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Hidalgo-Tenorio C, Moya R, Omar M, Muñoz L, SamPedro A, López-Hidalgo J, Garcia-Vallecillos C, Gómez-Ronquillo P. Safety and Immunogenicity of the Nonavalent Human Papillomavirus Vaccine in Women Living with HIV. Vaccines (Basel) 2024; 12:838. [PMID: 39203964 PMCID: PMC11359547 DOI: 10.3390/vaccines12080838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND The objectives were to evaluate the safety and immunogenicity of the nonavalent human papillomavirus (nHPV) vaccine in adult Spanish women living with HIV (WLHIV); the prevalence of anal and cervical dysplasia and nHPV vaccine genotypes in the anus and cervix; and risk factors for high-risk HPV (HR-HPV) infection in anal mucosa. METHODS In this single-center, open-arm, non-randomized clinical trial, the nHPV vaccine was administered at 0, 2, and 6 months to WLHIV enrolled between February 2020 and November 2023, measuring vaccine antibody titers pre-vaccination and at 2, 6, and 7 months after the first dose. Cervical and anal cytology and HPV PCR genotyping studies were performed. Women with abnormal cytology and/or anal or cervical HPV infection at baseline underwent high-resolution anoscopy and/or colposcopy. RESULTS A total of 122 participants were included with mean age of 49.6 years: 52.5% smoked; 10.7% had anal-genital condylomatosis; 38.5% were infected by HR-HPV in the anus and 25.4% in the cervix, most frequently HPV 16; 19.1% had anal intraepithelial neoplasia 1-(AIN1); and 3.1% had cervical intraepithelial neoplasia 1 and 2 (CIN1/CIN2). Vaccine administration did not modify viral-immunological status (CD4 [809 ± 226.8 cells/uL vs. 792.35 ± 349.95; p = 0.357]) or plasma HIV load (3.38 ± 4.41 vs. 1.62 ± 2.55 cop/uL [log]; p = 0.125). Anti-HPV antibodies ([IQR: 0-0] vs. 7.63 nm [IQR: 3.46-19.7]; p = 0.0001) and seroconversion rate (8.2% vs. 96.7% [p = 0.0001]) were increased at 7 versus 0 months. There were no severe vaccine-related adverse reactions; injection-site pain was reported by around half of the participants. HR-HPV infection in the anus was solely associated with a concomitant cervix infection (HR 5.027; 95% CI: 1.009-25.042). CONCLUSIONS nHPV vaccine in adult WLHIV is immunogenic and safe.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Infectious Disease Unit, Hospital Universitario Virgen de las Nieves, IBS-Granada, 18012 Granada, Spain; (C.G.-V.); (P.G.-R.)
| | - Raquel Moya
- Internal Medicine, Complejo Hospitalario de Jaén, 23007 Jaén, Spain;
| | - Mohamed Omar
- Infectious Disease Unit, Complejo Hospitalario de Jaén, 23007 Jaén, Spain;
| | - Leopoldo Muñoz
- Infectious Diseases Unit, Hospital Universitario San Cecilio, IBS-Granada, 18012 Granada, Spain;
| | - Antonio SamPedro
- Microbiology Department, Hospital Universitario Virgen de las Nieves, IBS-Granada, 18012 Granada, Spain;
| | - Javier López-Hidalgo
- Pathology Department, Hospital Universitario Virgen de las Nieves, IBS-Granada, 18012 Granada, Spain;
| | - Coral Garcia-Vallecillos
- Infectious Disease Unit, Hospital Universitario Virgen de las Nieves, IBS-Granada, 18012 Granada, Spain; (C.G.-V.); (P.G.-R.)
| | - Patricia Gómez-Ronquillo
- Infectious Disease Unit, Hospital Universitario Virgen de las Nieves, IBS-Granada, 18012 Granada, Spain; (C.G.-V.); (P.G.-R.)
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Samaha H, Yigitkanli A, Naji A, Kazzi B, Tanios R, Dib SM, Ofotokun I, Rouphael N. Burden of Vaccine-Preventable Diseases in People Living with HIV. Vaccines (Basel) 2024; 12:780. [PMID: 39066418 PMCID: PMC11281599 DOI: 10.3390/vaccines12070780] [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: 06/18/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Vaccine-preventable diseases (VPDs) pose a serious public health concern for people living with HIV (PLH). PLH experience a delayed and weakened response to many vaccines available, compared to the general population. Lower seroconversion rates, along with a decreased efficacy and durability of vaccines, increases the susceptibility of PLH to VPDs. Vaccination guidelines specifically targeting this population have been modified to overcome these challenges. However, vaccine uptake remains suboptimal due to multiple barriers, highlighting the need for further studies and the additional implementation of public health measures specifically tailored to PLH.
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Affiliation(s)
- Hady Samaha
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA 30030, USA; (A.Y.); (A.N.); (B.K.); (R.T.); (S.M.D.); (N.R.)
| | - Arda Yigitkanli
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA 30030, USA; (A.Y.); (A.N.); (B.K.); (R.T.); (S.M.D.); (N.R.)
| | - Amal Naji
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA 30030, USA; (A.Y.); (A.N.); (B.K.); (R.T.); (S.M.D.); (N.R.)
| | - Bahaa Kazzi
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA 30030, USA; (A.Y.); (A.N.); (B.K.); (R.T.); (S.M.D.); (N.R.)
| | - Ralph Tanios
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA 30030, USA; (A.Y.); (A.N.); (B.K.); (R.T.); (S.M.D.); (N.R.)
| | - Serena Maria Dib
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA 30030, USA; (A.Y.); (A.N.); (B.K.); (R.T.); (S.M.D.); (N.R.)
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Nadine Rouphael
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, Decatur, GA 30030, USA; (A.Y.); (A.N.); (B.K.); (R.T.); (S.M.D.); (N.R.)
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Bechini A, Cosma C, Di Pisa G, Fanfani A, Ionita G, Liedl D, Lunetta C, Martorella L, Mele S, Stacchini L, Vaccaro G, Zuccaro O, Valente S, Prandi GM, Bonanni P, Boccalini S. Human Papilloma Virus Vaccination and Cervical Screening in the Italian Regions: An Overview of the Current State of the Art. Vaccines (Basel) 2024; 12:504. [PMID: 38793755 PMCID: PMC11125645 DOI: 10.3390/vaccines12050504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Human Papilloma Virus (HPV) infection and HPV-related cancers can be prevented through vaccinations and mass cervical screening programmes. The Ministry of Health in Italy provides recommendations on primary and secondary prevention of HPV-related diseases, but the 19 Italian regions and 2 autonomous provinces have organisational and decision-making autonomy, with differences in the strategies for offering prevention. The aim of this study is to describe the HPV vaccination and cervical screening offered in all Italian regions. Regional official documents up until 31 December 2021 were first identified. Subsequently, primary and secondary prevention experts from each region were interviewed to validate the previously collected data. The National Immunisation Plan (NIP) 2017-2019 recommends HPV vaccination from the age of 11 for both sexes, with a coverage target of 95%. HPV vaccination is offered free of charge or co-payment. All regions have screening programmes for cervical cancer, using PAP or HPV-DNA tests every three to five years. All regions have an electronic registry for vaccination and screening status. All regions have developed awareness-raising campaigns. It is important to harmonise regional policies with the implementation of information systems integration. The collected data could enhance both regional and national public health initiatives, bolstering the resilience of vaccination programs.
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Affiliation(s)
- Angela Bechini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (P.B.); (S.B.)
| | - Claudia Cosma
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Giulia Di Pisa
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Alice Fanfani
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Giulia Ionita
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Davide Liedl
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Carla Lunetta
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Linda Martorella
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Silvia Mele
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Lorenzo Stacchini
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Gabriele Vaccaro
- Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; (G.D.P.); (A.F.); (G.I.); (D.L.); (C.L.); (L.M.); (S.M.); (L.S.); (G.V.)
| | - Ornella Zuccaro
- Department of Prevention and Public Health, Local Health Authority Asl Roma 2, 00182 Rome, Italy;
| | | | | | - Paolo Bonanni
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (P.B.); (S.B.)
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy; (A.B.); (P.B.); (S.B.)
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Asempah E, Wiktorowicz ME. Understanding HPV Vaccination Policymaking in Rwanda: A Case of Health Prioritization and Public-Private-Partnership in a Low-Resource Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6998. [PMID: 37947556 PMCID: PMC10649882 DOI: 10.3390/ijerph20216998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Rwanda is the first African country to implement a national HPV vaccination program in 2011. This study sought to clarify the HPV vaccination policymaking process in Rwanda through the lens of Kingdon's multiple stream framework and Foucault's concept of governmentality. Perspectives of policymakers engaged in HPV vaccination policy were gathered from published sources, along with key informant interviews. Rwanda's track record of successful vaccination programs enabled by a culture of local accountability created public and private sector incentives. Effective stakeholder engagement, health priority setting, and resource mobilization garnered locally and through international development aid, reflect indicators of policy success. The national HPV policymaking process in Rwanda unfolded in a relatively cohesive and stable policy network. Although peripheral stakeholder resistance and a constrained national budget can present a threat to policy survival, the study shows that such factors as the engagement of policy entrepreneurs within a policy network, private sector incentives, and international aid were effective in ensuring policy resolution.
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Affiliation(s)
- Eric Asempah
- School of Health Policy & Management, Faculty of Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada;
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Yuan D, Liu S, Liu Y, Ouyang F, Ai W, Shi L, Liu X, Qiu T, Wang B, Zhou Y. HPV Infection Profiles among People Living with HIV and HPV Vaccine Acceptance among Individuals with Different HIV Infection Statuses in China: A Systematic Meta-Analysis. Vaccines (Basel) 2023; 11:1614. [PMID: 37897016 PMCID: PMC10610837 DOI: 10.3390/vaccines11101614] [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: 08/25/2023] [Revised: 09/24/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
To understand the HPV infection profiles among Chinese HIV/AIDS patients and the HPV vaccine acceptance among unvaccinated Chinese people with different HIV infection statuses after the HPV vaccine launch in China, this study searched Web of Science, PubMed, Cochrane Library, Embase, Scopus, CNKI, WANFANG, SinoMed, and VIP databases up to 23 June 2023, according to the registered protocol (CRD42023449913). A total of 58 studies were included. The results showed that the HPV infection rate among Chinese HIV/AIDS patients was 52.54% (95% CI: 42.11-62.86%) and higher in males than in females (74.55% vs. 41.04%); meanwhile, the rate was higher in the anus than in the cervix (69.22% vs. 41.71%). Although there was no statistical difference, the high-risk HPV infection rate (38.98%) was higher than low-risk HPV (23.86%), and single infections were more common (28.84%) than multiple infections (19.23%). HPV vaccine acceptance among the unvaccinated Chinese population was 59.19% (95% CI: 52.50-65.89%), and was slightly higher among HIV-infected rather than non-HIV-infected individuals (67.72% vs. 59.58%). There was a difference in acceptance among respondents from different regions. Although the difference in acceptance rate between males and females was not statistically significant (61.10% vs. 61.18%), MSM had a higher acceptance rate than non-MSM (84.28% vs. 59.05%). HPV infection is prevalent among HIV patients, demonstrating the need to increase the frequency of HPV screening for PLWH. The HPV vaccine acceptance rate is higher than that of non-HIV-infected individuals. Male acceptance is almost the same as female's, with MSM acceptance higher than non-MSM, suggesting that using MSM, especially MSM in PLWH, as an entry point may be a practical avenue to explore to further expand the scope of HPV vaccination.
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Affiliation(s)
- Defu Yuan
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Shanshan Liu
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Yangyang Liu
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Fei Ouyang
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Wei Ai
- School of Public Health, Nanjing Medical University, Nanjing 211166, China;
| | - Lingen Shi
- Department of HIV/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; (L.S.); (X.L.); (T.Q.)
| | - Xiaoyan Liu
- Department of HIV/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; (L.S.); (X.L.); (T.Q.)
| | - Tao Qiu
- Department of HIV/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; (L.S.); (X.L.); (T.Q.)
| | - Bei Wang
- Department of Epidemiology and Health Statistics, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China; (D.Y.); (S.L.); (Y.L.); (F.O.)
| | - Ying Zhou
- Department of HIV/STD Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China; (L.S.); (X.L.); (T.Q.)
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Tortellini E, Fosso Ngangue YC, Dominelli F, Guardiani M, Falvino C, Mengoni F, Carraro A, Marocco R, Pasculli P, Mastroianni CM, Ciardi MR, Lichtner M, Zingaropoli MA. Immunogenicity and Efficacy of Vaccination in People Living with Human Immunodeficiency Virus. Viruses 2023; 15:1844. [PMID: 37766251 PMCID: PMC10534440 DOI: 10.3390/v15091844] [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: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
People living with HIV (PLWH) remain at high risk of mortality and morbidity from vaccine-preventable diseases, even though antiretroviral therapy (ART) has restored life expectancy and general well-being. When, which, and how many doses of vaccine should be administered over the lifetime of PLWH are questions that have become clinically relevant. Immune responses to most vaccines are known to be impaired in PLWH. Effective control of viremia with ART and restored CD4+ T-cell count are correlated with an improvement in responsiveness to routine vaccines. However, the presence of immune alterations, comorbidities and co-infections may alter it. In this article, we provide a comprehensive review of the literature on immune responses to different vaccines in the setting of HIV infection, emphasizing the potential effect of HIV-related factors and presence of comorbidities in modulating such responses. A better understanding of these issues will help guide vaccination and prevention strategies for PLWH.
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Affiliation(s)
- Eeva Tortellini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Yann Collins Fosso Ngangue
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Federica Dominelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Mariasilvia Guardiani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Carmen Falvino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Raffaella Marocco
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
| | - Miriam Lichtner
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy; (R.M.); (M.L.)
- Department of Neurosciences, Mental Health, and Sense Organs, NESMOS, Sapienza University of Rome, 00185 Rome, Italy
| | - Maria Antonella Zingaropoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (Y.C.F.N.); (F.D.); (M.G.); (C.F.); (F.M.); (A.C.); (P.P.); (C.M.M.); (M.R.C.); (M.A.Z.)
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Ejaz M, Ekström AM, Ali TS, Salazar M, Ahmed A, Ali D, Haroon A, Siddiqi S. Integration of human papillomavirus associated anal cancer screening into HIV care and treatment program in Pakistan: perceptions of policymakers, managers, and care providers. BMC Public Health 2023; 23:1034. [PMID: 37259085 DOI: 10.1186/s12889-023-15896-1] [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: 04/09/2022] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The incidence of anal cancer, largely associated with anal human papillomavirus (HPV) infection, is increasing among men who have sex with men (MSM), and transgender women living with or without HIV. Screening for anal cancer to detect anal precancerous lesions in high-risk groups is an important opportunity for prevention but still lacking in many low-and-middle-income countries. The aim of this study was to explore the readiness of Pakistan's healthcare system to integrate anal cancer and HPV screening into a national HIV program, as perceived by policymakers, health managers, and healthcare providers. DESIGN This qualitative study using key-informant interviews with participants influence in policy making, implementation and advocacy from public and private sector were conducted between March 2021 to August 2021 in Karachi Pakistan. METHODS Key informants were purposely selected from different domains of the healthcare system responsible for the target group of interest, MSM and transgender-women in general and people living with HIV in particular. A total of 18 key informants, at different levels of seniority were recruited from governmental and non-governmental organizations, high-level infectious disease healthcare managers, and United Nations Program representatives. Qualitative content analysis was used to identify the manifest and latent themes, based on socioecological framework. RESULTS The results were grouped into five major themes; (1) The policy context and priorities, (2) Health systems factors, (3) Community environment, (4) Healthcare setting & providers and (5) Individual-level obstacles. The policy actors expressed their concerns about their limited voice in country's health and health related priority setting. Informants reported a lack of political will and suggested that government should bring a change in the paradigm of healthcare service delivery from reactive to proactive approach. Although, participants unanimously favored integration of HPV preventive services into existing HIV program, they also identified several service delivery barriers including trained workforce shortage, limited capacity of information technology, lack of supplies needed for screening, lack of financing, and lack of services that could meet key-populations needs. Participants also predicted other implementation challenges such as stigma, social victimization, and systemic discrimination against at-risk groups at healthcare facilities. CONCLUSION Although policy makers and health providers in Pakistan saw a clear need to scale-up and integrate anal cancer screening for key populations, the feasibility of this is dependent on political will, financing, anti-stigma and discrimination interventions and health system efficiency.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health, Karolinska Institutet Stockholm, Widerströmska Huset 18 A 171 77, Stockholm, Sweden.
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet Stockholm, Widerströmska Huset 18 A 171 77, Stockholm, Sweden
- Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
| | | | - Mariano Salazar
- Department of Global Public Health, Karolinska Institutet Stockholm, Widerströmska Huset 18 A 171 77, Stockholm, Sweden
| | - Alyan Ahmed
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Dania Ali
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Ayman Haroon
- Department of Biostatistics and Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
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Huff KA, Braun A, Salvaggio MR, McGough P, Frank-Pearce SG, Kendzor DE, Bui TC. Promoting HPV Vaccination in People with HIV: Factors to Consider. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5345. [PMID: 37047959 PMCID: PMC10094493 DOI: 10.3390/ijerph20075345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
People with HIV (PWH) and their sexual partners have increased risk of human papillomavirus (HPV) infection. Despite recommended HPV vaccination for PWH aged 18-26 years, vaccination rates among PWH remain low. This qualitative study used the Information-Motivation-Behavioral Skills (IMBS) model to identify factors influencing the decisions of PWH around promoting HPV vaccination to their sexual partners. Fourteen PWH with diverse sociodemographic characteristics participated in four focus-group discussions. Data were analyzed using thematic content analysis; codes and themes included IMBS constructs. For the information construct, the need for improved HPV education emerged as the driving factor for HPV vaccine uptake and discussing HPV vaccines with partners. Focal reasons for being unvaccinated included low knowledge of HPV risk, asymptomatic cancer-causing HPV, HPV vaccines, and vaccine eligibility. Salient factors in the motivation construct included the preventive benefits of HPV vaccination to both self and sexual partners. Salient factors in the behavioral skills construct included: accessing vaccine, low self-confidence and skills for promoting vaccination, relationships with sexual partners, partners' vaccine hesitancy, and stigma. Race/ethnicity impacted HPV vaccination promotion; important determinants included perceptions of HPV-related diseases as "White people's diseases" among Black people, and discrimination against those with HPV-related diseases among the Hispanic population.
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Affiliation(s)
- Kinsey A. Huff
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (K.A.H.); (D.E.K.)
| | - Ashlea Braun
- Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University, Stillwater, OK 74078, USA;
| | - Michelle R. Salvaggio
- Infectious Diseases Section, Department of Internal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Patrick McGough
- Oklahoma City-County Health Department, Oklahoma City, OK 73111, USA;
| | - Summer G. Frank-Pearce
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Darla E. Kendzor
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (K.A.H.); (D.E.K.)
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
| | - Thanh Cong Bui
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (K.A.H.); (D.E.K.)
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
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9
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Giannone G, Giuliano AR, Bandini M, Marandino L, Raggi D, Earle W, Ayres B, Pettaway CA, McNeish IA, Spiess PE, Necchi A. HPV vaccination and HPV-related malignancies: impact, strategies and optimizations toward global immunization coverage. Cancer Treat Rev 2022; 111:102467. [DOI: 10.1016/j.ctrv.2022.102467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/02/2022]
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10
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Staadegaard L, Rönn MM, Soni N, Bellerose ME, Bloem P, Brisson M, Maheu-Giroux M, Barnabas RV, Drolet M, Mayaud P, Dalal S, Boily MC. Immunogenicity, safety, and efficacy of the HPV vaccines among people living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101585. [PMID: 35936024 PMCID: PMC9350866 DOI: 10.1016/j.eclinm.2022.101585] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 01/21/2023] Open
Abstract
Background Vaccines have been demonstrated to protect against high-risk human papillomavirus infection (HPV), including HPV-16/18, and cervical lesions among HIV negative women. However, their efficacy remains uncertain for people living with HIV (PLHIV).We systematically reviewed available evidence on HPV vaccine on immunological, virological, or other biological outcomes in PLHIV. Methods We searched five electronic databases (PubMed, Medline and Embase, clinicaltrials.gov and the WHO clinical trial database) for longitudinal prospective studies reporting immunogenicity, virological, cytological, histological, clinical or safety endpoints following prophylactic HPV vaccination among PLHIV. We included studies published by February 11th, 2021. We summarized results, assessed study quality, and conducted meta-analysis and subgroup analyses, where possible. Findings We identified 43 publications stemming from 18 independent studies (Ns =18), evaluating the quadrivalent (Ns =15), bivalent (Ns =4) and nonavalent (Ns =1) vaccines. A high proportion seroconverted for the HPV vaccine types. Pooled proportion seropositive by 28 weeks following 3 doses with the bivalent, quadrivalent, and nonavalent vaccines were 0.99 (95% confidence interval: 0.95-1.00, Ns =1), 0.99 (0.98-1.00, Ns =9), and 1.00 (0.99-1.00, Ns =1) for HPV-16 and 0.99 (0.96-1.00, Ns =1), 0.94 (0.91-0.96, Ns =9), and 1.00 (0.99-1.00, Ns =1) for HPV-18, respectively. Seropositivity remained high among people who received 3 doses despite some declines in antibody titers and lower seropositivity over time, especially for HPV-18, for the quadrivalent than the bivalent vaccine, and for HIV positive than negative individuals. Seropositivity for HPV-18 at 29-99 weeks among PLHIV was 0.72 (0.66-0.79, Ns =8) and 0.96 (0.92-0.99, Ns =2) after 3 doses of the quadrivalent and bivalent vaccine, respectively and 0.94 (0.90-0.98, Ns =3) among HIV-negative historical controls. Evidence suggests that the seropositivity after vaccination declines over time but it can lasts at least 2-4 years. The vaccines were deemed safe among PLHIV with few serious adverse events. Evidence of HPV vaccine efficacy against acquisition of HPV infection and/or associated disease from the eight trials available was inconclusive due to the low quality. Interpretation PLHIV have a robust and safe immune response to HPV vaccination. Antibody titers and seropositivity rates decline over time but remain high. The lack of a formal correlate of protection and efficacy results preclude definitive conclusions on the clinical benefits. Nevertheless, given the burden of HPV disease in PLHIV, although the protection may be shorter or less robust against HPV-18, the robust immune response suggests that PLHIV may benefit from receiving HPV vaccination after acquiring HIV. Better quality studies are needed to demonstrate the clinical efficacy among PLHIV. Funding World Health Organization. MRC Centre for Global Infectious Disease Analysis, Canadian Institutes of Health Research, UK Medical Research Council (MRC).
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Affiliation(s)
- Lisa Staadegaard
- Department of Infectious Diseases Epidemiology, Imperial College, London, United Kingdom
| | - Minttu M. Rönn
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Nirali Soni
- Department of Infectious Diseases Epidemiology, Imperial College, London, United Kingdom
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Meghan E. Bellerose
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Paul Bloem
- World Health Organization, Geneva, Switzerland
| | - Marc Brisson
- Laval University, Québec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montreal, Canada
| | - Ruanne V. Barnabas
- Department of Global Health, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Melanie Drolet
- Centre de recherche du CHU de Québec-Université Laval, Canada
| | - Philippe Mayaud
- Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shona Dalal
- World Health Organization, Geneva, Switzerland
| | - Marie-Claude Boily
- Department of Infectious Diseases Epidemiology, Imperial College, London, United Kingdom
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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11
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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.
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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
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12
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Murenzi G, Shumbusho F, Hansen N, Munyaneza A, Gage JC, Muhoza B, Kanyabwisha F, Pierz A, Tuyisenge P, Anastos K, Castle PE. Long-term human papillomavirus vaccination effectiveness and immunity in Rwandan women living with and without HIV: a study protocol. BMJ Open 2022; 12:e061650. [PMID: 36008069 PMCID: PMC9422845 DOI: 10.1136/bmjopen-2022-061650] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Prophylactic human papillomavirus (HPV) vaccines have been shown to be highly effective in protecting women against cervical infections, high-grade abnormalities and cancer caused by the targeted HPV types. However, the evidence for their effectiveness in women living with HIV (WLWH) is less clear. METHODS WLWH and HIV-negative women who likely did (birth cohorts 1996 and later) and WLWH and HIV(-) negative who likely did not (birth cohorts before 1996) receive HPV vaccination (n=3028; 757 participants for each of the four groups). Between groups, we will compare cervicovaginal, anal and oral prevalent and 6-12 month persistent HPV6/11/16/18 infections as measured using a modified AmpFire HPV genotyping assay that tests for 15 high-risk or intermediate-risk HPV genotypes, HPV6 and HPV11. We will also compare the HPV immune response in HPV-vaccinated WLWH to HPV-vaccinated HIV-negative women using an anti-HPV16 and anti-HPV18 ELISA. Vaccination status will be confirmed through national vaccination records. ANALYSIS We will calculate point prevalence and prevalence of 6-12 month persisting infections by individual HPV-type specific infections and groups of infections for each anatomic site and for each group of women. Results will be stratified by age at vaccination, age at enrolment and the number of doses (3 vs 2) as well as other factors possibly associated with HPV prevalence. Differences in endpoints between groups, overall and between subgroups, will be tested for statistical significance (p<0.05) using Fisher's exact or Pearson χ2 test. Differences in geometric mean titres and seropositivity will be tested for statistical significance using the Mann-Whitney and Fisher's exact tests, respectively. ETHICS AND DISSEMINATION The study was approved by the Albert Einstein College of Medicine Institutional Review Board and the Rwanda National Ethics Committee. Results will be disseminated through publication in peer-reviewed journals.
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Affiliation(s)
- Gad Murenzi
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Fabienne Shumbusho
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Natasha Hansen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Athanase Munyaneza
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Benjamin Muhoza
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Faustin Kanyabwisha
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Amanda Pierz
- Department of Community Health and Health Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Patrick Tuyisenge
- Einstein-Rwanda Research and Capacity Building Program, Rwanda Military Hospital, Kigali, Rwanda
- Einstein-Rwanda Research and Capacity Building Program, Research for Development (RD Rwanda), Kigali, Rwanda
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Philip E Castle
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland, USA
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13
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Pérez-González A, Cachay E, Ocampo A, Poveda E. Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection. Microorganisms 2022; 10:1047. [PMID: 35630489 PMCID: PMC9147826 DOI: 10.3390/microorganisms10051047] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 12/01/2022] Open
Abstract
Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Although most HPV infections will spontaneously resolve, a considerable proportion of them will persist, increasing the risk of anogenital dysplasia, especially within certain populations, such as patients infected with human immunodeficiency virus (HIV). Furthermore, high-risk oncogenic HPV types (HR-HPV) are the main cause of cervix and other anogenital cancers, such as cancer of the vagina, vulva, penis, or anus. HIV and HPV coinfection is common among people living with HIV (PLWH) but disproportionally affects men who have sex with men (MSM) for whom the rate of persistent HPV infection and reinfection is noteworthy. The molecular interactions between HIV and HPV, as well as the interplay between both viruses and the immune system, are increasingly being understood. The immune dysfunction induced by HIV infection impairs the rate of HPV clearance and increases its oncogenic risk. Despite the availability of effective antiretroviral therapy (ART), the incidence of several HPV-related cancers is higher in PLWH, and the burden of persistent HPV-related disease has become a significant concern in an aging HIV population. Several public health strategies have been developed to reduce the transmission of HIV and HPV and mitigate the consequences of this type of coinfection. Universal HPV vaccination is the most effective preventive tool to reduce the incidence of HPV disease. In addition, screening programs for HPV-related cervical and vulvovaginal diseases in women are well-recognized strategies to prevent cervical cancer. Similarly, anal dysplasia screening programs are being implemented worldwide for the prevention of anal cancer among PLWH. Herein, the main epidemiological features and clinical implications of HIV and HPV coinfection are reviewed, focusing mainly on the relationship between HIV immune status and HPV-related diseases and the current strategies used to reduce the burden of HPV-related disease.
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Affiliation(s)
- Alexandre Pérez-González
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), 36312 Vigo, Spain;
- Infectious Disease Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain;
| | - Edward Cachay
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California at San Diego, San Diego, CA 92093, USA;
| | - Antonio Ocampo
- Infectious Disease Unit, Internal Medicine Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain;
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), 36312 Vigo, Spain;
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14
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Kang M, Umbleja T, Ellsworth G, Aberg J, Wilkin T. Effects of Sex, Existing Antibodies, and HIV-1-Related and Other Baseline Factors on Antibody Responses to Quadrivalent HPV Vaccine in Persons With HIV. J Acquir Immune Defic Syndr 2022; 89:414-422. [PMID: 34907980 PMCID: PMC8881300 DOI: 10.1097/qai.0000000000002891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We compared antibody (Ab) responses to a quadrivalent (types 6, 11, 16, and 18) human papillomavirus (HPV) vaccine between men and women with HIV-1. METHODS A retrospective analysis of participant-level data from published clinical trials of HPV vaccine administered at study entry and at weeks 8 and 24 was conducted separately for baseline Ab undetectable and baseline Ab detectable using Ab titers and titer changes from baseline, respectively, at week 28 and year 1.5. Generalized estimating equations accounted for multiple HPV types and were adjusted for multiple baseline factors, including existing HPV antibodies before vaccination from natural exposure. RESULTS We evaluated 575 participants with CD4+ count >200 cells/mm3, 323 men and 252 women: median ages 46 and 38 years, respectively. Week 28 and year 1.5 Ab titers were similar between men and women regardless of the baseline Ab detection in multivariate models. HIV-1 RNA ≥400 copies/mm3 was associated with a lower week 28 Ab response; in baseline Ab detectable, the baseline HPV Ab titer level, HPV DNA detection, and lower CD4+/CD8+ ratio were also associated with a lower response. CD4+/CD8+ ratio was a stronger predictor in the year 1.5 Ab analysis than in the week 28 analysis. Ab responses among baseline Ab detectable were only somewhat higher than those among baseline Ab undetectable (eg, type 16 week 28 median 3.46 vs 3.20 log10 mMU/mL) despite the existing baseline titer (median 1.74). CONCLUSIONS We did not find any sex differences of serologic response to HPV vaccine. Ab titer gain was lower in those with preexisting antibodies due to previous natural infection.
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Affiliation(s)
- Minhee Kang
- Center for Biostatistics in AIDS Research in the Department
of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research in the Department
of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Grant Ellsworth
- Division of Infectious Diseases, Weill Cornell Medicine,
New York, NY
| | - Judith Aberg
- Division of Infectious Diseases, Icahn School of Medicine
at Mount Sinai, New York, NY
| | - Timothy Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine,
New York, NY
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15
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Albuquerque A, Stockdale CK, Heller D, Bornstein J, Roberts JM, Preti M, Poynten IM, Vieira-Baptista P. Vulvar High-Grade Squamous Intraepithelial Lesions and Cancer as a Risk Factor for Anal Cancer: A Review. J Low Genit Tract Dis 2022; 26:32-37. [PMID: 34670242 DOI: 10.1097/lgt.0000000000000631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Anal squamous cell carcinoma (ASCC) has a higher incidence described in certain groups, namely, in women with vulvar high-grade squamous intraepithelial lesions (vHSILs) and/or human papillomavirus squamous cell carcinoma (VSCC). This review describes terminology, vHSIL, and VSCC in their association with ASCC and the published recommendations for early detection of this cancer in these women. MATERIALS AND METHODS A narrative review was conducted by the authors on vHSIL and VSCC as risk factors for ASCC. RESULTS The ASCC and VSCC incidence are increasing. Women with vHSIL and/or VSCC can present with ASCC at diagnosis, being one of the highest-risk groups. Suspicious symptoms include rectal bleeding, pain, and a sensation of an anal mass. Digital anorectal examination can help detect early ASCC. Sensitivity of anal cytology in women with vHSIL and VSCC seems low, with the exception of immunosuppressed women with genital neoplasia (cervix, vagina, and vulva). There are still insufficient data on high-resolution anoscopy in women with vHSIL and/or VSCC as a screening method. CONCLUSIONS Clinicians need be aware that women with vHSIL and VSCC comprise one of the highest-risk groups for ASCC. Inquiring suggestive symptoms of ASCC and a digital anorectal examination can help in the early detection of this type of cancer.
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Affiliation(s)
- Andreia Albuquerque
- CINTESIS-Center for Health Technology and Services Research, Medical Research Center, University of Porto, Porto, Portugal
| | | | | | - Jacob Bornstein
- Bar Ilan University and Galilee Medical Center, Nahariya, Israel
| | | | - Mario Preti
- Department of Surgical Science University of Torino, Torino, Italy
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16
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Jani C, Al Omari O, Singh H, Walker A, Patel K, Mouchati C, Radwan A, Pandit Z, Hanbury G, Crowley C, Marshall DC, Goodall R, Shalhoub J, Salciccioli JD, Tapan U. Trends of HIV-Related Cancer Mortality between 2001 and 2018: An Observational Analysis. Trop Med Infect Dis 2021; 6:tropicalmed6040213. [PMID: 34941669 PMCID: PMC8707967 DOI: 10.3390/tropicalmed6040213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022] Open
Abstract
The burden of AIDS-defining cancers has remained relatively steady for the past two decades, whilst the burden of non-AIDS-defining cancer has increased. Here, we conduct a study to describe mortality trends attributed to HIV-associated cancers in 31 countries. We extracted HIV-related cancer mortality data from 2001 to 2018 from the World Health Organization Mortality Database. We computed age-standardized death rates (ASDRs) per 100,000 population using the World Standard Population. Data were visualized using Locally Weighted Scatterplot Smoothing (LOWESS). Data for females were available for 25 countries. Overall, there has been a decrease in mortality attributed to HIV-associated cancers among most of the countries. In total, 18 out of 31 countries (58.0%) and 14 out of 25 countries (56.0%) showed decreases in male and female mortality, respectively. An increasing mortality trend was observed in many developing countries, such as Malaysia and Thailand, and some developed countries, such as the United Kingdom. Malaysia had the greatest increase in male mortality (+495.0%), and Canada had the greatest decrease (−88.5%). Thailand had the greatest increase in female mortality (+540.0%), and Germany had the greatest decrease (−86.0%). At the endpoint year, South Africa had the highest ASDRs for both males (16.8/100,000) and females (19.2/100,000). The lowest was in Japan for males (0.07/100,000) and Egypt for females (0.028/100,000).
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Affiliation(s)
- Chinmay Jani
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Correspondence: ; Tel.: +1-857-284-3042
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
| | - Harpreet Singh
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Alexander Walker
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
| | - Kripa Patel
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Smt NHL Municipal Medical College, Ahmedabad 380006, Gujarat, India
| | - Christian Mouchati
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Amr Radwan
- Department of Internal Medicine, Section of Hematology and Oncology, Boston Medical Center, Boston, MA 02118, USA; (A.R.); (U.T.)
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Zuha Pandit
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
| | - Georgina Hanbury
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Conor Crowley
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Division of Pulmonary and Critical Care, Lahey Hospital, Burlington, MA 01805, USA
| | - Dominic C. Marshall
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Richard Goodall
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Joseph Shalhoub
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Justin D. Salciccioli
- Harvard Medical School, Boston, MA 02115, USA;
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Umit Tapan
- Department of Internal Medicine, Section of Hematology and Oncology, Boston Medical Center, Boston, MA 02118, USA; (A.R.); (U.T.)
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
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Castle PE, Einstein MH, Sahasrabuddhe VV. Cervical cancer prevention and control in women living with human immunodeficiency virus. CA Cancer J Clin 2021; 71:505-526. [PMID: 34499351 PMCID: PMC10054840 DOI: 10.3322/caac.21696] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Despite being highly preventable, cervical cancer is the fourth most common cancer and cause of cancer death in women globally. In low-income countries, cervical cancer is often the leading cause of cancer-related morbidity and mortality. Women living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are at a particularly high risk of cervical cancer because of an impaired immune response to human papillomavirus, the obligate cause of virtually all cervical cancers. Globally, approximately 1 in 20 cervical cancers is attributable to HIV; in sub-Saharan Africa, approximately 1 in 5 cervical cancers is due to HIV. Here, the authors provide a critical appraisal of the evidence to date on the impact of HIV disease on cervical cancer risk, describe key methodologic issues, and frame the key outstanding research questions, especially as they apply to ongoing global efforts for prevention and control of cervical cancer. Expanded efforts to integrate HIV care with cervical cancer prevention and control, and vice versa, could assist the global effort to eliminate cervical cancer as a public health problem.
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Affiliation(s)
- Philip E. Castle
- Division of Cancer PreventionNational Cancer InstituteNational Institutes of HealthRockvilleMaryland
- Division of Cancer Epidemiology and GeneticsNational Cancer InstituteNational Institutes of HealthRockvilleMaryland
| | - Mark H. Einstein
- Department of Obstetrics, Gynecology, and Reproductive HealthRutgers New Jersey Medical SchoolNewarkNew Jersey
| | - Vikrant V. Sahasrabuddhe
- Division of Cancer PreventionNational Cancer InstituteNational Institutes of HealthRockvilleMaryland
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Miller CN, Kemp TJ, Abrahamsen M, Isaacs-Soriano K, Dunham K, Sirak B, Pan Y, Lazcano-Ponce E, Salmeron J, Pinto LA, Giuliano AR. Increases in HPV-16/18 antibody avidity and HPV-specific memory B-cell response in mid-adult aged men post-dose three of the quadrivalent HPV vaccine. Vaccine 2021; 39:5295-5301. [PMID: 34373120 PMCID: PMC8493556 DOI: 10.1016/j.vaccine.2021.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/28/2021] [Accepted: 07/23/2021] [Indexed: 11/09/2022]
Abstract
Strong quantitative and functional antibody responses to the quadrivalent human papillomavirus (HPV) vaccine were reported in mid-adult aged men, but there are limited data on the avidity of the antibody response and the memory B-cell response following vaccination. Although circulating antibodies induced by vaccination are believed to be the main mediators of protection against infection, evaluation of avidity of antibodies and memory B cell responses are critical for a better understanding of the vaccine immunogenicity mechanisms. Both the modified enzyme-linked immunosorbent assay (ELISA) and the enzyme-linked immunosorbent spot (ELISpot) assay are tools to measure the humoral and cellular immune responses post vaccination to characterize vaccine immunogenicity. The avidity of HPV-16 and HPV-18 specific IgG in the serum of mid-adult aged men (N = 126) who received three quadrivalent HPV vaccine doses was examined using a modified ELISA. HPV-16 memory B-cell responses were assessed via ELISpot at month 0 (prior to vaccination) and 1-month post-dose three of the vaccine (month 7). The quadrivalent vaccine induced an increase in HPV-16 and HPV-18 antibody avidity at month 7. HPV-18 avidity levels moderately correlated with anti-HPV-18 antibody titers, but no association was observed for HPV-16 antibody titers and avidity levels. The HPV-16-specific memory B-cell response was induced following three vaccine doses, however, no association with anti-HPV-16 antibody avidity was observed. Three doses of quadrivalent HPV vaccine increased antibody affinity maturation for HPV-16/18 and increased the frequency of anti-HPV-16 memory B-cells in mid-adult aged men.
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Affiliation(s)
- Cheryl N Miller
- Vaccine, Immunity, and Cancer Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | - Troy J Kemp
- Vaccine, Immunity, and Cancer Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, FL, USA
| | - Kimberly Isaacs-Soriano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, FL, USA
| | - Kim Dunham
- Vaccine, Immunity, and Cancer Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, FL, USA
| | - Yuanji Pan
- Vaccine, Immunity, and Cancer Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | | | - Jorge Salmeron
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Ligia A Pinto
- Vaccine, Immunity, and Cancer Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD, USA.
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer (CIIRC), Moffitt Cancer Center, Tampa, FL, USA
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Palefsky JM, Poongulali S, Lensing S, Lee J, Da Costa M, Chein A, Beulah F, Murugavel KG, Kumarasamy N. AIDS Malignancy Consortium 054: Safety and Immunogenicity of the Quadrivalent Vaccine in Indian Women Living With HIV. J Acquir Immune Defic Syndr 2021; 87:875-881. [PMID: 33587509 PMCID: PMC9310671 DOI: 10.1097/qai.0000000000002657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human papillomavirus (HPV)-associated cervical cancer is a leading cause of death among Indian women. Indian women living with HIV (WLWH) may be at especially high risk. The quadrivalent HPV (qHPV) vaccine is effective in prevention of initial infection with HPV-6/11/16/18 in HIV-negative women. Little is known about previous exposure to HPV-6/11/16/18, safety, and immunogenicity of qHPV in Indian WLWH. METHODOLOGY One hundred fifty WLWH with different CD4 levels and HIV viral load (VL) were vaccinated at 0/2/6 months at CART-CRS-IDMC, Chennai, India. Serology was performed at weeks 0, 28, and 52 for HPV-6/11/16/18 using a competitive Luminex immunoassay and for HPV-16/18 using a pseudovirion-based neutralization assay. RESULTS Mean age was 30.8 years (range, 19-44 years). 71/87/73/81% of women were naive (sero-negative and DNA-negative) to HPV-6/11/16/18 at baseline, respectively. Among per-protocol women naive to HPV-6/11/16/18 at baseline, 100/99/99/90%, respectively, seroconverted at week 28 and 95/96/98/71% were sero-positive at week 52, respectively. Pseudovirion-based neutralization assay identified more seroconversion to HPV-18 than competitive Luminex immunoassay. There were no significant differences in the proportion seroconverting by baseline or nadir CD4 or HIV VL; however, there was a trend for increased proportion seroconverting to HPV-18 among women with higher baseline CD4 level (P = 0.052). There were no qHPV-related serious adverse events and no change in CD4 level or HIV VL among women on ART. CONCLUSIONS qHPV vaccine was safe and immunogenic in Indian WLWH. A high proportion were naive to HPV-6/11/16/18 and may benefit from vaccination although many were married and several years post-initiation of sexual activity.
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Affiliation(s)
- Joel M Palefsky
- Department of Medicine, University of California, San Francisco, CA
| | - Selvamuthu Poongulali
- Chennai Antiviral Research and Treatment Centre Clinical Research Site, CART-CRS-Infectious Diseases Medical Centre, VHS Chennai, India
| | - Shelly Lensing
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR; and YRGCARE Infectious Diseases Laboratory
| | - Jeannette Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR; and YRGCARE Infectious Diseases Laboratory
| | - Maria Da Costa
- Department of Medicine, University of California, San Francisco, CA
| | - Aung Chein
- Department of Medicine, University of California, San Francisco, CA
| | - Faith Beulah
- Chennai Antiviral Research and Treatment Centre Clinical Research Site, CART-CRS-Infectious Diseases Medical Centre, VHS Chennai, India
| | - K G Murugavel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR; and YRGCARE Infectious Diseases Laboratory
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Centre Clinical Research Site, CART-CRS-Infectious Diseases Medical Centre, VHS Chennai, India
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20
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Palefsky JM, Lensing SY, Belzer M, Lee J, Gaur AH, Mayer K, Futterman D, Stier EA, Paul ME, Chiao EY, Reirden D, Goldstone SE, Tirado M, Cachay ER, Barroso LF, Da Costa M, Darragh TM, Rudy BJ, Wilson CM, Kahn JA. High prevalence of anal high-grade squamous intraepithelial lesions, and prevention through human papillomavirus vaccination, in young men who have sex with men living with HIV. Clin Infect Dis 2021; 73:1388-1396. [PMID: 33991185 PMCID: PMC8528397 DOI: 10.1093/cid/ciab434] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Indexed: 01/06/2023] Open
Abstract
Background Men who have sex with men (MSM) are at high risk for human papillomavirus (HPV)–related anal cancer. Little is known about the prevalence of low-grade squamous intraepithelial lesions (LSILs) and the anal cancer precursor, high-grade squamous intraepithelial lesions (HSILs), among young MSM with HIV (MSMLWH). HPV vaccination is recommended in this group, but its safety, immunogenicity, and protection against vaccine-type HPV infection and associated LSILs/HSILs have not been studied. Methods Two hundred and sixty MSMLWH aged 18–26 years were screened at 17 US sites for a clinical trial of the quadrivalent (HPV6,11,16,18) HPV (qHPV) vaccine. Those without HSILs were vaccinated at 0, 2, and 6 months. Cytology, high-resolution anoscopy with biopsies of lesions, serology, and HPV testing of the mouth/penis/scrotum/anus/perianus were performed at screening/month 0 and months 7, 12, and 24. Results Among 260 MSMLWH screened, the most common reason for exclusion was detection of HSILs in 88/260 (34%). 144 MSMLWH were enrolled. 47% of enrollees were previously exposed to HPV16. No incident qHPV type–associated anal LSILs/HSILs were detected among men naive to that type, compared with 11.1, 2.2, 4.5, and 2.8 cases/100 person-years for HPV6,11,16,18–associated LSILs/HSILs, respectively, among those previously exposed to that type. qHPV was immunogenic and safe with no vaccine-associated serious adverse events. Conclusions 18–26-year-old MSMLWH naive to qHPV vaccine types were protected against incident qHPV type–associated LSILs/HSILs. Given their high prevalence of HSILs, there is an urgent need to vaccinate young MSMLWH before exposure to vaccine HPV types, before initiating sexual activity, and to perform catch-up vaccination.
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Affiliation(s)
- Joel M Palefsky
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Shelly Y Lensing
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Marvin Belzer
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Jeannette Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aditya H Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kenneth Mayer
- Fenway Health and Harvard Medical School, Boston, MA, USA
| | | | | | - Mary E Paul
- Baylor College of Medicine, Houston, TX, USA
| | | | - Daniel Reirden
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Maribel Tirado
- Cancer Control and Population Sciences Program, University of Puerto Rico, San Juan, PR, USA
| | | | - Luis F Barroso
- Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Maria Da Costa
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Teresa M Darragh
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Bret J Rudy
- Department of Pediatrics, New York University Grossman School of Medicine New York, NY, USA
| | - Craig M Wilson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA
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21
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Meites E, Winer RL, Newcomb ME, Gorbach PM, Querec TD, Rudd J, Collins T, Lin J, Moore J, Remble T, Swanson F, Franz J, Bolan RK, Golden MR, Mustanski B, Crosby RA, Unger ER, Markowitz LE. Vaccine Effectiveness Against Prevalent Anal and Oral Human Papillomavirus Infection Among Men Who Have Sex With Men-United States, 2016-2018. J Infect Dis 2021; 222:2052-2060. [PMID: 32504091 DOI: 10.1093/infdis/jiaa306] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In the United States, human papillomavirus (HPV) vaccination has been recommended for young adult men who have sex with men (MSM) since 2011. METHODS The Vaccine Impact in Men study surveyed MSM and transgender women aged 18-26 years in 3 US cities during 2016-2018. Self-collected anal swab and oral rinse specimens were assessed for 37 types of HPV. We compared HPV prevalence among vaccinated and unvaccinated participants and determined adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). RESULTS Among 1767 participants, 704 (39.8%) self-reported receiving HPV vaccine. Median age at vaccination (18.7 years) was older than age at first sex (15.7 years). Quadrivalent vaccine-type HPV was detected in anal or oral specimens from 475 (26.9%) participants. Vaccine-type HPV prevalence was lower among vaccinated (22.9%) compared with unvaccinated (31.6%) participants; aPR for those who initiated vaccination at age ≤18 years was 0.41 (CI, 0.24-0.57) and at age >18 years was 0.82 (CI, 0.67-0.98). Vaccine effectiveness of at least 1 HPV vaccine dose at age ≤18 years or >18 years was 59% and 18%, respectively. CONCLUSIONS Findings suggest real-world effectiveness of HPV vaccination among young adult MSM. This effect was stronger with younger age at vaccination.
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Affiliation(s)
- Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, USA
| | - Troy D Querec
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Rudd
- Maximus Services LLC, CDC Contractor, Atlanta, Georgia, USA
| | - Tom Collins
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - John Lin
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Janell Moore
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, USA
| | - Thomas Remble
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Fred Swanson
- Gay City Health Project, Seattle, Washington, USA
| | - Justin Franz
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Matthew R Golden
- Center for AIDS & STD, University of Washington, Seattle, Washington, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard A Crosby
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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22
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Imburgia TM, Shew ML, Gravitt PE, Katzenellenbogen RA. Considerations for Child Cancer Survivors and Immunocompromised Children to Prevent Secondary HPV-associated Cancers. Transplantation 2021; 105:736-742. [PMID: 32890137 DOI: 10.1097/tp.0000000000003444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Survivors of childhood cancer and other immunocompromised children are at high risk for the development of secondary human papillomavirus (HPV)-associated cancers. In this overview, the authors examine the epidemiology of vaccine efficacy, the natural history of HPV infections, and accelerated HPV-associated cancer development in these populations. The authors highlight the opportunities for preventive care and future research directives.
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Affiliation(s)
- Teresa M Imburgia
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
- Epidemiology Department, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Marcia L Shew
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Patti E Gravitt
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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23
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Diana G, Corica C. Human Papilloma Virus vaccine and prevention of head and neck cancer, what is the current evidence? Oral Oncol 2021; 115:105168. [PMID: 33730628 DOI: 10.1016/j.oraloncology.2020.105168] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/12/2020] [Accepted: 12/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Human Papilloma Virus is associated with the development of cancers in the head and neck region. We have witnessed, in the last decades, an increase in number of cases directly related to HPV infection, in particular in the Western Countries. Recently the FDA expanded the indications for Gardasil-9® to include the prevention of head and neck cancer. Objective of this paper is to review the evidence supporting its use. MATERIALS AND METHODS Bibliographic review enquiring Medline, Web of Science and the Cochrane Library to assess the efficacy of vaccination against oncogenic HPV in the prevention of head and neck squamous cell carcinoma. RESULTS Two prospective and 4 retrospective studies have evaluated vaccination in prevention of head and neck cancer, using persistent oral infection as surrogate of efficacy. All studies showed lower prevalence of oral infection up to 4 years following vaccination. Vaccine efficacy was estimated between 88 and 93.3%. Because of low vaccine coverage the estimated population-level effect against oral HPV16/18/6/11 infections was only 17.0%. CONCLUSIONS Antibodies concentration in the oral fluid correlate with serum level, but the threshold to ensure protection is unknown. Duration of protection has not been established. HPV vaccination can provide protection from re-infection (at different mucosal sites) in previously exposed individuals, suggesting possible use of HPV vaccine later in life. Other studies should focus on confirming causal relationship between vaccination and prevention of persistent oral infection and investigate the duration of efficacy, which is crucial in its effectiveness against HNSCC.
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Affiliation(s)
- Giovanni Diana
- Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, UK.
| | - Clementina Corica
- Universidad Europea, Passeig de l'Albereda, 7, 46010 València, Spain
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24
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Effectiveness of the Quadrivalent HPV Vaccine in Preventing Anal ≥ HSILs in a Spanish Population of HIV+ MSM Aged > 26 Years. Viruses 2021; 13:v13020144. [PMID: 33498165 PMCID: PMC7908967 DOI: 10.3390/v13020144] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/22/2022] Open
Abstract
Anal squamous cell carcinoma is the most frequent virus-related non-AIDS-defining neoplasia among HIV-infected individuals, especially MSM. The objectives of this study were to analyze the effectiveness of the quadrivalent HPV (qHPV) vaccine to prevent anal ≥ high-grade squamous intraepithelial lesions (≥HSILs), external ano-genital lesions (EAGLs), and infection by qHPV vaccine genotypes in HIV+ MSM, and to study the immunogenicity of the vaccine and risk factors for ≥ HSILs. This study is nested within a randomized, double-blind, placebo-controlled trial of the qHPV vaccine, which enrolled participants between May 2012 and May 2014, with a 48-month follow-up. A vaccine or placebo was administered at 0, 2, and 6 months, and vaccine antibody titers were evaluated at 7, 12, 24, 36, and 48 months. Data were gathered at 12, 24, 36, and 48 months on sexual habits, CD4/CD8 cell/counts, HIV viral load, and the results of cytology (Thin Prep® Pap Test), HPV PCR genotyping (Linear Array HPV Genotyping Test), and high-resolution anoscopy (Zeiss 150 fc© colposcope). The study included 129 patients (mean age of 38.8 years, 40 [31%] with a history of AIDS, 119 [92.2%] receiving ART, and 4 [3.3%] with virological failure), 66 (51.2%) in vaccine arm and 63 (48.4%) in placebo arm. The vaccine and placebo groups did not differ in ≥ HSILs (14.1 vs. 13.1%, respectively, p = 0.98) or EAGL (11.1 vs. 6.8%, p = 0.4) rates during follow-up; however, a protective effect against HPV 6 was observed during the first year of follow-up in the vaccine versus placebo group (7.5% vs. 23.4%; p = 0.047). A between-arm difference (p = 0.0001) in antibodies against qHPV vaccine genotypes was observed at 7 months (76.9% in vaccine arm vs. 30.2% in placebo arm), 12 months (68.1% vs. 26.5%), 24 months (75% vs. 32.5%), 36 months (90% vs. 24.4%), and 48 months (87.2% vs. 30%). Finally, the factor associated with the risk of anal ≥ HSIL onset during the four-year follow-up was the receipt of the last dose of the vaccine less than 6 months earlier in comparison to those vaccinated for a longer period (82.4% vs. 17.6% (OR 0.869 [95% CI, 0.825-0.917]). Vaccine and placebo arms did not significantly differ in ≥ HSIL or EAGL rates or in protection against infection by HPV genotype vaccine except for HPV6 at 12 months after the first dose. A long-lasting immune response was observed in almost all the vaccinated men. The main protective factor against ≥ HSIL was to have completed the vaccination regimen more than 6 months earlier.
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25
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Paulsen MR, Patel NR, Sulis C, Farraye FA, Bhat S. Human Papillomavirus, Herpes Zoster, and Hepatitis B Vaccinations in Immunocompromised Patients: An Update for Pharmacists. J Pharm Pract 2020; 34:943-951. [PMID: 32938309 DOI: 10.1177/0897190020958261] [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: 12/19/2022]
Abstract
PURPOSE Current evidence regarding efficacy and safety of human papillomavirus 9-valent (9vHPV), recombinant zoster (RZV), and CpG-adjuvanted recombinant hepatitis B (HepB-CpG) vaccines in adults with human immunodeficiency virus, inflammatory bowel disease, solid organ transplant, and allogeneic hematopoietic stem cell transplant is reviewed. SUMMARY Patients immunocompromised due to underlying disease or treatment are at increased risk for infections; however, insufficient understanding of various vaccines' efficacy, safety, indications, and contraindications in this population has led to suboptimal vaccination rates. The Infectious Disease Society of America (IDSA) published guidelines on vaccines in immunocompromised populations in 2013. Since then, several advances have been made including an expanded indication with 9vHPV for use in males and females 9 to 45 years old, and the introduction of new vaccines for herpes zoster (RZV) and hepatitis B (HepB-CpG). Pharmacists are instrumental to vaccination efforts and may benefit from a review of recent vaccine updates. CONCLUSION The 9vHPV can be used in men and women ages 9 to 45 years old regardless of immune status. RZV safety and efficacy in several immunocompromised populations has been demonstrated; however, manufacturers and major societies have yet to update their recommendations. HepB-CpG may be used in most immunocompromised patients yet remains under-utilized.
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Affiliation(s)
| | - Nikitha R Patel
- Department of Clinical Pharmacy, Boston Medical Center, Boston, MA, USA
| | - Carol Sulis
- Department of Infectious Disease, Boston Medical Center, Boston, MA, USA
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Shubha Bhat
- Department of Clinical Pharmacy, Boston Medical Center, Boston, MA, USA
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26
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Bhatla N, Meena J, Gupta K, Pal B, Divakar H, Bhalerao S, Peedicayil A, Srivastava S, Basu P, Purandare CN. Human papillomavirus vaccination: Good clinical practice recommendations from the Federation of Obstetric and Gynecological Societies of India. J Obstet Gynaecol Res 2020; 46:1651-1660. [PMID: 32627278 DOI: 10.1111/jog.14345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/07/2020] [Indexed: 12/24/2022]
Abstract
Human papillomavirus (HPV) vaccination offers an excellent prospect for the primary prevention of cervical cancer. The bivalent and quadrivalent vaccines are both available in India. The nonavalent vaccine is licensed but not yet available. However, there still remain controversies regarding the vaccination of older women, immunocompromised females and other special groups. To provide recommendations for HPV vaccination in India. The Federation of Obstetric and Gynecological Societies of India (FOGSI) convened an expert group on cervical cancer prevention to formulate good clinical practice recommendations (GCPR) with respect to vaccine efficacy and safety, target groups, optimal timing and dosing schedules. HPV vaccines are licensed for females aged 9-45 years in India and have been seen to be safe and effective. FOGSI recommends HPV vaccination of all girls <15 years of age as the best target group, in whom two-doses at an interval of 6 months, extendable to 18 months, are recommended. Three-doses are recommended in girls >15 years of age, immunocompromised persons and sexual assault survivors. Older women and women with abnormal screening results may be vaccinated with an understanding that vaccination does not protect against already acquired infections and screening has to continue. Single-dose vaccination results are promising. Increased awareness is required to reduce vaccine hesitancy. HPV vaccination should be the priority to achieve the elimination of cervical cancer. The introduction of affordable HPV vaccines and reduced dose schedules will improve coverage.
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Affiliation(s)
- Neerja Bhatla
- All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Meena
- All India Institute of Medical Sciences, New Delhi, India
| | - Krishnendu Gupta
- Ramakrishna Mission Seva Pratisthan and Vivekananda Institute of Medical Sciences, Kolkata, India
| | | | | | | | | | | | - Partha Basu
- Early Detection and Prevention Section(EDP)/Screening Group (SCR) International Agency for Research on Cancer, World Health Organization, Lyon, France
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Rabelo FEF, Oliveira FHD, Melo BDGD, Borges ERO, Pena NR, Ferreira RP, Prates TO, Paes JF. Anal cancer screening in a high-risk behavior group: A local picture. JOURNAL OF COLOPROCTOLOGY 2020. [DOI: 10.1016/j.jcol.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Study objectives To perform anal lesion and anal cancer screening in men living with HIV/AIDS.
Methods This is a descriptive, observational, cross-sectional study. Data were obtained from the Specialized Assistance Service (SAE) in Divinópolis, Minas Gerais. A sociodemographic, epidemiological, and sexual behavior questionnaire was applied; material was collected for cytology, high-resolution anoscopy (AAR) was performed, and an acceptability questionnaire applied.
Main results Of the 50 men living with HIV/AIDS invited to participate in this study, 6% were excluded because they were illiterate, 40% refused to participate, and 54% participated in the survey. Among these, all answered the self-administered questionnaire. However, ten (37.0%) underwent proctological examination and anal cytology. Of these, two did not respond to the acceptability questionnaire. No anal lesions were identified during AAR and no biopsy was required. A 10% change in anal cytology was found.
Conclusions Through the study it was possible to construct a flow of referrals from the SAE to the UFSJ Coloproctology outpatient clinic. Moreover, the existence of internal stigmas on the part of the participants regarding the proctological examination and the lack of information about anal cancer screening are challenges to be overcome.
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Affiliation(s)
- Fernanda Elias Ferreira Rabelo
- Universidade Federal de São João Del Rei (UFSJ), Campus Centro Oeste, Divinópolis , MG, Brazil
- Sociedade Brasileira de Coloproctologia, Brazil
| | - Fábio Henrique de Oliveira
- Universidade Federal de São João Del Rei (UFSJ), Campus Centro Oeste, Divinópolis , MG, Brazil
- Sociedade Brasileira de Coloproctologia, Brazil
| | | | | | - Nicholas Resende Pena
- Universidade Federal de São João Del Rei (UFSJ), Campus Centro Oeste, Divinópolis , MG, Brazil
| | - Rayara Pupo Ferreira
- Universidade Federal de São João Del Rei (UFSJ), Campus Centro Oeste, Divinópolis , MG, Brazil
| | - Thais Oliveira Prates
- Universidade Federal de São João Del Rei (UFSJ), Campus Centro Oeste, Divinópolis , MG, Brazil
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Incidence, Clearance, and Persistence of Anal Human Papillomavirus in Men Who Have Sex With Men Living With Human Immunodeficiency Virus: Implications for Human Papillomavirus Vaccination. Sex Transm Dis 2020; 46:229-233. [PMID: 30870323 DOI: 10.1097/olq.0000000000000958] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Men who have sex with men living with human immunodeficiency virus have a high risk of anal cancer. We estimate the likely benefit of human papillomavirus (HPV) vaccination among participants of the Anal Cancer Examination study. METHODS Anal swabs were collected for the detection and genotyping of anal HPV DNA by linear array (Roche Diagnostics) in this 2-year multicenter prospective cohort. We calculated the proportion of men, stratified by age, without detectable vaccine type-specific DNA. RESULTS Overall, 255 men, with a median age of 50 years (interquartile range, 44-56 years) contributed 488.9 person-years of follow-up. After 2 years of follow-up, 149 (58%; 95% confidence interval [CI], 52-65) had at least 1 high-risk HPV (HRHPV), and 71 (28%, 95% CI, 22-34) had HPV types 16/18 detected. Assuming that DNA-negative men would receive vaccine protection, vaccination at baseline could potentially prevent HRHPV infection in 10.2% of men (95% CI, 6.8-14.6, 26 of 255) 2 years later from incident HRHPV covered by the bivalent and quadrivalent vaccine, and 29.4% of men (95% CI, 23.9-35.4, 75/255) from incident HRHPV covered by the nonavalent vaccine. CONCLUSION Though there is high prevalence of anal HPV in men who have sex with men living with human immunodeficiency virus, there was also a high incidence of HRHPV vaccine types in the 2-year follow-up, indicating potential for prevention if these men were not previously infected with HPV vaccine types and were vaccinated at their baseline visit.
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Abstract
OBJECTIVES Approximately 8,300 new cases of anal carcinoma will be diagnosed in the United States in 2019. Anal squamous cell carcinoma (SCC) accounts for about 70% of all anal cancers. As cancer prevention and treatments have evolved over time, medical management of human immunodeficiency virus has improved, and sexual behaviors have changed, anal carcinoma incidence rates (IRs) may have also changed. METHODS The 9 oldest Surveillance, Epidemiology, and End Results registries were used to identify and determine IR of carcinoma in situ (CIS) and invasive SCC for 9757 patients below 65 years diagnosed with anal SCC/CIS from 1973 to 2014. Joinpoint regression models identified time points at which incidence trends changed. RESULTS The incidence of CIS decreased since 2010 (age-adjusted IR annual percent change [APC]: -5.65, 95% CI: -10.0 to -1.1), especially for men (APC: -8.30, 95% CI: -12.6 to -3.8). In contrast, the incidence of SCC increased since 2007 (APC: 2.59, 95% CI: 0.1-5.2). During 2010-2014, men were more likely to present with CIS (incidence rate ratio [IRR]: 3.234, 95% CI: 3.000-3.489) but less likely to present with localized (IRR: 0.827, 95% CI: 0.754-0.906), regional (IRR: 0.603, 95% CI: 0.537-0.676), and distant SCC (IRR: 0.751, 95% CI: 0.615-0.915) compared with women. CONCLUSIONS The previously observed rise in anal SCC/CIS incidence slowed in 2010, largely due to a decline in CIS rates. Patients were more likely to present with CIS than SCC at any stage. Future studies are necessary to determine if this decline in CIS precedes a decline in invasive SCC.
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Derstenfeld A, Cullingham K, Ran ZC, Litvinov IV. Review of Evidence and Recommendation for Human Papillomavirus (HPV) Vaccination of Canadian Males Over the Age of 26 Years. J Cutan Med Surg 2020; 24:285-291. [DOI: 10.1177/1203475420911635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Human papillomavirus (HPV) remains the most common sexually transmitted infection with a lifetime incidence of over 75%. Based on US data from the Centers for Disease Control and Prevention (CDC), 64% of invasive HPV-associated cancers are attributable to HPV 16 or 18 (65% for females; 63% males) and may be prevented by vaccination with either the quadrivalent or nonavalent HPV vaccine. Public HPV vaccination programs are now the norm for women aged 9-45 years and men aged 9-26 years in Canada. Yet, only recently have guidelines begun to consider vaccination of men older than 26 years of age. There now exist compelling reasons to recommend vaccination against HPV amongst males >26 years of age. Recognizing that the risks posed by HPV infection persist beyond 26 years of age, that the vaccination of men aged 26-45 years with HPV vaccine confers immunogenicity at levels demonstrably efficacious against HPV-related diseases, and that the Food and Drug Administration recently expanded the HPV vaccination to include older men, it is argued that HPV vaccination in men older than 26 years of age should be routinely recommended.
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Affiliation(s)
- Alex Derstenfeld
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Kyle Cullingham
- Department of Dermatology, Stonebridge Medical Specialists, Saskatoon, SK, Canada
- Pharmacy and Therapeutics Committee, Canadian Dermatology Association, Ottawa, ON, Canada
| | - Zhuo Cai Ran
- Pharmacy and Therapeutics Committee, Canadian Dermatology Association, Ottawa, ON, Canada
- Division of Dermatology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Ivan V. Litvinov
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Pharmacy and Therapeutics Committee, Canadian Dermatology Association, Ottawa, ON, Canada
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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31
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Nailescu C, Nelson RD, Verghese PS, Twombley KE, Chishti AS, Mills M, Mahan JD, Slaven JE, Shew ML. Human Papillomavirus Vaccination in Male and Female Adolescents Before and After Kidney Transplantation: A Pediatric Nephrology Research Consortium Study. Front Pediatr 2020; 8:46. [PMID: 32154194 PMCID: PMC7045870 DOI: 10.3389/fped.2020.00046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/28/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Kidney transplant (KT) recipients have higher incidence of malignancies, including Human Papillomavirus (HPV)-associated cancers. Thus, HPV vaccines may have an important role in preventing HPV-related disease in this population; however, immunogenicity and safety data are lacking. Objective: To examine the immunological response and tolerability to HPV vaccination in pediatric KT recipients compared to future KT candidates. Methods: The quadrivalent HPV vaccine was administered to girls and boys age 9-18 recruited from seven centers part of the Pediatric Nephrology Research Consortium. Subjects were recruited for three groups: (1) CKD: chronic kidney disease stages 3, 4, and 5 not on dialysis; (2) Dialysis; (3) KT recipients. The outcome consisted of antibody concentrations against HPV 6, 11, 16, and 18. Geometric mean titers (GMTs) and seroconversion rates were compared. Vaccine tolerability was assessed. Results: Sixty-five participants were recruited: 18 in the CKD, 18 in the dialysis, and 29 into the KT groups. KT patients had significantly lower GMTs after vaccination for all serotypes. The percentages of subjects who reached seroconversion were overall lower for the KT group, reaching statistical significance for HPV 6, 11, and 18. Comparing immunosuppressed subjects (anyone taking immunosuppression medications, whether KT recipient or not) with the non-immunosuppressed participants, the former had significantly lower GMTs for all the HPV serotypes and lower seroconversion rates for HPV 6, 11, and 18. KT females had higher GMTs and seroconversion rates for certain serotypes. There were no adverse events in either group. Conclusions: HPV vaccine was well-tolerated in this population. Pediatric KT recipients had in general lower GMTs and seroconversion rates compared to their peers with CKD or on dialysis. Immunosuppression played a role in the lack of seroconversion. Our results emphasize the importance of advocating for HPV vaccination prior to KT and acknowledge its safety post transplantation. Future studies are needed to investigate the effect of a supplemental dose of HPV vaccine in KT recipients who do not seroconvert and to evaluate the long-term persistence of antibodies post-KT.
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Affiliation(s)
- Corina Nailescu
- Department of Pediatrics, Indiana University, Riley Hospital for Children, Indianapolis, IN, United States
| | - Raoul D Nelson
- Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, UT, United States
| | - Priya S Verghese
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States
| | - Katherine E Twombley
- Department of Pediatrics, Medical University of South Carolina Children's Hospital, Charleston, SC, United States
| | - Aftab S Chishti
- Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States
| | - Michele Mills
- Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - James E Slaven
- Department of Biostatistics, Indiana University, Indianapolis, IN, United States
| | - Marcia L Shew
- Department of Pediatrics, Indiana University, Riley Hospital for Children, Indianapolis, IN, United States
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Sadlier C, Lynam A, Kerr C, Sheils O, Bergin C. Anal cancer in people living with HIV: A case series. Int J STD AIDS 2019; 31:82-84. [PMID: 31842694 DOI: 10.1177/0956462419878039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Human papillomavirus (HPV) causes almost 5% of all cancers worldwide including cervical cancer, oropharyngeal cancers, vulval cancer, penile cancer and anal cancer. HPV-associated anal squamous cell carcinoma is a rare occurrence in the general population; however, the incidence is increasing. Certain groups including people living with HIV are disproportionately affected. In this case series, we report baseline demographics, clinical characteristics and outcome of anal cancer cases presenting in people living with HIV over a ten-year period (2006–2015).
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Affiliation(s)
- Corinna Sadlier
- Cork University Hospital, Wilton Road, Cork, Ireland.,Trinity College Dublin, Dublin, Ireland
| | - Almida Lynam
- Department of Genitourinary Medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland
| | - Colm Kerr
- Department of Genitourinary Medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland
| | - Orla Sheils
- Trinity College Dublin, Dublin, Ireland.,Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Colm Bergin
- Trinity College Dublin, Dublin, Ireland.,Department of Genitourinary Medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland
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Allen-Leigh B, Rivera-Rivera L, Yunes-Díaz E, Portillo-Romero AJ, Brown B, León-Maldonado L, Vargas-Guadarrama G, Salmerón J, Lazcano-Ponce EC. Uptake of the HPV vaccine among people with and without HIV, cisgender and transgender women and men who have sex with men and with women at two sexual health clinics in Mexico City. Hum Vaccin Immunother 2019; 16:981-990. [PMID: 31657665 DOI: 10.1080/21645515.2019.1675456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Our aim was to better understand Human Papillomavirus (HPV) vaccine acceptance among Mexican adults including people with and without HIV, cisgender men who have sex with men (MSM) or with women (MSW), cisgender and transgender women. A computer-assisted, self-administered questionnaire was completed by healthcare users and participants recruited through community organizations, and the first dose of the quadrivalent HPV vaccine was offered at no cost at a large sexual health clinic in Mexico City, from May to December 2018. Socio-demographic characteristics and factors associated with HPV vaccine acceptance were analyzed using logistic regression.The sample of 1915 participants included 1341 cisgender men (70.9%, 1247 MSM and 94 MSW), 396 (20.7%) cisgender women and 178 (9.3%) transwomen; 615 people (32.1%) were HIV positive. Uptake of the HPV vaccine was higher in men and transwomen (91.5% and 87%, respectively) than among cisgender women (81.8%; p < .001). Cisgender women (OR 0.43, 95%CI 0.30-0.61, p < .05) were less likely to accept HPV vaccination than men. Married/partnered people were less likely to accept HPV vaccination compared to those who were single (OR 0.70, 95%CI 0.51-0.97). People living with HIV were not significantly more likely to accept HPV vaccination (OR 1.7; 95%CI 0.86-1.61).HPV vaccine acceptance was high among adult Mexican study participants; it may be higher than among other Mexican adults given most of these individuals are engaged in care. Modifications will be needed in national and international recommendations on HPV vaccination in adults if healthcare personnel are to recommend the vaccine to the population groups studied.
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Affiliation(s)
- Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Leonor Rivera-Rivera
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Elsa Yunes-Díaz
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Brandon Brown
- School of Medicine, University of California at Riverside, Riverside, California, USA
| | - Leith León-Maldonado
- Cátedra CONACYT-Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico.,Academic Unit in Epidemiological Research. Center for Research in Policies, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Galileo Vargas-Guadarrama
- Center for the Prevention and Comprehensive Care of HIV/AIDS in Mexico City, Condesa Clinic, Mexico City, Mexico
| | - Jorge Salmerón
- Academic Unit in Epidemiological Research. Center for Research in Policies, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Wilkin TJ, Chen H, Cespedes MS, Leon-Cruz JT, Godfrey C, Chiao EY, Bastow B, Webster-Cyriaque J, Feng Q, Dragavon J, Coombs RW, Presti RM, Saah A, Cranston RD. A Randomized, Placebo-Controlled Trial of the Quadrivalent Human Papillomavirus Vaccine in Human Immunodeficiency Virus-Infected Adults Aged 27 Years or Older: AIDS Clinical Trials Group Protocol A5298. Clin Infect Dis 2019; 67:1339-1346. [PMID: 29659751 DOI: 10.1093/cid/ciy274] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/03/2018] [Indexed: 11/14/2022] Open
Abstract
Background Adults living with human immunodeficiency virus (HIV) are at increased risk for anal and oropharyngeal cancer caused by human papillomavirus (HPV). The efficacy of HPV vaccines in this population is unknown. Methods In this phase 3, double-blind, randomized, controlled trial, we assigned HIV-infected adults aged ≥27 years to the quadrivalent HPV (types 6, 11, 16, 18) vaccine or placebo (1:1) stratified by sex and presence of anal high-grade squamous intraepithelial lesions on biopsy (bHSIL). The primary endpoint was vaccine efficacy against incident persistent anal infection with quadrivalent vaccine types or single detection at the final visit that were not present at baseline. Secondary endpoints included vaccine efficacy for anal bHSIL after week 52, persistent oral HPV infection. Results A total of 575 participants were randomized. The Data and Safety Monitoring Board stopped the study early due to futility. Vaccine efficacy was 22% (95.1% confidence interval [CI], -31%, 53%) for prevention of persistent anal infection or single detection at the final visit, 0% (95% CI -44%, 31%) for improving bHSIL outcomes and 88% (95.1% CI 2%, 98%) for preventing persistent oral HPV infection, but was 32% (95.1% CI -80%, 74%) for 6-month persistent oral HPV infection or single detection at the final visit. Conclusions These results do not support HPV vaccination of HIV-infected adults aged ≥27 years to prevent new anal HPV infections or to improve anal HSIL outcomes. However, our data suggest a role for prevention of oral HPV infections, but this finding should be confirmed in future studies. Clinical Trials Registration NCT01461096.
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Affiliation(s)
- Timothy J Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Huichao Chen
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michelle S Cespedes
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jorge T Leon-Cruz
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Catherine Godfrey
- Division of AIDS, National Institutes of Allergy and Infectious Diseases, Rockville, Maryland
| | | | - Barbara Bastow
- Social & Scientific Systems, Inc., Silver Spring, Maryland
| | | | - Qinghua Feng
- Department of Pathology, University of Washington, Seattle
| | - Joan Dragavon
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Robert W Coombs
- Department of Laboratory Medicine, University of Washington, Seattle.,Department of Medicine, University of Washington, Seattle
| | - Rachel M Presti
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | | | - Ross D Cranston
- Department of Medicine, University of Pittsburgh, Pennsylvania
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Portnoy A, Campos NG, Sy S, Burger EA, Cohen J, Regan C, Kim JJ. Impact and Cost-Effectiveness of Human Papillomavirus Vaccination Campaigns. Cancer Epidemiol Biomarkers Prev 2019; 29:22-30. [DOI: 10.1158/1055-9965.epi-19-0767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/13/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022] Open
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Zhan Y, Liu X, Feng Y, Wu S, Jiang Y. Safety and efficacy of human papillomavirus vaccination for people living with HIV: A systematic review and meta-analysis. Int J STD AIDS 2019; 30:1105-1115. [PMID: 31551002 DOI: 10.1177/0956462419852224] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The current evidence regarding the safety and immunogenicity of human papillomavirus (HPV) vaccinations for people living with HIV (PLWH) is unclear. We searched PubMed, Embase, Cochrane Library and Web of Science databases from inception to 23 November 2018. The pooled proportion, relative risk (RR) and the standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated. Twenty-four studies consisting of 7507 participants were identified. The pooled proportion of adverse events in HIV-infected vaccinees was 60% and the antibody seroconversion rates in HPV-6, -11, -16, -18 subtypes were all above 90%. When compared with the placebo groups, the risk of adverse events was not different except for the injection site reactions (RR: 2.63, 95% CI: 1.72–4.01, p < 0.001), and the level of CD4 was relatively lower (SMD: −0.17, 95% CI: −0.29 to −0.04, p = 0.01) in the HIV-positive vaccinees groups. When compared with HIV-negative vaccinees, the risk of adverse events was not different, but the pooled RR and SMD indicated that antibody seroconversion and geometric mean titer for HPV-18 in HIV-positive groups was lower (RR: 0.91, 95% CI: 0.87–0.95, p < 0.001; SMD: −0.43, 95% CI: −0.62 to −0.24, p < 0.001). The study proves that HPV vaccine is safe and efficacious for PLWH and has important implications for international guidelines and strategies for HPV vaccination.
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Affiliation(s)
- Yongle Zhan
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Xuan Liu
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yahui Feng
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Sansan Wu
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yu Jiang
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
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Mavundza EJ, Wiyeh AB, Mahasha PW, Halle-Ekane G, Wiysonge CS. A systematic review of immunogenicity, clinical efficacy and safety of human papillomavirus vaccines in people living with the human immunodeficiency virus. Hum Vaccin Immunother 2019; 16:426-435. [PMID: 31448991 PMCID: PMC7062428 DOI: 10.1080/21645515.2019.1656481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/26/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023] Open
Abstract
The human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide. People living with the human immunodeficiency virus (HIV) are at high risk of HPV infection. This systematic review evaluates the immunogenicity, clinical efficacy, and safety of prophylactic HPV vaccines in people living with HIV. We registered the protocol for this review in the International Prospective Register of Systematic Reviews (CRD42018109898) and prepared the review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Five randomized trials with 1042 participants are included in this review. One trial with 120 participants compared the bivalent HPV vaccine to placebo, three trials with 830 participants compared the quadrivalent vaccine to placebo, and another trial with 92 participants compared the quadrivalent to the bivalent vaccine. There was low to moderate certainty evidence suggesting that seroconversion was higher among participants in the vaccine arms compared to the placebo arms for both vaccines. In one study with very low certainty evidence, participants who received the bivalent vaccine had higher anti-HPV-18 geometric mean titers (GMTs) compared to those who received the quadrivalent vaccine, despite little difference in anti-HPV-16 GMTs between the two vaccines. There were no differences in the incident and persistent HPV infections in both groups. None of the studies reported data on the incidence of precancerous lesions, or cancer. There were no reports of serious adverse events following vaccination in any of the trials. None of the included studies assessed the effects of HPV vaccines in adolescents living with HIV. Very limited evidence suggests lower immunogenicity of HPV vaccines in HIV positive compared to HIV-negative people. Finally, the long-term effect of the HPV vaccine in the incidence of cervical precancerous lesions and cervical cancer needs to be monitored. There is an urgent need for more high-quality randomized controlled trials that can address these gaps.
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Affiliation(s)
- Edison J. Mavundza
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Alison B. Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Phetole W. Mahasha
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | | | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Kojic EM, Conley L, Bush T, Cu-Uvin S, Unger ER, Henry K, Hammer J, Escota G, Darragh TM, Palefsky JM, Brooks JT, Patel P. Prevalence and Incidence of Anal and Cervical High-Risk Human Papillomavirus (HPV) Types Covered by Current HPV Vaccines Among HIV-Infected Women in the SUN Study. J Infect Dis 2019; 217:1544-1552. [PMID: 29452366 DOI: 10.1093/infdis/jiy087] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/13/2018] [Indexed: 12/20/2022] Open
Abstract
Background Nonavalent (9v) human papilloma virus vaccine targets high-risk human papillomavirus (HR-HPV) types 16, 18, 31, 33, 45, 52, 58, and low-risk 6, 11. We examined prevalence, incidence, and clearance of anal and cervical HR-HPV in HIV-infected women. Methods The SUN Study enrolled 167 US women in 2004-2006. Anal and cervical specimens were collected annually for cytology and identification of 37 HPV types: 14 HR included: 9v 16, 18, 31, 33, 45, 52, 58; non-9v 35, 39, 51, 56, 59, 66, 68. Results Baseline characteristics of 126 women included: median age 38 years; 57% non-Hispanic black; 67% HIV RNA < 400 copies/mL; 90% CD4 counts ≥200 cells/mm3. HPV prevalence at anus and cervix was 90% and 83%; for 9v HR-HPV types, 67% and 51%; non-9v HR-HPV, 54% and 29%, respectively. The 9v and non-9v HR-HPV incidence rates/100 person-years were similar (10.4 vs 9.5; 8.5 vs 8.3, respectively); 9v clearance rates were 42% and 61%; non-9v 46% and 59%, in anus and cervix, respectively. Conclusions Anal HR-HPV prevalence was higher than cervical, with lower clearance; incidence was similar. Although prevalence of non-9v HR-HPV was substantial, 9v HR-HPV types were generally more prevalent. These findings support use of nonavalent vaccine in HIV-infected women.
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Affiliation(s)
- Erna Milunka Kojic
- Division of Infectious Diseases, Mount Sinai St Luke's and West Hospitals, New York
| | - Lois Conley
- Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tim Bush
- Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Keith Henry
- Hennepin County Medical Center, Minneapolis, Minnesota
| | - John Hammer
- Denver Infectious Disease Consultants, Rose Medical Center, Colorado
| | - Gerome Escota
- Washington University School of Medicine, St Louis, Missouri
| | | | | | - John T Brooks
- Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pragna Patel
- Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sociodemographic Predictors of Anal Cancer Screening and Follow-up in Human Immunodeficiency Virus-Infected Individuals. Cancer Nurs 2019; 41:424-430. [PMID: 28723723 DOI: 10.1097/ncc.0000000000000524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Anal cancer in the United States is generally rare; however, human immunodeficiency virus (HIV)-infected individuals are 28 times more likely to be given a diagnosis of anal cancer than the general population. OBJECTIVE The aim of this study was to examine the rates and sociodemographic predictors of anal cancer screening and follow-up anoscopy in a sample of HIV-infected individuals. METHODS Data for this study (n = 200) were derived from a retrospective chart review of randomly selected HIV-infected individuals. Data analyses included Pearson's correlation coefficient statistic to examine bivariate associations and logistic regression modeling for prediction of anal Papanicolaou test screening and follow-up anoscopy. RESULTS Screening rates and follow-up after an abnormal anal Pap test were low. Women were less likely to be screened for anal cancer (odds ratio [OR], 0.244; P = .007). Men who have sex with men were almost 4 times more likely to be screened for anal cancer (OR, 3.7; P = .02). Men who have sex with men were 6 times more likely to have follow-up after an abnormal anal Pap test compared with heterosexual men or women of any sexual orientation (OR, 6.88; P = .002). CONCLUSIONS High-risk groups for anal cancer should be targeted for preventative measures as part of a cancer prevention plan to decrease the personal and clinical burden associated with anal cancer. IMPLICATIONS FOR PRACTICE Cancer prevention is a multistep process that requires screening and follow-up efforts, where healthcare providers play a vital role in these efforts. Findings from this study can inform strategies to improve screening and follow-up rates in HIV-infected individuals.
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40
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Binda GA, Gagliardi G, Dal Conte I, Verra M, Cassoni P, Cavazzoni E, Stocco E, Delmonte S, De Nardi P, Sticchi L, Mistrangelo M. Practice parameters for the diagnosis and treatment of anal intraepithelial neoplasia (AIN) on behalf of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 2019; 23:513-528. [PMID: 31243606 DOI: 10.1007/s10151-019-02019-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022]
Abstract
Squamous cell carcinoma (SCC) of the anus is a human papilloma virus (HPV) related malignancy that is preceded by anal intraepithelial neoplasia (AIN) making this cancer, at least theoretically, a preventable disease. In the past 10 years the diagnosis, management and nomenclature of AIN has dramatically changed. Increased life expectancy in human immunodeficiency virus (HIV) positive patients due to highly active antiretroviral therapy (HAART) has caused an increase in the incidence of SCC of the anus. While many experts recommend screening and treatment of anal high-grade squamous intraepithelial lesion (HSIL), there is no consensus on the optimal management these lesions. Therefore, there is a need to review the current evidence on diagnosis and treatment of AIN and formulate recommendations to guide management. Surgeons who are members of the Italian Society of Colorectal Surgery (SICCR) with a recognized interest in AIN were invited to contribute on various topics after a comprehensive literature search. Levels of evidence were classified using the Oxford Centre for Evidence-based Medicine of 2009 and the strength of recommendation was graded according to the United States (US) preventive services task force. These recommendations are among the few entirely dedicated only to the precursors of SCC of the anus and provide an evidence-based summary of the current knowledge about the management of AIN that will serve as a reference for clinicians involved in the treatment of patients at risk for anal cancer.
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Affiliation(s)
- G A Binda
- Coloproctological Surgery, Biomedical Institute, Via Prà 1/b, 16157, Genoa, Italy.
| | - G Gagliardi
- Department of Surgery, University of Illinois at Chicago, Chicago, USA
| | - I Dal Conte
- Sexually Transmitted Infection Clinic, ASL Città di Torino, Turin, Italy
| | - M Verra
- Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - P Cassoni
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - E Cavazzoni
- Department of Surgery, University of Perugia School of Medicine, Perugia, Italy
| | - E Stocco
- Department of Surgery, ASS-5 Friuli Venezia Giulia, 33078, San Vito al Tagliamento, Italy
| | - S Delmonte
- Medical Science Department, Dermatologic Clinic, University of Turin, Turin, Italy
| | - P De Nardi
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - L Sticchi
- Hygiene Unit, Department of Health Sciences (DISSAL), IRCCS Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - M Mistrangelo
- Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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41
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Chin-Hong PV, Reid GE. Human papillomavirus infection in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13590. [PMID: 31077438 DOI: 10.1111/ctr.13590] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
These guidelines from the American Society of Transplantation Infectious Diseases Community of Practice update the epidemiology and management of human papillomavirus (HPV) infections in organ transplant recipients. HPV is one of the most common sexually transmitted infections and is associated with cancers of the anogenital region. Increasing evidence suggests an association with head and neck cancers as well. Solid organ transplant recipients have a higher risk of HPV infection than the general population. Infection manifests as premalignant lesions, warts, or cancer of the cervix, penis, vulva, scrotum, and anal canal. Most are asymptomatic initially, so diagnosis can be difficult without screening. A vaccine is available though not effective in preventing all cancer-causing strains. Organ transplant recipients should be screened for HPV-associated cancers and appropriate therapy initiated in a timely manner. Further studies are warranted to delineate the most effective screening methods and therapeutic modalities, including whether changes in immunosuppression are effective in attenuating disease.
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Affiliation(s)
- Peter V Chin-Hong
- Division of Infectious Diseases, University of California at San Francisco, San Francisco, California
| | - Gail E Reid
- Division of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois
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Schim van der Loeff MF, Vorsters A, Marra E, Van Damme P, Hogewoning A. Should female sex workers be offered HPV vaccination? Hum Vaccin Immunother 2019; 15:1544-1548. [PMID: 31063078 PMCID: PMC6746505 DOI: 10.1080/21645515.2019.1602432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/12/2019] [Accepted: 03/28/2019] [Indexed: 12/29/2022] Open
Abstract
Prophylactic vaccines are efficacious in preventing Human Papillomavirus (HPV) infection and subsequent cervical intraepithelial neoplasia (CIN), cervical cancer, other anogenital cancers, and anogenital warts. Female sex workers (SW) are at increased risk of acquiring sexually transmitted infections, including HPV. There are several reasons to offer HPV vaccination to SW: they are at high risk for HPV and often unvaccinated, and the immunogenicity of the vaccine is also excellent in previously HPV exposed women. Furthermore, women with disease caused by HPV may still benefit from vaccination. The efficacy of vaccinating mid-adult women (26-44 years old) against persistent HPV infection and CIN2+ is good. Although an SW may have been infected or exposed to HPV, she may not have been exposed to all vaccine-included hrHPV types. Vaccination induces mucosal immunity via the production of neutralizing antibodies on the surface of the female genital tract, thus preventing potential transmission to clients. Nevertheless, some considerations argue against offering vaccination to SWs. Current vaccines are only prophylactic and as such, do not affect current HPV infections. Women who have previously cleared HPV infections, may do so again and thus not need vaccination. Fewer SW might be naïve to HPV-types than currently thought. HPV vaccination has probably no effect on latent infections. Vaccinating sometime after sexual debut could be too late, as infections have already occurred. Taken together, some data suggest that vaccination of SW may offer health benefits, also for the community, but sufficient evidence is lacking. In certain cases, HPV vaccination of SW may be recommended. Evidence-based, public health decisions concerning vaccination of SW are challenging and could be facilitated with more research in this high-risk group.
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Affiliation(s)
- Maarten F. Schim van der Loeff
- Department of Infectious Disease, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerpen, Antwerp, Belgium
| | - Elske Marra
- Department of Infectious Disease, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute, University of Antwerpen, Antwerp, Belgium
| | - Arjan Hogewoning
- Department of Infectious Disease, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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43
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Pinto LA, Wilkin TJ, Kemp TJ, Abrahamsen M, Isaacs-Soriano K, Pan Y, Webster-Cyriaque J, Palefsky JM, Giuliano AR. Oral and systemic HPV antibody kinetics post-vaccination among HIV-positive and HIV-negative men. Vaccine 2019; 37:2502-2510. [PMID: 30940485 PMCID: PMC6863043 DOI: 10.1016/j.vaccine.2019.03.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 12/21/2022]
Abstract
Duration and functional aspects of the oral and systemic antibody responses following HPV vaccination in HIV-negative (HIV-) and HIV-positive (HIV+) men are not well characterized. Oral and systemic HPV-16 and HPV-18-specific antibody levels were evaluated over 18-months of follow-up, in HIV+ and HIV- men. Sera and oral gargles from 147 HIV- men, ages 27-45 and 75 HIV+ men, ages 22-61, who received 3-doses of quadrivalent HPV vaccine were tested for HPV-16 and HPV-18 antibodies at Day 1, Month 7 (1 month post-dose 3), and Month 18 (12 months post-dose 3) and HPV avidity (Day 1, and Month 7) using L1-VLP ELISA. All individuals seroconverted, regardless of HIV-status, following 3-doses of vaccine for HPV-16 and HPV-18. Serum HPV-16 and HPV-18 antibody geometric mean levels were >2-fold lower in HIV+ compared to HIV- men at Month 7 (HPV-16: 808.5 versus 2119.8 EU/mL, and HPV-18: 285.8 versus 611.6 EU/mL, p < 0.001) but not significantly different at Month 18 (HPV-16: 281.8 versus 359.7 EU/mL, p = 0.145, and HPV-18: 120.2 versus 93.4 EU/mL, p = 0.372). Post-vaccination, only oral HPV-16 antibody levels at Month 7 were significantly different between HIV+ and HIV- men (127.7 versus 177.1 EU/mg of IgG, p = 0.008). Among baseline HPV-seronegative men, circulating levels of HPV-16 and HPV-18 antibodies were up to >3 fold lower in HIV+ men, at Months 7 and 18. In contrast, levels of HPV-16 and HPV-18 antibodies after vaccination were not inferior in baseline HPV-seropositive, HIV+ men. HPV-16 and HPV-18 avidity was lower among HIV+ compared to HIV- men at Month 7 (HPV-16: 1.95 M versus 2.12 M, p = 0.027; HPV-18: 1.50 M versus 1.72 M, p < 0.001). Although differences in peak antibody levels were observed between HIV+ and HIV- men following 3 doses of vaccine, plateau antibody levels were overall comparable, and avidity was relatively high for both groups. These data indicate that the vaccine induced antibody affinity maturation in both HIV+ and HIV- men and will likely result in long-term protective immune responses.
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MESH Headings
- Adult
- Alphapapillomavirus/immunology
- Antibodies, Neutralizing/blood
- Antibodies, Viral/blood
- Antibody Affinity
- HIV Infections/complications
- HIV Infections/epidemiology
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/administration & dosage
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/immunology
- Human papillomavirus 16/immunology
- Human papillomavirus 18/immunology
- Humans
- Kinetics
- Male
- Middle Aged
- Mouth/immunology
- Papillomavirus Infections/immunology
- Papillomavirus Infections/prevention & control
- Vaccination
- Young Adult
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Affiliation(s)
- Ligia A Pinto
- HPV Immunology and HPV Serology Laboratories, Frederick National Laboratory for Cancer Research, Frederick, MD, United States.
| | - Timothy J Wilkin
- Weill Cornell Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, United States
| | - Troy J Kemp
- HPV Immunology and HPV Serology Laboratories, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Kimberly Isaacs-Soriano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Yuanji Pan
- HPV Immunology and HPV Serology Laboratories, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | | | | | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
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Stankiewicz Karita HC, Hauge K, Magaret A, Mao C, Schouten J, Grieco V, Xi LF, Galloway DA, Madeleine MM, Wald A. Effect of Human Papillomavirus Vaccine to Interrupt Recurrence of Vulvar and Anal Neoplasia (VIVA): A Trial Protocol. JAMA Netw Open 2019; 2:e190819. [PMID: 30977845 PMCID: PMC6481452 DOI: 10.1001/jamanetworkopen.2019.0819] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Human papillomavirus (HPV), particularly HPV type 16, causes most anal and vulvar high-grade squamous intraepithelial lesions (HSIL), which are precursors to cancer. After initial treatment of HSIL, more than 30% of patients will have disease recurrence, with even higher recurrence among HIV-positive individuals and men who have sex with men. Recurrences can be debilitating and lead to significant morbidity and medical expense. Observational studies suggest a possible therapeutic benefit of the licensed HPV vaccines in reducing recurrent lesions in previously infected persons. OBJECTIVE To test whether the licensed prophylactic HPV vaccine (Gardasil-9) can reduce the risk of HSIL recurrence by 50% in previously unvaccinated individuals recently treated for anal or vulvar HSIL. DESIGN, SETTING, AND PARTICIPANTS This is a trial protocol for a randomized, double-blind, placebo-controlled, proof-of-concept clinical trial. Eligible participants are aged 27 to 69 at study start and have not received prior HPV vaccination, have had anal or vulvar HSIL diagnosed on or after January 1, 2014, and have no evidence of HSIL recurrence at screening. Persons infected with HIV are eligible for the study provided they are receiving antiretroviral therapy. Target enrollment is 345 individuals. The primary outcome is time to histopathologically confirmed recurrence of HSIL. Differences in the risk for recurrence of HSIL will be evaluated using Cox proportional hazard models. Additional analyses include (1) frequency of HSIL recurrence; (2) role of HPV antibodies in deterring recurrence; (3) role of HPV persistence in recurrence, as measured by HPV genotype or HPV-16 variant lineage determined using swab samples collected at months 0, 18, and 36; and (4) incidence of adverse events. The study will be conducted at the University of Washington Virology Research Clinic from 2017 through 2022. Participants will be followed up for up to 36 months in the clinic, and up to 42 months by telephone. DISCUSSION Management of persistent or rapidly recurring anogenital HSIL remains challenging. Results from this study will provide evidence on whether incorporating the nonavalent HPV vaccine into routine care can decrease recurrence of anal and vulvar HSIL. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03051516.
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Affiliation(s)
| | - Kirsten Hauge
- Department of Medicine, University of Washington, Seattle
| | - Amalia Magaret
- Department of Biostatistics, University of Washington, Seattle
- Division of Vaccine and Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Constance Mao
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Jeffrey Schouten
- Department of Medicine, University of Washington, Seattle
- Division of Vaccine and Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Surgery, University of Washington, Seattle
| | - Verena Grieco
- Department of Pathology, University of Washington, Seattle
| | - Long Fu Xi
- Department of Epidemiology, University of Washington, Seattle
| | - Denise A Galloway
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Margaret M Madeleine
- Department of Epidemiology, University of Washington, Seattle
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anna Wald
- Department of Medicine, University of Washington, Seattle
- Division of Vaccine and Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Laboratory Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
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45
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Halkitis PN, Valera P, LoSchiavo CE, Goldstone SE, Kanztanou M, Maiolatesi AJ, Ompad DC, Greene RE, Kapadia F. Human Papillomavirus Vaccination and Infection in Young Sexual Minority Men: The P18 Cohort Study. AIDS Patient Care STDS 2019; 33:149-156. [PMID: 30932696 PMCID: PMC6459271 DOI: 10.1089/apc.2018.0276] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We examined the prevalence of infection with human papillomavirus (HPV) and HIV in a cohort of young gay, bisexual, and other men who have sex with men [sexual minority men (SMM)]. HPV vaccination uptake was assessed; HIV antibody testing was performed and genetic testing for oral and anal HPV infection was undertaken. We examined both HPV vaccination and infection in relation to key demographic and structural variables. Participants (n = 486) were on average 23 years old; 70% identified as a member of a racial/ethnic minority group, and 7% identified as transgender females. Only 18.1% of the participants indicated having received the full dosage of HPV vaccination and 45.1% were unvaccinated. Slightly over half the participants (58.6%) were infected with HPV, with 58.1% testing positive for anal infection and 8.8% for oral infection. HIV seropositivity was associated with infection to oral HPV [adjusted odds ratio (AOR) = 4.03] and vaccine-preventable HPV, whereas both neighborhood-level poverty (AOR = 1.68) and HIV infection (AOR = 31.13) were associated with anal infection to HPV (AOR = 1.68). Prevalence of HPV infection is high among unvaccinated young SMM, despite the availability and eligibility for vaccination. HPV infection adds further health burden to these populations and is particularly concerning for those who are HIV positive as HIV infection increases the risk of developing HPV-related cancers. These findings underscore a missed prevention opportunity for an at-risk and underserved population and suggest the need for active strategies to increase HPV vaccination uptake in young SMM before the onset of sexual behavior.
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Affiliation(s)
- Perry N. Halkitis
- Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Medicine, RWJ School of Medicine, Rutgers University, Newark, New Jersey
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
- School of Public Affairs and Administration, Rutgers University, Newark, New Jersey
| | - Pamela Valera
- Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Caleb E. LoSchiavo
- Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Stephen E. Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Kanztanou
- Department of Epidemiology and Preventive Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anthony J. Maiolatesi
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Danielle C. Ompad
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Epidemiology, College of Global Public Health, New York University, New York, New York
| | - Richard E. Greene
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Medicine, Langone School of Medicine, New York University, New York, New York
| | - Farzana Kapadia
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Epidemiology, College of Global Public Health, New York University, New York, New York
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El Chaer F, El Sahly HM. Vaccination in the Adult Patient Infected with HIV: A Review of Vaccine Efficacy and Immunogenicity. Am J Med 2019; 132:437-446. [PMID: 30611828 DOI: 10.1016/j.amjmed.2018.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 12/20/2022]
Abstract
Patients infected with HIV remain at increased risk of mortality and morbidity from diseases that are preventable with vaccines partly due to the persisting immunopathology that results in impaired responses to vaccination despite virologic suppression. Because data on clinical effectiveness in patients who are immunocompromised remain limited, undervaccination of individuals with HIV poses a major concern. Multiple societies have published recommendations on vaccination in individuals infected with HIV. Many of these recommendations are based on extrapolation of data from clinical trials that usually exclude patients with HIV, although there is a growing body of data from patients infected with HIV as well. In this review, we describe the available literature on vaccine response in the adult patient with HIV as measured by immunogenicity or vaccine efficacy.
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Affiliation(s)
- Firas El Chaer
- Department of Medicine, University of Maryland School of Medicine, Baltimore; University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
| | - Hana M El Sahly
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Tx.
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Abstract
Many of the therapeutic options for patients with inflammatory bowel disease (IBD) suppress the immune system, which increases the risk of certain infections in these patients. Effective vaccines exist and offer protection against a number of infectious diseases. However, data has shown that IBD patients are inadequately vaccinated and, as a result, are at risk of developing certain preventable infections. Furthermore, gastroenterologists' knowledge regarding the appropriate immunizations to administer to their IBD patients is suboptimal. Areas covered: Over the past several years, there has been a considerable amount of research contributing to our knowledge regarding vaccination of patients with IBD. Expert opinion: This updated review article focuses on the current immunization schedule for the IBD patient and stresses the important role of the gastroenterologist as an active participant in the health maintenance of their IBD patients.
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Affiliation(s)
- Samantha Zullow
- a Department of Medicine, Division of Gastroenterology and Hepatology , New York University School of Medicine , New York , NY , USA
| | - Francis A Farraye
- b Department of Medicine, Section of Gastroenterology , Boston University School of Medicine , Boston , MA , USA
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48
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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: 26] [Impact Index Per Article: 5.2] [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.
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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
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49
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Abstract
The prevalence of anal human papillomavirus (HPV) infection and anal high-grade squamous intraepithelial lesion (HSIL) remain high among HIV-infected individuals on effective antiretroviral therapy (ART). The incidence of HPV-related anal cancers has continued to increase since the introduction of ART. Therefore, ART may confer only limited benefit with respect to reducing the risk of anal HSIL and cancer. Efforts are in progress to define the efficacy of secondary prevention programs for prevention of anal cancer. In the modern ART era, anal cancer recurrence and survival outcomes are similar in HIV-infected and HIV-uninfected patients, but HIV-infected patients may experience more toxicities. This article reviews the current literature on HPV-associated anal cancer in the HIV-infected population, including epidemiology, screening, clinical characteristics, and treatment outcomes.
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Affiliation(s)
- Chia-Ching J Wang
- Division of Hematology/Oncology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
- , 995 Potrero Avenue, Building 80, 4th Floor, San Francisco, CA, 94110, USA
| | - Joel M Palefsky
- Division of Infectious Diseases, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA.
- , 513 Parnassus Ave, Med Sci Room 420E, Box 0654, San Francisco, CA, 94143, USA.
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50
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Abstract
Since their discovery as the etiologic agents of cervical cancer in the mid-1970s, human papillomaviruses (HPVs) have been linked with a growing number of epithelial-derived tumors, including head and neck squamous cell carcinomas. HPV demonstrates a particular predilection for causing tumors of the oropharynx, with the majority of cases involving infection with high-oncogenic risk HPV-16. People living with HIV are at increased risk of infection with HPV- and HPV-related oral complications even with adequate control of their HIV infection with antiretroviral therapy. In this chapter, we discuss the molecular mechanisms that underlie HPV-mediated oncogenesis in the oropharynx. We also describe the progress that has been made in understanding the epidemiology of oral HPV infection and the determinants of oral HPV-related pathology. Finally, we examine what can be done to treat and prevent oral HPV infection, benign lesions, and cancer, particularly in the context of the HIV-positive patient.
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