc Biol Sci 2015; 282:20141069. [PMID: 25429011 DOI: 10.1098/rspb.2014.1069] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The human papillomavirus (HPV) vaccines hold great promise for preventing several cancers caused by HPV infections. Yet little attention has been given to whether HPV could respond evolutionarily to the new selection pressures imposed on it by the novel immunity response created by the vaccine. Here, we present and theoretically validate a mechanism by which the vaccine alters the transmission-recovery trade-off that constrains HPV's virulence such that higher oncogene expression is favoured. With a high oncogene expression strategy, the virus is able to increase its viral load and infected cell population before clearance by the vaccine, thus improving its chances of transmission. This new rapid cell-proliferation strategy is able to circulate between hosts with medium to high turnover rates of sexual partners. We also discuss the importance of better quantifying the duration of challenge infections and the degree to which a vaccinated host can shed virus. The generality of the models presented here suggests a wider applicability of this mechanism, and thus highlights the need to investigate viral oncogenicity from an evolutionary perspective.
Collapse
Affiliation(s)
- Carmen Lía Murall
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - Chris T Bauch
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - Troy Day
- Department of Mathematics and Statistics and Department of Biology, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
17
|
Bown E, Shah V, Sridhar T, Boyle K, Hemingway D, Yeung JM. Cancers of the anal canal: diagnosis, treatment and future strategies. Future Oncol 2015; 10:1427-41. [PMID: 25052753 DOI: 10.2217/fon.14.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Anal cancer is an uncommon cancer; however, it is rising in incidence. There is confusion regarding nomenclature and the distinction between anal canal cancer and anal margin cancer. This article discusses the modern definition, etiology and staging of anal canal and anal margin cancers. Modern chemotherapy and radiotherapy regimens are discussed, in addition to modern imaging and radiotherapy techniques. Future preventative strategies and potential novel treatments are discussed.
Collapse
Affiliation(s)
- Emma Bown
- Department of Colorectal Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | | | | | | | | | | |
Collapse
|
18
|
The diversity of human papillomavirus infection among human immunodeficiency virus-infected women in Yunnan, China. Virol J 2014; 11:202. [PMID: 25481842 PMCID: PMC4279793 DOI: 10.1186/s12985-014-0202-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 11/14/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Yunnan has one of the oldest and the most severe human immunodeficiency virus (HIV) epidemics in China. We conducted an observational study to evaluate the human papillomavirus (HPV) genotype distribution in relation to cervical neoplastic disease risk among HIV-infected women in Yunnan. METHODS We screened 301 HIV-infected non-pregnant women in Mangshi prefecture in Yunnan province. All consenting participants underwent simultaneous and independent assessment by cervical cytology, colposcopy-histopathology, and HPV genotyping. Unadjusted and multivariable-adjusted multinomial logistic regression analysis was conducted to evaluate factors associated with single or multiple carcinogenic HPV genotypes. RESULTS HPV genotypes were present in 43.5% (131/301) overall, and carcinogenic HPV genotypes were present in 37.5% (113/301) women. Among women with carcinogenic HPV genotypes, 80 (70.8% of 113) had a single carcinogenic HPV type, while 33 (29.2%) women had multiple (2 or more) carcinogenic HPV types. Overall, the most common carcinogenic HPV types were HPV52 (7.3%), HPV58 (6.6%), HPV18 (6.3%), HPV16 (6.0%), and HPV33 (5.3%). In women with cervical precancerous lesions (i.e., high-grade squamous intraepithelial lesions [HSIL] on cytology or cervical intraepithelial neoplasia grade 2 or worse [CIN2+] detected on colposcopy-histology), the most commonly detected genotypes were HPV16 (28.6%), HPV52 (25.0%), HPV58 (17.9%), HPV18 (10.7%) and HPV31 (10.7%). Increasing age was an independent risk factor associated with presence of single carcinogenic HPV types (adjusted odds ratio: 1.04, 95%CI: 1.01-1.07, p = 0.012) but not with the presence of multiple carcinogenic types in the multivariable-adjusted models. CONCLUSIONS As HIV-infected women continue to live longer on antiretroviral therapy in China, it will be increasingly important to screen for, and prevent, HPV-associated cervical cancer in this population, especially given the wide diversity and multiplicity of HPV genotypes.
Collapse
|
19
|
HPV vaccine acceptability in Africa: a systematic review. Prev Med 2014; 69:274-9. [PMID: 25451327 DOI: 10.1016/j.ypmed.2014.08.035] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/14/2014] [Accepted: 08/30/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The objective of this study was to provide a systematic review of peer-reviewed literature on the factors associated with HPV vaccine acceptability among adults in African countries. METHODS A systematic search was conducted across five electronic databases: EMBASE, PsychINFO, CINAHL, Global Health and Ovid MEDLINE, to identify studies related to HPV vaccination acceptability in African countries (August 2013). The Health Belief Model was used to guide data abstraction and synthesis. RESULTS Fourteen unique studies representing ten sub-Saharan African countries were identified, with more than half published within the last two years. Acceptability of the HPV vaccine for daughters was high (range 59-100%); however, vaccine-related awareness and knowledge were low. Perceived barriers including accessibility and cost concerns were important for acceptance, as were cues to action from healthcare providers and governments. CONCLUSIONS This review suggests that acceptability of the HPV vaccine in countries in this region will be high. Broad knowledge gaps were highlighted regarding HPV and cervical cancer and these should be addressed. Education on the vaccine's effectiveness and reducing perceived barriers to vaccination would also be useful. Public endorsement by governments and healthcare providers will likely also increase acceptance.
Collapse
|
20
|
de Araujo-Souza PS, Ramanakumar AV, Candeias JMG, Thomann P, Trevisan A, Franco EL, Villa LL. Determinants of baseline seroreactivity to human papillomavirus type 16 in the Ludwig-McGill cohort study. BMC Infect Dis 2014; 14:578. [PMID: 25730386 PMCID: PMC4247698 DOI: 10.1186/s12879-014-0578-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 10/22/2014] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Immunity plays an important role in controlling human papillomavirus (HPV) infection and associated lesions. Unlike infections caused by other viruses, natural HPV infection does not always result in a protective antibody response. Therefore, HPV antibodies are also considered markers of cumulative exposure. The aim of this study was to identify determinants of HPV16 seroreactivity at enrollment among women from the Ludwig-McGill cohort, a natural history study of HPV infection and risk of cervical neoplasia. METHODS HPV16 serology was assessed by ELISA for L1 and L2 capsid antigens, while HPV typing and viral load measurements were performed by PCR-based methods. The associations were analyzed by unconditional logistic regression. RESULTS Of 2049 subjects, 425 (20.7%) were strongly seropositive for HPV16. In multivariate analysis, seroreactivity was positively correlated with age, lifetime number of sexual partners, frequency of sex, and HPV16 viral load, and negatively associated with duration of smoking. CONCLUSIONS HPV16 seroreactivity is determined by factors that reflect viral exposure.
Collapse
Affiliation(s)
- Patrícia S de Araujo-Souza
- />Ludwig Institute for Cancer Research, São Paulo, Brazil
- />Department of Immunobiology, Fluminense Federal University, Niterói, Brazil
- />Program of Cellular Biology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | | | - João M G Candeias
- />Ludwig Institute for Cancer Research, São Paulo, Brazil
- />Department of Microbiology and Immunology, Institute of Biosciences, Universidade Estadual Paulista, Botucatu, Brazil
| | - Patrícia Thomann
- />Ludwig Institute for Cancer Research, São Paulo, Brazil
- />Institute of Gynaecological Cancer Research, São Paulo, Brazil
| | - Andrea Trevisan
- />Ludwig Institute for Cancer Research, São Paulo, Brazil
- />Division of Gynecologic Oncology, CHUM - Université de Montréal, Montreal, Canada
| | - Eduardo L Franco
- />Department of Oncology, McGill University, Montreal, Canada
- />Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Luisa L Villa
- />Ludwig Institute for Cancer Research, São Paulo, Brazil
- />Molecular Biology Laboratory, São Paulo Cancer Institute, ICESP, São Paulo, Brazil
- />Department of Radiology and Oncology, School of Medicine, University of São Paulo, São Paulo, Brazil
- />School of Medicine, University of São Paulo and Santa Casa de São Paulo, São Paulo, Brazil
| | | |
Collapse
|
21
|
Abstract
Over the last two decades in particular there has been a remarkable increase in the number of solid organ transplants being performed worldwide alongside improvements in long-term survival rates. However, the infrastructure at transplant centres has been unable to keep pace with the current volume of the transplant patient work load. These pressures on transplant specialist centres has led to calls for an increased role of the general practitioner (GP) managing particular aspects of transplant patients' medical care. Indeed, many aspects of follow-up care such as screening for malignancies, preventing infection through immunisation programmes, and managing cardiovascular risk factors are already important aspects of family practice medicine. This paper aims to review some of the aspects of transplant patient care that is important for healthcare workers in family practice to manage.
Collapse
Affiliation(s)
- Lloyd D. Hughes
- Department of Ageing and Health, Academic Foundation Doctor, NHS Tayside and University of Dundee, 1 Albert Crescent, Newport on Tay, Kingdom of Fife, DD6 8DT, Scotland
| |
Collapse
|
22
|
Brotherton JML, Gertig DM. Primary prophylactic human papillomavirus vaccination programs: future perspective on global impact. Expert Rev Anti Infect Ther 2013; 9:627-39. [PMID: 21819329 DOI: 10.1586/eri.11.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Of the 40 types of human papillomavirus that can infect the mucosal epithelium, four types can now be prevented using prophylactic vaccination. Two of these types (high-risk types 16 and 18) cause 70% of cervical cancers, a proportion of other genital cancers and a subset of head and neck cancers. The low-risk types 6 and 11 cause 90% of genital warts and the disease recurrent respiratory papillomatosis. Thus, if primary HPV vaccination programs can be implemented effectively, the potential for a reduction in global disease burden is great. This article considers the current issues and challenges in delivering primary HPV vaccination programs effectively and the likely impact of the vaccines in both the near and more distant future.
Collapse
Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, Victorian Cytology Service Registries, Victorian Cytology Service, PO Box 310, East Melbourne, Victoria 8002, Australia.
| | | |
Collapse
|
23
|
Phylogenetic considerations in designing a broadly protective multimeric L2 vaccine. J Virol 2013; 87:6127-36. [PMID: 23536682 DOI: 10.1128/jvi.03218-12] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
While the oncogenic human papillomavirus (HPV) types with the greatest medical impact are clustered within the α9 and α7 species, a significant fraction of cervical cancers are caused by α5, α6, and α11 viruses. Benign genital warts are caused principally by the α10 viruses HPV6 and HPV11. In an effort to achieve broad protection against both cervical cancer- and genital wart-associated types, we produced at high levels in bacteria a multimeric protein (α11-88x8) fusing eight polypeptides corresponding to a protective domain comprising L2 residues ∼11 to 88 derived from HPV6 (α10), HPV16 (α9), HPV18 (α7), HPV31 (α9), HPV39 (α7), HPV51 (α5), HPV56 (α6), and HPV73 (α11) and a truncated derivative with the last three units deleted (α11-88x5). Mice were immunized three times with α11-88x8 or α11-88x5 adjuvanted with alum or the licensed HPV vaccines and challenged intravaginally with HPV6, HPV16, HPV26, HPV31, HPV33, HPV35, HPV45, HPV51, HPV56, HPV58, or HPV59 pseudovirions. The α11-88x5 and α11-88x8 vaccines induced similarly robust protection against each HPV type tested and indistinguishable HPV16-neutralizing antibody titers. Passive transfer of α11-88x8 antisera was protective. Further, rabbit antisera to α11-88x8 and α11-88x5 similarly neutralized native HPV18 virions. These findings suggest that immunologic competition between units is not a significant issue and that it is not necessary to include a unit of L2 derived from each species to achieve broader protection against diverse medically significant HPV types than is achieved with the licensed HPV vaccines.
Collapse
|
24
|
Seale H, Trung L, Mackie FE, Kennedy SE, Boros C, Marshall H, Tidswell J, Shaw PJ, Montgomery K, MacIntyre CR. A qualitative study investigating knowledge and attitudes regarding human papillomavirus (HPV) and the HPV vaccine among parents of immunosuppressed children. Vaccine 2012; 30:7027-31. [PMID: 23059356 DOI: 10.1016/j.vaccine.2012.09.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 09/06/2012] [Accepted: 09/26/2012] [Indexed: 11/26/2022]
Abstract
Barriers influencing the willingness of parents to vaccinate immunocompetent children include a lack of knowledge about human papillomavirus (HPV) and low perception of risk regarding their child's acquisition of HPV infection. However, it cannot be assumed that the facilitators and barriers of HPV vaccination are the same for parents/guardians of children who are immunocompromised, or who have chronic medical conditions. This study aimed to document the knowledge and attitudes of parents/guardians of immunosuppressed children and adolescents towards HPV infection and the vaccine. A study using qualitative methods which incorporated 27 semi-structured interviews was undertaken with parents/guardians of immunosuppressed children vaccinated against HPV at three hospitals in two states of Australia. Thematic analysis revealed that while participants acknowledged that they had heard of HPV, they did not have a strong sense of what it actually was. The level of concern held about their child acquiring an HPV infection (prior to vaccination) ranged from 'not at all' to 'extremely'. Some believed that their child was at increased risk of developing a severe HPV-related illness because of their underlying condition. The participants supported their child receiving the HPV vaccine, as they did not want to take a risk with a disease that may cause their child to return to hospital for treatment. The majority had little apprehension about the use of the HPV vaccine but expressed some concern that potential adverse effects would be more severe for immunosuppressed children. However, they stressed their belief in the safety of the vaccine and their trust in the child's health team. Our study results show that parents of children with impaired immunity would benefit from further information about the safety of the vaccine and about the important role of the vaccine for boys as well as girls.
Collapse
Affiliation(s)
- Holly Seale
- School of Public Health & Community Medicine, University of New South Wales, Sydney 2052, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Banura C, Mirembe FM, Katahoire AR, Namujju PB, Mbidde EK. Universal routine HPV vaccination for young girls in Uganda: a review of opportunities and potential obstacles. Infect Agent Cancer 2012; 7:24. [PMID: 22950658 PMCID: PMC3523036 DOI: 10.1186/1750-9378-7-24] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 08/22/2012] [Indexed: 11/25/2022] Open
Abstract
This article reviews the existing realities in Uganda to identify opportunities and potential obstacles of providing universal routine HPV vaccination to young adolescent girls. Cervical cancer is a public health priority in Uganda where it contributes to about 50-60% of all female malignancies. It is associated with a dismal 5-year relative survival of approximately 20%. With adequate financial resources, primary prevention through vaccination is feasible using existing education and health infrastructure. Cost-effectiveness studies show that at a cost of US$2 per dose, the current vaccines would be cost effective. With optimal (≥70%) coverage of the target population, the lifetime risk of cervical cancer could be reduced by >50%. Uganda fulfils 4 out of the 5 criteria set by the WHO for the introduction of routine HPV vaccination to young adolescent girls. The existing political commitment, community support for immunization and the favorable laws and policy environment all provide an opportunity that should not be missed to introduce this much needed vaccine to the young adolescent girls. However, sustainable financing by the government without external assistances remains a major obstacle. Also, the existing health delivery systems would require strengthening to cope with the delivery of HPV vaccine to a population that is normally not targeted for routine vaccination. Given the high incidence of cervical cancer and in the absence of a national screening program, universal HPV vaccination of Ugandan adolescent girls is critical for cervical cancer prevention.
Collapse
Affiliation(s)
- Cecily Banura
- Child Health and Development Centre, Makerere University College of Health Sciences, P. O. Box 6717, Kampala, Uganda
| | - Florence M Mirembe
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Anne R Katahoire
- Child Health and Development Centre, Makerere University College of Health Sciences, P. O. Box 6717, Kampala, Uganda
| | - Proscovia B Namujju
- Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda
- National Institute for Health and Welfare, Oulu, Finland
| | - Edward K Mbidde
- Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda
| |
Collapse
|
26
|
Weinberg A, Song LY, Saah A, Brown M, Moscicki AB, Meyer WA, Bryan J, Levin MJ. Humoral, mucosal, and cell-mediated immunity against vaccine and nonvaccine genotypes after administration of quadrivalent human papillomavirus vaccine to HIV-infected children. J Infect Dis 2012; 206:1309-18. [PMID: 22859825 DOI: 10.1093/infdis/jis489] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To characterize the immunogenicity of a quadrivalent human papillomavirus vaccine (QHPV) in human immunodeficiency virus (HIV)-infected children, we studied their immune responses to 3 or 4 doses. METHODS HIV-infected children aged 7-12 years with a CD4 cell percentage of ≥15% of lymphocytes, received 3 doses of QHPV with or without a fourth dose after 72 weeks. Type-specific and cross-reactive antibodies and cell-mediated immunity were measured. RESULTS Type-specific antibodies to HPV6, 11, and 16 were detected in 100% and ≥94% of children at 4 and 72 weeks, respectively, after the third QHPV dose. Corresponding numbers for HPV18 were 97% and 76%, respectively. A fourth QHPV dose increased seropositivity to ≥96% for all vaccine genotypes. Four weeks after the third QHPV dose, 67% of vaccinees seroconverted to HPV31, an HPV16-related genotype not in the vaccine; 69% and 39% of vaccinees developed mucosal HPV16 and 18 immunoglobulin G antibodies, respectively; and 60% and 52% of vaccinees developed cytotoxic T lymphocytes (CTLs) for HPV16 and 31, respectively. CONCLUSIONS Three QHPV doses generated robust and persistent antibodies to HPV6, 11, and 16 but comparatively weaker responses to HPV18. A fourth dose increased antibodies against all vaccine genotypes in an anamnestic fashion. CTLs and mucosal antibodies against vaccine genotypes, as well as cross-reactive antibodies and CTL against nonvaccine genotypes, were detected.
Collapse
Affiliation(s)
- Adriana Weinberg
- University of Colorado-Denver School of Medicine, Aurora, CO 80045, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Gormley RH, Kovarik CL. Human papillomavirus–related genital disease in the immunocompromised host. J Am Acad Dermatol 2012; 66:867.e1-14; quiz 881-2. [DOI: 10.1016/j.jaad.2010.12.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 12/17/2010] [Accepted: 12/19/2010] [Indexed: 11/30/2022]
|
28
|
|
29
|
Stanley MA. Genital human papillomavirus infections: current and prospective therapies. J Gen Virol 2012; 93:681-691. [PMID: 22323530 DOI: 10.1099/vir.0.039677-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Infection with human papillomaviruses (HPVs) is very common and associated with benign and malignant epithelial proliferations of skin and internal squamous mucosae. A subset of the mucosal HPVs are oncogenic and associated with 5 % of all cancers in men and women. There are two licensed prophylactic vaccines, both target HPV 16 and 18, the two most pathogenic, oncogenic types and one, additionally, targets HPV 6 and 11 the cause of genital warts. The approach of deliberate immunization with oncogenic HPV E6 and/or E7 proteins and the generation of antigen-specific cytotoxic T-cells as an immunotherapy for HPV-associated cancer and their high-grade pre-cancers has been tested with a wide array of potential vaccine delivery systems in Phase I/II trials with varying success. Understanding local viral and tumour immune evasion strategies is a prerequisite for the rational design of therapeutic vaccines for HPV-associated infection and disease, progress in this is discussed. There are no antiviral drugs for the treatment of HPV infection and disease. Current therapies are not targeted antiviral therapies, but either attempt physical removal of the lesion or induce inflammation and a bystander immune response. There has been recent progress in the identification and characterization of molecular targets for small molecule antagonists of the HPV proteins E1, E2 and E6 or their interactions with their cellular targets. Lead compounds that could disrupt E1-E2 protein-protein interactions have been discovered as have inhibitors of E6-E6-AP-binding interactions. Some of these compounds showed nanomolar affinities and high specificities and demonstrate the feasibility of this approach for HPV infections. These studies are, however, at an early phase and it is unlikely that any specific anti-HPV chemotherapeutic will be in the clinic within the next 10-20 years.
Collapse
|
30
|
No JH, Kim MK, Jeon YT, Kim YB, Song YS. Human papillomavirus vaccine: widening the scope for cancer prevention. Mol Carcinog 2011; 50:244-53. [PMID: 21465574 DOI: 10.1002/mc.20657] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Human papillomavirus (HPV) is the necessary cause of cervical cancer. The HPV oncoproteins E6 and E7 have crucial roles in various steps of carcinogenesis, inducing degradation of p53 and destabilization of pRb. Several clinical trials show that recombinant HPV vaccines are safe and effective in preventing persistent infection of HPV and associated anogenital lesions. Although most clinical studies to date have investigated the effectiveness of HPV vaccines in young female subjects, elderly females and males may also be candidates for HPV vaccines. Prophylactic HPV vaccination may be an ideal preventive method for other HPV-associated cancers in addition to cervical carcinoma. Carcinogenesis by HPV, efficacy trials of currently available HPV vaccines, and the possible roles of HPV vaccines in the prevention of HPV-associated cancers are reviewed in this article.
Collapse
Affiliation(s)
- Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | |
Collapse
|
31
|
|
32
|
Abstract
UNLABELLED Over 4500 hematopoietic stem cell transplants (HSCT) are performed on patients in the United States each year. As HSCT patients shift their survivorship care from large transplant centers to community health care providers, many gynecologists are assuming their pre- and post-HSCT gynecologic care. This article reviews recommendations, current research, and expert opinions on the gynecologic care of HSCT patients. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completing this educational activity, the physician should be better able to implement strategies for the prevention and management of menstrual bleeding during hematopoietic stem cell transplants; educate female patients regarding Fertility Preservation options before hematopoietic stem cell transplantation; and apply posthematopoietic stem cell transplant reproductive care screening and treatment recommendations for bone health, sexual health, and secondary cancer development.
Collapse
|
33
|
Villa LL. HPV prophylactic vaccination: The first years and what to expect from now. Cancer Lett 2010; 305:106-12. [PMID: 21190794 DOI: 10.1016/j.canlet.2010.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 12/02/2010] [Accepted: 12/03/2010] [Indexed: 01/11/2023]
Abstract
New prophylactic HPV vaccines have the power to prevent many HPV infections, thus reducing the burden of HPV-associated diseases. Two vaccines composed of HPV L1 proteins self assembled into virus-like particles (VLPs) have been developed: one containing VLPS of HPV types 6, 11, 16 and 18, while the other vaccine is composed of HPV 16 and 18 VLPs. Large phase II and III clinical trials to assess prophylactic efficacy have been conducted in which both HPV infection endpoints and disease endpoints were evaluated, particularly high-grade cervical intraepithelial neoplasia--CIN2 or CIN3--as well as vulvar and vaginal intraepithelial neoplasias--VIN or VaIN--and genital warts for the quadrivalent vaccine. Very high efficacy rates were observed in different populations that included young women between 16 and 26 years of age, and older (up to 55). More recently, the quadrivalent vaccine has been shown to be efficacious in men to prevent genital and anal infection and disease caused by the types included in the vaccine. Based on demonstrated clinical efficacy and favorable safety profile, HPV prophylactic vaccine are being introduced worldwide aiming the reduction of the morbidity and mortality of tumors caused by HPV. From 2006 when first approved in the USA, hundreds of countries have licensed the HPV vaccines, a significant proportion of which are offering the vaccine to young women in national immunization programs supported by the government. The ultimate goal is to implement worldwide cervical cancer control programs to include HPV vaccination and screening with cytology and HPV DNA testing, particularly in less-developed countries where it is most needed.
Collapse
Affiliation(s)
- Luisa Lina Villa
- Virology Group, Ludwig Institute for Cancer Research, Hospital Alemão Oswaldo Cruz, Rua João Julião 245, São Paulo, SP, Brazil
| |
Collapse
|
34
|
Safety and immunogenicity of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine in HIV-infected children 7 to 12 years old. J Acquir Immune Defic Syndr 2010; 55:197-204. [PMID: 20574412 DOI: 10.1097/qai.0b013e3181de8d26] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quadrivalent human papillomavirus vaccine (QHPV) is > 95% effective in preventing infection with vaccine-type human papillomavirus. The safety and immunogenicity of QHPV are unknown in HIV-infected children. METHODS HIV-infected children (N = 126)-age > 7 to < 12 years, with a CD4% ≥ 15-and on stable antiretroviral therapy if CD4% was < 25-were blindly assigned to receive a dose of QHPV or placebo (3:1 ratio) at 0, 8, and 24 weeks. Adverse events were evaluated after each dose. Serum antibody against QHPV antigens was measured by a competitive Luminex immunoassay 1 month after the third QHPV dose. RESULTS The safety profile of QHPV was similar in the 2 study arms and to that previously reported for QHPV recipients. QHPV did not alter the CD4% or plasma HIV RNA. Seroconversion to all 4 antigens occurred in > 96% of QHPV recipients and in no placebo recipients. Geometric mean titer was > 27 to 262 times greater than the seropositivity cutoff value, depending on the antigen, but was 30%-50% lower against types 6 and 18 than those of age-similar historical controls. CONCLUSIONS QHPV was safe and immunogenic in this cohort of HIV-infected children. Efficacy trials are warranted.
Collapse
|
35
|
Tornesello ML, Loquercio G, Tagliamonte M, Rossano F, Buonaguro L, Buonaguro FM. Human papillomavirus infection in urine samples from male renal transplant patients. J Med Virol 2010; 82:1179-85. [PMID: 20513081 DOI: 10.1002/jmv.21784] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Renal allograft recipients have a well-documented increased incidence of human papillomavirus (HPV)-related malignancies and preventive strategies should be specifically implemented. While in females the use of the Papanicolau test and HPV detection assay are used currently as a screening test for cervical cancer, no diagnostic procedures have been implemented to monitor HPV infection in males. The aim of this study was to test for HPV infection and to determine the spectrum of viral genotypes in urine samples of men with renal transplants. The study included 88 patients who underwent kidney transplantation between 1999 and 2005. HPV sequences were detected by nested PCR, using the broad-spectrum consensus-primer pairs MY09/MY11 and the new MGP system, and characterized by nucleotide sequence analysis. Overall, 43 (48.9%) samples were found positive for HPV sequences and the most common genotypes were HPV 16 (53.5%) and HPV 54 (9.3%) followed by HPV 6, 53, 56, 58, 66, 11, 12, 20, 45, 62, and 71, in descending order of prevalence. The majority of HPV 16 isolates were classified as European and only one as African-1 variant on the basis of nucleotide signature present within the MGP L1 region. The high prevalence of HPV 16 among renal allograft recipients suggests that an HPV-16-based preventive or therapeutic vaccine may be effective for prevention or treatment of HPV-related neoplasia in this group of immune compromised patients.
Collapse
Affiliation(s)
- Maria Lina Tornesello
- Molecular Biology and Viral Oncology and AIDS Reference Centre, National Cancer Institute Fondazione Pascale, Naples, Italy
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
With the approval of Gardasil (Merck and Co., Inc., Whitehouse Station, NJ) in June of 2006 and the pending approval of Cervarix (GlaxoSmithKline, London, UK), two prophylactic human papillomavirus (HPV) vaccines will be available for clinical use. Randomized controlled trials have shown that both vaccines are safe and highly effective in preventing persistent infection and lesions caused by HPV 16 and 18--the types responsible for 70% of cervical cancers worldwide. Determining an effective vaccination strategy is now the most pressing issue facing clinicians, parents, public health officials, and policy makers. We discuss the appropriate age of vaccination, vaccine acceptance, implementation strategies in low resource settings, and the future of screening.
Collapse
Affiliation(s)
- Alisa Ames
- Department of Epidemiology and Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E6535, Baltimore, MD 21231, USA
| | | |
Collapse
|
37
|
Broomall EM, Reynolds SM, Jacobson RM. Epidemiology, clinical manifestations, and recent advances in vaccination against human papillomavirus. Postgrad Med 2010; 122:121-9. [PMID: 20203463 DOI: 10.3810/pgm.2010.03.2129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In October 2009, the Advisory Committee on Immunization Practices (ACIP) approved a newly licensed vaccine, Cervarix, directed against human papillomavirus (HPV) to prevent cervical cancer. The ACIP also expanded its recommendations against HPV by giving permission to physicians to vaccinate males aged 9 to 26 years with the previously licensed vaccine, Gardasil, to prevent genital warts, in addition to its previous recommendation for females aged 9 to 26 years to prevent cervical cancer and genital warts. The marketing, expense, safety, and reactivity of Gardasil continue to be the subject of controversy. Of the >100 types of HPVs, approximately 40 are sexually transmitted, and HPV is the most common sexually transmitted disease. By age 50 years, 80% of women will have contracted a sexually transmitted HPV infection. While most individuals are clear of infection by 2 years, some types of HPV carry a high risk for progressing to cancer, and HPV is identified in >99% of patients with cervical cancer. Each year in the United States approximately 12,000 women develop cervical cancer and nearly 4000 die of it. Human papillomavirus is also associated with genital warts and other anogenital cancers. The United States has now licensed 2 vaccines against HPV, Gardasil and Cervarix. Gardasil has been shown to be safe and effective in preventing HPV infections by types 6, 11, 16, and 18; types 16 and 18 are associated with 2 high-risk types of cervical cancer and are associated with 70% of all cervical cancers. Types 6 and 11 are associated with 90% of anogenital warts. Cervarix has also been shown to be safe and effective in preventing HPV infections by types 16 and 18, but offers no known protection against anogenital warts.
Collapse
Affiliation(s)
- Eileen M Broomall
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905-0001, USA
| | | | | |
Collapse
|
38
|
Practice improvement in cervical screening and management (PICSM): symposium on management of cervical abnormalities in adolescents and young women. J Low Genit Tract Dis 2010; 14:73-80. [PMID: 20043357 DOI: 10.1097/lgt.0b013e3181cec411] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Luchters SMF, Broeck DV, Chersich MF, Nel A, Delva W, Mandaliya K, Depuydt CE, Claeys P, Bogers JP, Temmerman M. Association of HIV infection with distribution and viral load of HPV types in Kenya: a survey with 820 female sex workers. BMC Infect Dis 2010; 10:18. [PMID: 20102630 PMCID: PMC2845133 DOI: 10.1186/1471-2334-10-18] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 01/26/2010] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) and HIV are each responsible for a considerable burden of disease. Interactions between these infections pose substantial public health challenges, especially where HIV prevalence is high and HPV vaccine coverage low. METHODS Between July 2005 and January 2006, a cross-sectional community-based survey in Mombasa, Kenya, enrolled female sex workers using snowball sampling. After interview and a gynaecological examination, blood and cervical cytology samples were taken. Quantitative real-time PCR detected HPV types and viral load measures. Prevalence of high-risk HPV was compared between HIV-infected and -uninfected women, and in women with abnormal cervical cytology, measured using conventional Pap smears. RESULTS Median age of the 820 participants was 28 years (inter-quartile range [IQR] = 24-36 years). One third of women were HIV infected (283/803; 35.2%) and these women were y more likely to have abnormal cervical cytology than HIV-negative women (27%, 73/269, versus 8%, 42/503; P < 0.001). Of HIV-infected women, 73.3% had high-risk HPV (200/273) and 35.5% had HPV 16 and/or 18 (97/273). Corresponding figures for HIV-negative women were 45.5% (229/503) and 15.7% (79/503). After adjusting for age, number of children and condom use, high-risk HPV was 3.6 fold more common in HIV-infected women (95%CI = 2.6-5.1). Prevalence of all 15 of the high-risk HPV types measured was higher among HIV-infected women, between 1.4 and 5.5 fold. Median total HPV viral load was 881 copies/cell in HIV-infected women (IQR = 33-12,110 copies/cell) and 48 copies/cell in HIV-uninfected women (IQR = 6-756 copies/cell; P < 0.001). HPV 16 and/or HPV 18 were identified in 42.7% of LSIL (32/75) and 42.3% of HSIL (11/26) lesions (P = 0.98). High-risk HPV types other than 16 and 18 were common in LSIL (74.7%; 56/75) and HSIL (84.6%; 22/26); even higher among HIV-infected women. CONCLUSIONS HIV-infected sex workers had almost four-fold higher prevalence of high-risk HPV, raised viral load and more precancerous lesions. HPV 16 and HPV 18, preventable with current vaccines, were associated with cervical disease, though other high-risk types were commoner. HIV-infected sex workers likely contribute disproportionately to HPV transmission dynamics in the general population. Current efforts to prevent HIV and HPV are inadequate. New interventions are required and improved implementation of existing strategies.
Collapse
Affiliation(s)
- Stanley MF Luchters
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
- International Centre for Reproductive Health (ICRH), Ghent University, Belgium
| | - Davy Vanden Broeck
- International Centre for Reproductive Health (ICRH), Mombasa, Kenya
- International Centre for Reproductive Health (ICRH), Ghent University, Belgium
| | - Matthew F Chersich
- International Centre for Reproductive Health (ICRH), Ghent University, Belgium
- Reproductive Health and HIV Research Unit (RHRU), University of Witwatersrand, South Africa
| | - Annalene Nel
- International Partnership for Microbicides (IPM), Paarl, South Africa
| | - Wim Delva
- International Centre for Reproductive Health (ICRH), Ghent University, Belgium
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, South Africa
| | | | - Christophe E Depuydt
- Applied Molecular Biology Research (AMBIOR), University of Antwerp, Belgium
- Laboratory for clinical pathology (Labo Lokeren - Campus Riatol), Antwerp, Belgium
| | - Patricia Claeys
- International Centre for Reproductive Health (ICRH), Ghent University, Belgium
| | - John-Paul Bogers
- Applied Molecular Biology Research (AMBIOR), University of Antwerp, Belgium
- Laboratory for clinical pathology (Labo Lokeren - Campus Riatol), Antwerp, Belgium
| | - Marleen Temmerman
- International Centre for Reproductive Health (ICRH), Ghent University, Belgium
| |
Collapse
|
40
|
Louie KS, De Sanjose S, Mayaud P. Epidemiology and prevention of human papillomavirus and cervical cancer in sub-Saharan Africa: a comprehensive review. Trop Med Int Health 2009; 14:1287-302. [DOI: 10.1111/j.1365-3156.2009.02372.x] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Strickler HD. Does HIV/AIDS have a biological impact on the risk of human papillomavirus-related cancers? J Natl Cancer Inst 2009; 101:1103-5. [PMID: 19648509 DOI: 10.1093/jnci/djp236] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
|
42
|
Chaturvedi AK, Madeleine MM, Biggar RJ, Engels EA. Risk of human papillomavirus-associated cancers among persons with AIDS. J Natl Cancer Inst 2009; 101:1120-30. [PMID: 19648510 DOI: 10.1093/jnci/djp205] [Citation(s) in RCA: 344] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although risk of human papillomavirus (HPV)-associated cancers of the anus, cervix, oropharynx, penis, vagina, and vulva is increased among persons with AIDS, the etiologic role of immunosuppression is unclear and incidence trends for these cancers over time, particularly after the introduction of highly active antiretroviral therapy in 1996, are not well described. METHODS Data on 499 230 individuals diagnosed with AIDS from January 1, 1980, through December 31, 2004, were linked with cancer registries in 15 US regions. Risk of in situ and invasive HPV-associated cancers, compared with that in the general population, was measured by use of standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). We evaluated the relationship of immunosuppression with incidence during the period of 4-60 months after AIDS onset by use of CD4 T-cell counts measured at AIDS onset. Incidence during the 4-60 months after AIDS onset was compared across three periods (1980-1989, 1990-1995, and 1996-2004). All statistical tests were two-sided. RESULTS Among persons with AIDS, we observed statistically significantly elevated risk of all HPV-associated in situ (SIRs ranged from 8.9, 95% CI = 8.0 to 9.9, for cervical cancer to 68.6, 95% CI = 59.7 to 78.4, for anal cancer among men) and invasive (SIRs ranged from 1.6, 95% CI = 1.2 to 2.1, for oropharyngeal cancer to 34.6, 95% CI = 30.8 to 38.8, for anal cancer among men) cancers. During 1996-2004, low CD4 T-cell count was associated with statistically significantly increased risk of invasive anal cancer among men (relative risk [RR] per decline of 100 CD4 T cells per cubic millimeter = 1.34, 95% CI = 1.08 to 1.66, P = .006) and non-statistically significantly increased risk of in situ vagina or vulva cancer (RR = 1.52, 95% CI = 0.99 to 2.35, P = .055) and of invasive cervical cancer (RR = 1.32, 95% CI = 0.96 to 1.80, P = .077). Among men, incidence (per 100 000 person-years) of in situ and invasive anal cancer was statistically significantly higher during 1996-2004 than during 1990-1995 (61% increase for in situ cancers, 18.3 cases vs 29.5 cases, respectively; RR = 1.71, 95% CI = 1.24 to 2.35, P < .001; and 104% increase for invasive cancers, 20.7 cases vs 42.3 cases, respectively; RR = 2.03, 95% CI = 1.54 to 2.68, P < .001). Incidence of other cancers was stable over time. CONCLUSIONS Risk of HPV-associated cancers was elevated among persons with AIDS and increased with increasing immunosuppression. The increasing incidence for anal cancer during 1996-2004 indicates that prolonged survival may be associated with increased risk of certain HPV-associated cancers.
Collapse
Affiliation(s)
- Anil K Chaturvedi
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Blvd, EPS 7072, Rockville, MD 20852, USA.
| | | | | | | |
Collapse
|
43
|
Affiliation(s)
- Jessica A Kahn
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| |
Collapse
|
44
|
Wake RM, Rebe K, Burch VC. Patient perception of cervical screening among women living with human immuno-deficiency virus infection attending an antiretroviral therapy clinic in urban South Africa. J OBSTET GYNAECOL 2009; 29:44-8. [PMID: 19280495 DOI: 10.1080/01443610802484070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aims to ascertain the perception of cervical screening practices among HIV-positive women attending an ART clinic in urban South Africa. It is a prospective cross-sectional study of 100 randomly selected patients using semi-structured interviews. Answers to fixed-response questions were recorded for statistical analysis and themes were identified from responses to open-ended questions. The study found that 59% of women surveyed reported ever having had a Papanicolau (Pap) smear and that 41% of these women had never been notified of the result. Many women surveyed lacked understanding of cervical screening; 78% had never heard of cervical cancer and around 40% had no correct knowledge about Pap smears. The findings suggest that cervical screening practices among HIV-positive women living in urban South Africa do not comply with the recommendations that are based on evidence of increased risk for this population. Systematic cervical screening programmes should be offered to HIV-positive women attending ART clinics in South Africa.
Collapse
Affiliation(s)
- R M Wake
- Infectious Diseases Unit, Department of Medicine, GF Jooste Hospital, Cape Town, South Africa.
| | | | | |
Collapse
|
45
|
Meys R, Gotch FM, Bunker CB. Human papillomavirus in the era of highly active antiretroviral therapy for human immunodeficiency virus: an immune reconstitution-associated disease? Br J Dermatol 2009; 162:6-11. [PMID: 19709102 DOI: 10.1111/j.1365-2133.2009.09365.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Human immunodeficiency virus (HIV)-related cutaneous and anogenital disease in the highly active antiretroviral therapy (HAART) era presents challenging problems for dermatologists. Immune reconstitution-associated diseases (IRADs) are common and important consequences of HAART. Dermatologists should be aware of the cutaneous manifestations of IRAD. The prevalence of clinical human papillomavirus (HPV)-related disease is increased in HIV and does not appear to be diminished by HAART. Many patients on HAART are dogged by persistent cutaneous warts. Anogenital precancer is also common in HIV and may be burgeoning with HAART. Clinicians should be aware of the increased risk of cervical, penile and vulval/vaginal cancers in treated and untreated patients with HIV. The increase in HPV infection in HIV-infected individuals may be, at least partly, due to increased exposure to diverse HPV types, particularly high-risk types that might be able to persist for longer in anogenital regions. Alternatively, persistent/emergent HPV disease in HIV infection might represent persistent or modulated immunodysregulation after HAART and be viewed as a form of IRAD. The immunopathogenesis of HPV IRAD is fascinating and possibly determined by host genotype.
Collapse
Affiliation(s)
- R Meys
- Department of Dermatology, Chelsea and Westminster Hospital, Imperial College, 369 Fulham Rd, London SW10 9NH, UK
| | | | | |
Collapse
|
46
|
Vidulich KA, Rady PL, He Q, Tyring SK, Duvic M. Detection of high-risk human papillomaviruses in verrucae of patients with mycosis fungoides and Sézary syndrome: a case series. Int J Dermatol 2009; 48:598-602. [DOI: 10.1111/j.1365-4632.2009.03766.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
47
|
Engels EA. Non-AIDS-defining malignancies in HIV-infected persons: etiologic puzzles, epidemiologic perils, prevention opportunities. AIDS 2009; 23:875-85. [PMID: 19349851 PMCID: PMC2677638 DOI: 10.1097/qad.0b013e328329216a] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Non-AIDS-defining malignancies have come to represent a growing fraction of the overall cancer burden in HIV-infected people, as improvements in HIV therapy prolong survival and reduce the incidence of AIDS-associated cancers. This review focuses on five non-AIDS-defining malignancies for which HIV-infected persons have an elevated risk, for which risk is substantial or increasing over time, and for which HIV infection may play an etiologic role. Among HIV-infected persons, lung cancer risk is high, in part due to frequent tobacco use in this population. Risks of anal cancer and liver cancer are also elevated, related to the high prevalence of infections with human papillomavirus and hepatitis B and C viruses. In addition, risk is elevated for Hodgkin lymphoma and several rare skin cancers, including Merkel cell carcinoma and sebaceous carcinoma. For anal cancer and Hodgkin lymphoma, it is particularly concerning that incidence in HIV-infected persons has risen in recent years, when highly active antiretroviral therapy has been available. Accumulating evidence supports the possibility that the high prevalence of known carcinogenic exposures (e.g., tobacco) and infections with oncogenic viruses does not completely explain the occurrence of these cancers. Indeed, HIV may act to increase the risk for each of these five non-AIDS-defining malignancies, although the mechanisms may vary, including immunosuppression, immune reconstitution, and chronic inflammation. These non-AIDS-defining cancers also present important opportunities for prevention (e.g., smoking cessation), screening (e.g., periodic anal Pap smear screening), and early detection.
Collapse
|
48
|
Lockwood-Rayermann S, McIntyre SJ. Understanding HPV disease and prevention: a guide for school nurses. J Sch Nurs 2009; 25:261-9. [PMID: 19363106 DOI: 10.1177/1059840509333787] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oncogenic human papillomavirus (HPV) causes 99.7% of all cervical cancers. HPV Types 16 and 18 are responsible for approximately 77% of cases, and peak prevalence occurs in females younger than 25 years of age. The recent implementation of HPV vaccination provides females with the opportunity to prevent infection. School nurses are advocates of student health and often a primary source of information. Therefore, they can play a key role in promoting vaccination prior to sexual debut. They can also promote regular cervical screening postvaccination, which may not be apparent to many students and parents. To deal with such issues, school nurses need a firm understanding of HPV and its role in cervical cancer. A greater understanding of HPV disease and prevention among school nurses, students, and parents may lead to greater reductions in the burden of cervical and other HPV-related diseases.
Collapse
Affiliation(s)
- Suzy Lockwood-Rayermann
- Center for Oncology Education & Research, Texax Christian University, Fort Worth, Texas, USA
| | | |
Collapse
|
49
|
Marin-Muller C, Li M, Chen C, Yao Q. Current understanding and potential immunotherapy for HIV-associated squamous cell carcinoma of the anus (SCCA). World J Surg 2009; 33:653-60. [PMID: 19052810 PMCID: PMC2924142 DOI: 10.1007/s00268-008-9835-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Squamous cell carcinoma of the anus (SCCA) is a rare disease in the average population but is an increasing concern among immunocompromised individuals, such as the HIV-seropositive. Coinfection with human papillomavirus (HPV) in this population is common. HPV infection is difficult to clear with a compromised immune system, which results in a greater risk of tumor development and a more aggressive progression of the disease. The recent approval of a prophylactic HPV vaccine for cervical cancer has sparked an interest in a search for improved immunotherapeutic multimodality therapies to combat anogenital tumors associated with the virus. In this review, we discuss the known mechanisms of action of HIV-associated SCCA, examine the current treatments for the disease, and focus on the potential of an immunotherapeutic vaccine approach for both prophylactic and therapeutic application.
Collapse
Affiliation(s)
- Christian Marin-Muller
- Molecular Surgeon Research Center, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Min Li
- Molecular Surgeon Research Center, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Changyi Chen
- Molecular Surgeon Research Center, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Qizhi Yao
- Molecular Surgeon Research Center, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
50
|
Katz KA, Clarke CA, Bernstein KT, Katz MH, Klausner JD. Is there a proven link between anal cancer screening and reduced morbidity or mortality? Ann Intern Med 2009; 150:283-4; author reply 284-5. [PMID: 19221387 DOI: 10.7326/0003-4819-150-4-200902170-00020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Kenneth A. Katz
- From Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103
| | - Christina A. Clarke
- From Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103
| | - Kyle T. Bernstein
- From Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103
| | - Mitchell H. Katz
- From Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103
| | - Jeffrey D. Klausner
- From Centers for Disease Control and Prevention, Atlanta, GA 30333; Northern California Cancer Center, Fremont, CA 94538; and San Francisco Department of Public Health, San Francisco, CA 94103
| |
Collapse
|