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Systematic review of the use of human papillomavirus vaccine as adjuvant therapy for juvenile-onset recurrent respiratory papillomatosis. Int J Pediatr Otorhinolaryngol 2022; 162:111314. [PMID: 36116179 DOI: 10.1016/j.ijporl.2022.111314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Juvenile-onset RRP (JoRRP) is considered a rare disease with high morbidity and healthcare costs. The management of RRP has received much scientific attention in recent years and several treatment methodologies have been explored, including therapeutic use of HPV vaccine. There has been increasing interest in the off-label use of the vaccine in virus-induced disease processes such as RRP, due to its immunomodulatory effect and activating role on the innate and adaptive immune system. This review explores the efficacy of the HPV vaccination as a therapeutic tool in the pediatric population. METHODS The review of the English literature included three electronic databases, PubMed, SCOPUS, and Cochrane, without publication date restrictions. Studies and reports identified by the database search were reviewed and assessed by two independent reviewers. RESULTS The literature searches identified 768 unique citations, from which 204 duplicates were removed (n = 564). A total of 547 articles were excluded as they did not meet our inclusion criteria. A total of 12 studies (3 experimental studies, 3 case series, 6 case reports) that met the inclusion criteria and reported one or more of the outcomes of interest were included for our review. The assessment of the outcome measures evaluated (number of surgeries during the follow-up period, ISI, SPM, Derkay or severity scores, and remission status) revealed that eight out of 12 studies included in the review showed varying degrees of potential benefits from the administration of the vaccine as a treatment modality compared to surgical interventions and/or concurrent adjuvant therapies alone. CONCLUSION We conclude that while the therapeutic use of HPV vaccination has shown promise for some JoRRP patients, it overall remains uncertain with the currently available data. There is a need for a prospective multi-centric trial with a larger sample size to fully characterize the potential use of the vaccine in the management of JoRRP.
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Rebolj M, Mathews CS, Pesola F, Cuschieri K, Denton K, Kitchener H. Age-specific outcomes from the first round of HPV screening in unvaccinated women: Observational study from the English cervical screening pilot. BJOG 2022; 129:1278-1288. [PMID: 34913243 DOI: 10.1111/1471-0528.17058] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report detailed age-specific outcomes from the first round of an English pilot studying the implementation of high-risk human papillomavirus (HR-HPV) testing in primary cervical screening. DESIGN Observational study with screening in 2013-2016, followed by two early recalls and/or colposcopy until the end of 2019. SETTING Six NHS laboratory sites. POPULATION A total of 1 341 584 women undergoing screening with HR-HPV testing or liquid-based cytology (LBC). METHODS Early recall tests and colposcopies were recommended, depending on the nature of the screening-detected abnormality. MAIN OUTCOME MEASURES We reported standard screening process indicators, e.g. proportions with an abnormality, including high-grade cervical intraepithelial neoplasia (CIN2+) or cancer, and the positive predictive value (PPV) of colposcopy for CIN2+, by screening test and age group. RESULTS Among unvaccinated women screened with HR-HPV testing at age 24-29 years, 26.9% had a positive test and 10.4% were directly referred to colposcopy following cytology triage, with a PPV for CIN2+ of 47%. At 50-64 years of age, these proportions were much lower: 5.3%, 1.2% and 27%, respectively. The proportions of women testing positive for HR-HPV without cytological abnormalities, whose early recall HR-HPV tests returned negative results, were similar across the age spans: 54% at 24-29 years and 55% at 50-64 years. Two-thirds of infections at any age were linked to non-16/18 genotypes. Among women with CIN2, CIN3 or cervical cancer, however, the proportion of non-16/18 infections increased with age. As expected, the detection of abnormalities was lower following screening with LBC. CONCLUSIONS These data provide a reliable reference for future epidemiological studies, including those concerning the effectiveness of HPV vaccination. TWEETABLE ABSTRACT Data from the English pilot study provide a comprehensive overview of abnormalities detected through HPV screening.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Christopher S Mathews
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Francesca Pesola
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian Scotland, Edinburgh, UK
| | - Karin Denton
- Severn Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Henry Kitchener
- Division of Cancer Sciences, University of Manchester, Manchester, UK
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Soheili M, Keyvani H, Soheili M, Nasseri S. Human papilloma virus: A review study of epidemiology, carcinogenesis, diagnostic methods, and treatment of all HPV-related cancers. Med J Islam Repub Iran 2021; 35:65. [PMID: 34277502 PMCID: PMC8278030 DOI: 10.47176/mjiri.35.65] [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: 10/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Human papillomavirus (HPV) infection is considered as the most common viral sexually transmitted infection worldwide. This poses an increasingly interdisciplinary medical challenge. Since there is vast scattered information in databases about HPV and the correlated diseases, we decided to collect useful data so that the experts can get a more comprehensive view of HPV. Methods: In this article, HPV-associated diseases, prevalence, prevention, and new treatments are discussed. The retrieved articles reporting the latest data about the required information for our review were selected through searching in Web of Science, Scopus, Medline (PubMed), EMBASE, Cochrane Library, Ovid, and CINHAL with language limitations of English and German. Results: There are 2 groups of HPVs: (1) low-risk HPV types that can lead to genital warts, and (2) high-risk HPV types that are involved in HPV-associated oncogenesis. About 70% of all sexually active women are infected and most of these infections heal within many weeks or months. In the case of HPV-persistence, a risk of preneoplasia or carcinoma exists. These types of viruses are responsible for the existence of genitoanal, gastrointestinal, urinary tract, and head and neck tumors. There is still no definite successful treatment. The detection of HPV-related condylomata occurs macroscopically in women and men, and the diagnosis of the precursors of cervical carcinoma in women is possible by Pap smear. Conclusion: For extragenital manifestations, there is no structured early detection program. Meanwhile, studies on HPV vaccines confirm that they should be used for the primary prevention of HPV-dependent diseases. However, we need more research to find out the real advantages and disadvantages of vaccines.
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Affiliation(s)
- Maryam Soheili
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Hossein Keyvani
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Soheili
- Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Human Revivification Society of Congress 60, Tehran, Iran
| | - Sherko Nasseri
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Molecular Medicine and Medical Genetics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Sauter SL, Zhang X, Romick-Rosendale L, Wells SI, Myers KC, Brusadelli MG, Poff CB, Brown DR, Panicker G, Unger ER, Mehta PA, Bleesing J, Davies SM, Butsch Kovacic M. Human Papillomavirus Oral- and Sero- Positivity in Fanconi Anemia. Cancers (Basel) 2021; 13:cancers13061368. [PMID: 33803570 PMCID: PMC8003090 DOI: 10.3390/cancers13061368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary People with Fanconi anemia (FA) are genetically susceptible to gynecological cancers and cancers of the head and neck. There are known associations between oral infection with human papillomavirus (HPV) and development of head and neck cancers. This study sought to measure how common oral HPV positivity is in a large sample of people with FA followed over 8 years, while also evaluating serum titers to ascertain natural exposure to HPV, and how well people with FA who were vaccinated responded to HPV vaccination. We found that oral HPV positivity is significantly higher in individuals with FA compared to family and unrelated controls, but that response to HPV vaccination between FA and controls is similar. Common risk factors associated with HPV in the general population did not predict oral DNA positivity in FA, unlike unrelated controls. Future mechanistic and vaccinations studies are needed to understand this phenomenon. Abstract High-risk human papillomavirus (HPV) is prevalent and known to cause 5% of all cancers worldwide. The rare, cancer prone Fanconi anemia (FA) population is characterized by a predisposition to both head and neck squamous cell carcinomas and gynecological cancers, but the role of HPV in these cancers remains unclear. Prompted by a patient-family advocacy organization, oral HPV and HPV serological studies were simultaneously undertaken. Oral DNA samples from 201 individuals with FA, 303 unaffected family members, and 107 unrelated controls were tested for 37 HPV types. Serum samples from 115 individuals with FA and 55 unrelated controls were tested for antibodies against 9 HPV types. Oral HPV prevalence was higher for individuals with FA (20%) versus their parents (13%; p = 0.07), siblings (8%, p = 0.01), and unrelated controls (6%, p ≤ 0.001). A FA diagnosis increased HPV positivity 4.84-fold (95% CI: 1.96–11.93) in adjusted models compared to unrelated controls. Common risk factors associated with HPV in the general population did not predict oral positivity in FA, unlike unrelated controls. Seropositivity and anti-HPV titers did not significantly differ in FA versus unrelated controls regardless of HPV vaccination status. We conclude that individuals with FA are uniquely susceptible to oral HPV independent of conventional risk factors.
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Affiliation(s)
- Sharon L. Sauter
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Xue Zhang
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Lindsey Romick-Rosendale
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Susanne I. Wells
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Kasiani C. Myers
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Marion G. Brusadelli
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Charles B. Poff
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Darron R. Brown
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Gitika Panicker
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (G.P.); (E.R.U.)
| | - Elizabeth R. Unger
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (G.P.); (E.R.U.)
| | - Parinda A. Mehta
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Jack Bleesing
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Stella M. Davies
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
| | - Melinda Butsch Kovacic
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (S.L.S.); (X.Z.); (L.R.-R.); (S.I.W.); (K.C.M.); (M.G.B.); (C.B.P.); (P.A.M.); (J.B.); (S.M.D.)
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, OH 45267, USA
- Correspondence:
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HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010-2019. Prev Med 2021; 144:106399. [PMID: 33388322 DOI: 10.1016/j.ypmed.2020.106399] [Citation(s) in RCA: 323] [Impact Index Per Article: 107.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022]
Abstract
WHO/UNICEF estimates for HPV vaccination coverage from 2010 to 2019 are analyzed against the backdrop of the 90% coverage target for HPV vaccination by 2030 set in the recently approved global strategy for cervical cancer elimination as a public health problem. As of June 2020, 107 (55%) of the 194 WHO Member States have introduced HPV vaccination. The Americas and Europe are by far the WHO regions with the most introductions, 85% and 77% of their countries having already introduced respectively. A record number of introductions was observed in 2019, most of which in low- and middle- income countries (LMIC) where access has been limited. Programs had an average performance coverage of around 67% for the first dose and 53% for the final dose of HPV. LMICs performed on average better than high- income countries for the first dose, but worse for the last dose due to higher dropout. Only 5 (6%) countries achieved coverages with the final dose of more than 90%, 22 countries (21%) achieved coverages of 75% or higher while 35 (40%) had a final dose coverage of 50% or less. When expressed as world population coverage (i.e., weighted by population size), global coverage of the final HPV dose for 2019 is estimated at 15%. There is a long way to go to meet the 2030 elimination target of 90%. In the post-COVID era attention should be paid to maintain the pace of introductions, specially ensuring the most populous countries introduce, and further improving program performance globally.
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Bucchi L, Mancini S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Falcini F, Giorgi Rossi P, Campari C, Canuti D, Di Felice E, de Bianchi PS, Ferretti S. Changes in the incidence of cervical tumours by disease stage in a cytology-based screening programme. J Med Screen 2019; 27:96-104. [PMID: 31690178 DOI: 10.1177/0969141319885989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report changes in incidence of cervical tumours by disease stage, following the introduction of an organized cytology-based screening programme. METHODS An intention-to-screen study of a cytology-based screening programme targeting 1,219,000 women aged 25-64 in northern Italy was carried out. Based on the previously reported trend in total incidence of cervical cancer, the study period 1995-2014 was divided into 1995-1996 (pre-screening, or reference, years), 1997-1998 (screening implementation phase), 1999-2006 (transition phase, when incidence decreased), and 2007-2014 (steady-state phase, when incidence stabilized again). Tumour stage was categorized as preinvasive (cervical intraepithelial neoplasia grade 3 (CIN3) and adenocarcinoma in situ), early (pT1a), advanced (pT1b or greater, ypT), and unknown (pT1 not otherwise specified, pTx, missing information). Average annual incidence rates observed in each phase were compared with the expected (reference) rates, using the incidence rate ratio, calculated with a Poisson regression model. RESULTS In the steady-state phase, incidence rate ratios were: CIN3, 1.55 (95% confidence interval, 1.41-1.70); early-stage squamous carcinoma, 0.49 (0.36-0.67); advanced-stage squamous carcinoma, 0.44 (0.33-0.57); unknown-stage squamous carcinoma, 0.69 (0.48-0.99); adenocarcinoma in situ, 1.44 (0.72-2.88); early-stage adenocarcinoma, 2.65 (0.82-8.53); advanced-stage adenocarcinoma, 1.03 (0.56-1.91); and unknown-stage adenocarcinoma, 0.46 (0.23-0.92). CONCLUSIONS After stabilization, changes in incidence by tumour stage included a 55% increase for CIN3 and a 50-55% decrease both for early- and advanced-stage squamous carcinoma, but no significant changes for glandular tumours. These data will serve to quantify the incremental impact of the implementation of human papillomavirus-based screening, introduced in 2015.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Forlì, Italy
- Local Health Authority, Forlì, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Campari
- Cancer Screening Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Enza Di Felice
- Department of Health, Emilia-Romagna Region, Bologna, Italy
| | | | - Stefano Ferretti
- University of Ferrara and Local Health Authority, Ferrara, Italy
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Mukanyangezi MF, Rugwizangoga B, Manzi O, Rulisa S, Hellstrand K, Tobin G, Martner A, Bienvenu E, Giglio D. Persistence rate of cervical human papillomavirus infections and abnormal cytology in Rwanda. HIV Med 2019; 20:485-495. [PMID: 31318136 DOI: 10.1111/hiv.12782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES In this study, we determined the incidence and persistence of human papillomavirus (HPV) strains and of squamous intraepithelial lesions (SIL) or worse cytology in 237 HIV-positive and HIV-negative Rwandan women and whether the interleukin (IL)-28B single nucleotide polymorphism (SNP) at rs12979860 correlated with susceptibility to and persistence of HPV infection. METHODS Cervical samples were collected at baseline and after 9, 18 and 24 months for a 40-HPV DNA screening test and a ThinPrep Pap test. Genotyping of the IL-28B SNP rs12979860 was performed using real-time polymerase chain reaction (PCR). RESULTS Chronic high-risk (HR) HPV infections occurred in 56% of HIV-positive women, while no HIV-negative women developed HPV chronicity. High-grade SIL (HSIL) or cancer was diagnosed in 38% of HIV-positive women with persistent HR-HPV infections. HIV and HR-HPV positivity at baseline were factors associated with an increased risk of HPV persistence. Additionally, HR-HPV positivity at baseline was associated with an increased risk of developing HSIL or worse cytology. The unfavourable T/x genotype at rs12979860 is common among Africans, and women with this genotype were found to be more commonly infected with HPV. CONCLUSIONS HPV screening in Rwanda may help to identify women at risk of developing cervical cancer and polymorphism in IL-28B may be associated with risk of contracting HPV infection.
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Affiliation(s)
- M F Mukanyangezi
- Department of Pharmacology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - B Rugwizangoga
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Tumour Immunology (TIMM) Laboratory, Sahlgrenska Cancer Center, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - O Manzi
- University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - S Rulisa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - K Hellstrand
- Tumour Immunology (TIMM) Laboratory, Sahlgrenska Cancer Center, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - G Tobin
- Department of Pharmacology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - A Martner
- Tumour Immunology (TIMM) Laboratory, Sahlgrenska Cancer Center, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - E Bienvenu
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - D Giglio
- Department of Pharmacology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Arroyo-Mühr LS, Lagheden C, Hultin E, Eklund C, Adami HO, Dillner J, Sundström K. The HPV16 Genome Is Stable in Women Who Progress to In Situ or Invasive Cervical Cancer: A Prospective Population-Based Study. Cancer Res 2019; 79:4532-4538. [PMID: 31289133 DOI: 10.1158/0008-5472.can-18-3933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/27/2019] [Accepted: 06/25/2019] [Indexed: 11/16/2022]
Abstract
The human papillomavirus (HPV) rate of evolution is essential for cancer-preventive strategies targeting HPV. We analyzed variability over time in a prospective, population-based nested case-control study of in situ (CIS) and invasive squamous cervical cancer (SCC). Among 757,690 women who participated in cervical screening in Sweden during 1969 to 2002, we identified 94 women who had HPV16 persistence in two serial cervical screening samples (median 24 months apart, range 0.5-178 months) and later were diagnosed with CIS (n = 59), SCC (n = 32), or remained healthy (n = 3). Whole-HPV16-genome sequencing and comparison of sequences in the serial samples revealed that all women had the same HPV16 lineage, particularly lineage A, in both serial smears. Fifty-six percent of women had an identical 7,906 base pair HPV16 sequence in both samples, and no woman had more than 15 nucleotide substitutions. The median substitution rate was 0 substitutions/site/year (95% confidence interval, 0-0.00008), with no variation between quartiles of follow-up. We concluded that in most women with HPV16 persistence preceding disease, the nucleotide substitution rate was not measurable within up to 15-years follow-up. This slow rate of evolution has important implications for both HPV-based screening and HPV vaccination. SIGNIFICANCE: These findings show there is no genomic variation over time in HPV16 infections progressing to cervical cancer, which could influence risk stratification of women when screening for cervical cancer and inform HPV vaccination strategies.
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Affiliation(s)
| | - Camilla Lagheden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Hultin
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carina Eklund
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Cervical Cancer Prevention, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. .,Center for Cervical Cancer Prevention, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
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Human papillomaviruses 16 and 58 are distributed widely among women living in Shanghai, China, with high-grade, squamous intraepithelial lesions. Epidemiol Infect 2018; 147:e42. [PMID: 30421694 PMCID: PMC6518836 DOI: 10.1017/s0950268818003011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The distribution of human papillomaviruses (HPVs) must be understood for the control and prevention of cervical cancer. Community-based Papanicolaou and HPV DNA tests were performed on 41 578 women. The prevalences of HPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68 were assessed. In total, 10% women were infected/co-infected by these HPVs. The infection rate increased from 7.1% in women aged ⩽30 years to 10.4% in those aged 50–60 years, and then decreased slightly to 9.9% in those aged >60 years. The HPV 16 and 58 positivity rates were significantly higher among women with high-grade squamous intraepithelial lesions (HSILs) than among those with cervicitis/negativity for intraepithelial lesion or malignancy (NILM) or low-grade SILs (LSILs). The HPV 18, 52 and 68 infection rates were significantly lower in women with HSILs than in those with NILM or LSILs. The proportion of women infected by multiple HPV strains was higher among those with HSILs. The proportions of the five most common genotypes, HPV 16, 18, 33, 52 and 58, increased with the number of co-infecting strains. HPV 16 and 58 were the high-risk HPVs in the Shanghai community and should be the focus in HPV screening and vaccination.
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Malagón T, Laurie C, Franco EL. Human papillomavirus vaccination and the role of herd effects in future cancer control planning: a review. Expert Rev Vaccines 2018; 17:395-409. [PMID: 29715059 DOI: 10.1080/14760584.2018.1471986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Vaccine herd effects are the indirect protection that vaccinated persons provide to those who remain susceptible to infection, due to the reduced transmission of infections. Herd effects have been an important part of the discourse on how to best implement human papillomavirus (HPV) vaccines and prevent HPV-related diseases. AREAS COVERED In this paper, we review the theory of HPV vaccine herd effects derived from mathematical models, give an account of observed HPV vaccine herd effects worldwide, and examine the implications of vaccine herd effects for future cervical cancer screening efforts. EXPERT COMMENTARY HPV vaccine herd effects improve the cost-effectiveness of vaccinating preadolescent girls, but contribute to making gender-neutral vaccination less economically efficient. Vaccination coverage and sexual mixing patterns by age are strong determinants of herd effects. Many countries worldwide are starting to observe reductions in HPV-related outcomes likely attributable to herd effects, most notably declining anogenital warts in young men, and declining HPV-16/18 infection prevalence in young unvaccinated women. Policy makers making recommendations for cervical cancer screening will have to consider HPV vaccination coverage and herd effects, as these will affect the positive predictive value of screening and the risk of cervical cancer in unvaccinated women.
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Affiliation(s)
- Talía Malagón
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Cassandra Laurie
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Eduardo L Franco
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
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Arbyn M, Xu L, Simoens C, Martin‐Hirsch PPL. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev 2018; 5:CD009069. [PMID: 29740819 PMCID: PMC6494566 DOI: 10.1002/14651858.cd009069.pub3] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Persistent infection with high-risk human papillomaviruses (hrHPV) types is causally linked with the development of cervical precancer and cancer. HPV types 16 and 18 cause approximately 70% of cervical cancers worldwide. OBJECTIVES To evaluate the harms and protection of prophylactic human papillomaviruses (HPV) vaccines against cervical precancer and HPV16/18 infection in adolescent girls and women. SEARCH METHODS We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase (June 2017) for reports on effects from trials. We searched trial registries and company results' registers to identify unpublished data for mortality and serious adverse events. SELECTION CRITERIA Randomised controlled trials comparing efficacy and safety in females offered HPV vaccines with placebo (vaccine adjuvants or another control vaccine). DATA COLLECTION AND ANALYSIS We used Cochrane methodology and GRADE to rate the certainty of evidence for protection against cervical precancer (cervical intraepithelial neoplasia grade 2 and above [CIN2+], CIN grade 3 and above [CIN3+], and adenocarcinoma-in-situ [AIS]), and for harms. We distinguished between the effects of vaccines by participants' baseline HPV DNA status. The outcomes were precancer associated with vaccine HPV types and precancer irrespective of HPV type. Results are presented as risks in control and vaccination groups and risk ratios (RR) with 95% confidence intervals in brackets. MAIN RESULTS We included 26 trials (73,428 participants). Ten trials, with follow-up of 1.3 to 8 years, addressed protection against CIN/AIS. Vaccine safety was evaluated over a period of 6 months to 7 years in 23 studies. Studies were not large enough or of sufficient duration to evaluate cervical cancer outcomes. All but one of the trials was funded by the vaccine manufacturers. We judged most included trials to be at low risk of bias. Studies involved monovalent (N = 1), bivalent (N = 18), and quadrivalent vaccines (N = 7). Most women were under 26 years of age. Three trials recruited women aged 25 and over. We summarize the effects of vaccines in participants who had at least one immunisation.Efficacy endpoints by initial HPV DNA statushrHPV negativeHPV vaccines reduce CIN2+, CIN3+, AIS associated with HPV16/18 compared with placebo in adolescent girls and women aged 15 to 26. There is high-certainty evidence that vaccines lower CIN2+ from 164 to 2/10,000 (RR 0.01 (0 to 0.05)) and CIN3+ from 70 to 0/10,000 (RR 0.01 (0.00 to 0.10). There is moderate-certainty evidence that vaccines reduce the risk of AIS from 9 to 0/10,000 (RR 0.10 (0.01 to 0.82).HPV vaccines reduce the risk of any CIN2+ from 287 to 106/10,000 (RR 0.37 (0.25 to 0.55), high certainty) and probably reduce any AIS lesions from 10 to 0/10,000 (RR 0.1 (0.01 to 0.76), moderate certainty). The size of reduction in CIN3+ with vaccines differed between bivalent and quadrivalent vaccines (bivalent: RR 0.08 (0.03 to 0.23), high certainty; quadrivalent: RR 0.54 (0.36 to 0.82), moderate certainty). Data in older women were not available for this comparison.HPV16/18 negativeIn those aged 15 to 26 years, vaccines reduce CIN2+ associated with HPV16/18 from 113 to 6 /10,000 (RR 0.05 (0.03 to 0.10). In women 24 years or older the absolute and relative reduction in the risk of these lesions is smaller (from 45 to 14/10,000, (RR 0.30 (0.11 to 0.81), moderate certainty). HPV vaccines reduce the risk of CIN3+ and AIS associated with HPV16/18 in younger women (RR 0.05 (0.02 to 0.14), high certainty and RR 0.09 (0.01 to 0.72), moderate certainty, respectively). No trials in older women have measured these outcomes.Vaccines reduce any CIN2+ from 231 to 95/10,000, (RR 0.41 (0.32 to 0.52)) in younger women. No data are reported for more severe lesions.Regardless of HPV DNA statusIn younger women HPV vaccines reduce the risk of CIN2+ associated with HPV16/18 from 341 to 157/10,000 (RR 0.46 (0.37 to 0.57), high certainty). Similar reductions in risk were observed for CIN3+ associated with HPV16/18 (high certainty). The number of women with AIS associated with HPV16/18 is reduced from 14 to 5/10,000 with HPV vaccines (high certainty).HPV vaccines reduce any CIN2+ from 559 to 391/10,000 (RR 0.70 (0.58 to 0.85, high certainty) and any AIS from 17 to 5/10,000 (RR 0.32 (0.15 to 0.67), high certainty). The reduction in any CIN3+ differed by vaccine type (bivalent vaccine: RR 0.55 (0.43 to 0.71) and quadrivalent vaccine: RR 0.81 (0.69 to 0.96)).In women vaccinated at 24 to 45 years of age, there is moderate-certainty evidence that the risks of CIN2+ associated with HPV16/18 and any CIN2+ are similar between vaccinated and unvaccinated women (RR 0.74 (0.52 to 1.05) and RR 1.04 (0.83 to 1.30) respectively). No data are reported in this age group for CIN3+ or AIS.Adverse effectsThe risk of serious adverse events is similar between control and HPV vaccines in women of all ages (669 versus 656/10,000, RR 0.98 (0.92 to 1.05), high certainty). Mortality was 11/10,000 in control groups compared with 14/10,000 (9 to 22) with HPV vaccine (RR 1.29 [0.85 to 1.98]; low certainty). The number of deaths was low overall but there is a higher number of deaths in older women. No pattern in the cause or timing of death has been established.Pregnancy outcomesAmong those who became pregnant during the studies, we did not find an increased risk of miscarriage (1618 versus 1424/10,000, RR 0.88 (0.68 to 1.14), high certainty) or termination (931 versus 838/10,000 RR 0.90 (0.80 to 1.02), high certainty). The effects on congenital abnormalities and stillbirths are uncertain (RR 1.22 (0.88 to 1.69), moderate certainty and (RR 1.12 (0.68 to 1.83), moderate certainty, respectively). AUTHORS' CONCLUSIONS There is high-certainty evidence that HPV vaccines protect against cervical precancer in adolescent girls and young women aged 15 to 26. The effect is higher for lesions associated with HPV16/18 than for lesions irrespective of HPV type. The effect is greater in those who are negative for hrHPV or HPV16/18 DNA at enrolment than those unselected for HPV DNA status. There is moderate-certainty evidence that HPV vaccines reduce CIN2+ in older women who are HPV16/18 negative, but not when they are unselected by HPV DNA status.We did not find an increased risk of serious adverse effects. Although the number of deaths is low overall, there were more deaths among women older than 25 years who received the vaccine. The deaths reported in the studies have been judged not to be related to the vaccine. Increased risk of adverse pregnancy outcomes after HPV vaccination cannot be excluded, although the risk of miscarriage and termination are similar between trial arms. Long-term of follow-up is needed to monitor the impact on cervical cancer, occurrence of rare harms and pregnancy outcomes.
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Affiliation(s)
- Marc Arbyn
- SciensanoUnit of Cancer Epidemiology, Belgian Cancer CentreJuliette Wytsmanstreet 14BrusselsBelgiumB‐1050
| | - Lan Xu
- SciensanoUnit of Cancer Epidemiology, Belgian Cancer CentreJuliette Wytsmanstreet 14BrusselsBelgiumB‐1050
| | - Cindy Simoens
- University of AntwerpLaboratory of Cell Biology and HistologyGroenenborgerlaan 171AntwerpBelgiumB‐2020
| | - Pierre PL Martin‐Hirsch
- Royal Preston Hospital, Lancashire Teaching Hospital NHS TrustGynaecological Oncology UnitSharoe Green LaneFullwoodPrestonLancashireUKPR2 9HT
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Gray P, Palmroth J, Luostarinen T, Apter D, Dubin G, Garnett G, Eriksson T, Natunen K, Merikukka M, Pimenoff V, Söderlund-Strand A, Vänskä S, Paavonen J, Pukkala E, Dillner J, Lehtinen M. Evaluation of HPV type-replacement in unvaccinated and vaccinated adolescent females-Post-hoc
analysis of a community-randomized clinical trial (II). Int J Cancer 2018; 142:2491-2500. [DOI: 10.1002/ijc.31281] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Penelope Gray
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Johanna Palmroth
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Tapio Luostarinen
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
| | | | - Gary Dubin
- Takeda Pharmaceuticals International; Switzerland
| | | | - Tiina Eriksson
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Kari Natunen
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Marko Merikukka
- Department of Vaccines; Institute for Health and Welfare; Laskut Finland
| | - Ville Pimenoff
- Faculty of Social Sciences; University of Tampere; Tampere Finland
- Catalan Institute of Oncology, IDIBELL; Barcelona Spain
| | | | - Simopekka Vänskä
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
- Department of Vaccines; Institute for Health and Welfare; Laskut Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynaecology; University of Helsinki; Helsinki Finland
| | - Eero Pukkala
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Joakim Dillner
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
| | - Matti Lehtinen
- Faculty of Social Sciences; University of Tampere; Tampere Finland
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
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Rosales C, Rosales R. Prophylactic and Therapeutic Vaccines against Human Papillomavirus Infections. Vaccines (Basel) 2017. [DOI: 10.5772/intechopen.69548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Individuals with inherited immunodeficiencies, autoimmune disorders, organ or bone marrow transplantation, or infection with human immunodeficiency virus (HIV) are at increased risk of infection with both low-risk and high-risk human papillomavirus (HPV) types. Chronic immunosuppression provides an environment for persistent HPV infection which carries a higher risk of malignant transformation. Screening guidelines have been developed or advocated for processes that have detectable premalignant lesions, such as anal cancer or cervical cancer. For other anatomic locations, such as cutaneous, penile, and oropharyngeal, a biopsy of suspicious lesions is necessary for diagnosis. HPV cannot be cultured from clinical specimens in the laboratory, and diagnosis relies on cytologic, histologic, or molecular methods.
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Tota JE, Jiang M, Ramanakumar AV, Walter SD, Kaufman JS, Coutlée F, Richardson H, Burchell AN, Koushik A, Mayrand MH, Villa LL, Franco EL. Epidemiologic Evaluation of Human Papillomavirus Type Competition and the Potential for Type Replacement Post-Vaccination. PLoS One 2016; 11:e0166329. [PMID: 28005904 PMCID: PMC5178990 DOI: 10.1371/journal.pone.0166329] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/26/2016] [Indexed: 11/18/2022] Open
Abstract
Background Millions of women have been vaccinated with one of two first-generation human papillomavirus (HPV) vaccines. Both vaccines remain in use and target two oncogenic types (HPVs 16 and 18); however, if these types naturally compete with others that are not targeted, type replacement may occur following reductions in the circulating prevalence of targeted types. To explore the potential for type replacement, we evaluated natural HPV type competition in unvaccinated females. Methods Valid HPV DNA typing information was available from five epidemiological studies conducted in Canada and Brazil (n = 14,685; enrollment across studies took place between1993 and 2010), which used similar consensus-primer PCR assays, capable of detecting up to 40 HPV types. A total of 38,088 cervicovaginal specimens were available for inclusion in our analyses evaluating HPV type-type interactions involving vaccine-targeted types (6, 11, 16, and 18), and infection with each of the other HPV types. Results Across the studies, the average age of participants ranged from 21.0 to 43.7 years. HPV16 was the most common type (prevalence range: 1.0% to 13.8%), and in general HPV types were more likely to be detected as part of a multiple infection than as single infections. In our analyses focusing on each of the vaccine-targeted HPV types separately, many significant positive associations were observed (particularly involving HPV16); however, we did not observe any statistically significant negative associations. Conclusions Our findings suggest that natural HPV type competition does not exist, and that type replacement is unlikely to occur in vaccinated populations.
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Affiliation(s)
- Joseph E. Tota
- McGill University, Department of Oncology, Montreal, Québec, Canada
- McGill University, Department of Epidemiology, Biostatistics, and Occupational Health, Montreal, Québec, Canada
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, Rockville, Maryland, United States of America
- * E-mail:
| | - Mengzhu Jiang
- McGill University, Department of Oncology, Montreal, Québec, Canada
| | | | - Stephen D. Walter
- McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada
| | - Jay S. Kaufman
- McGill University, Department of Epidemiology, Biostatistics, and Occupational Health, Montreal, Québec, Canada
| | - François Coutlée
- Université de Montréal, Département de Microbiologie et Infectiologie, Montreal, Québec, Canada
- Université de Montréal Hospital Research Centre, Montreal, Québec, Canada
| | - Harriet Richardson
- Queen’s University, Department of Public Health Sciences, Kingston, Ontario, Canada
| | - Ann N. Burchell
- McGill University, Department of Oncology, Montreal, Québec, Canada
- St. Michael’s Hospital, Department of Family and Community Medicine and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Anita Koushik
- Université de Montréal Hospital Research Centre, Montreal, Québec, Canada
- Université de Montréal, Département de médecine sociale et préventive, Montreal, Québec, Canada
| | - Marie Hélène Mayrand
- Université de Montréal Hospital Research Centre, Montreal, Québec, Canada
- Université de Montréal, Département d’obstétrique-gynécologie et Médecine Sociale et Préventive, Montreal, Québec, Canada
| | - Luisa L. Villa
- Universidade de São Paulo, Department of Radiology and Oncology, School of Medicine, São Paulo, Brazil
| | - Eduardo L. Franco
- McGill University, Department of Oncology, Montreal, Québec, Canada
- McGill University, Department of Epidemiology, Biostatistics, and Occupational Health, Montreal, Québec, Canada
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Seroepidemiological Evaluation of High-Risk Human Papillomavirus Types Among Married and Unmarried Iranian Women in Tehran, Iran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2016. [DOI: 10.5812/pedinfect.37766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Angioli R, Lopez S, Aloisi A, Terranova C, De Cicco C, Scaletta G, Capriglione S, Miranda A, Luvero D, Ricciardi R, Montera R, Plotti F. Ten years of HPV vaccines: State of art and controversies. Crit Rev Oncol Hematol 2016; 102:65-72. [DOI: 10.1016/j.critrevonc.2016.03.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/16/2016] [Accepted: 03/30/2016] [Indexed: 02/02/2023] Open
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HPV Testing of Biobanked Liquid-Based Cytology – a Validation Study. Int J Biol Markers 2016; 31:e218-23. [DOI: 10.5301/jbm.5000191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/20/2022]
Abstract
Introduction The aim of the study was to investigate whether biobanked liquid-based cytology (LBC) vaginal samples could be reanalyzed for the biomarkers HPV DNA and mRNA without loss of sensitivity. Methods One hundred LBC samples with ASCUS or CIN1 were tested for HPV DNA and mRNA before and after biobanking. DNA analysis targeted the viral genes E6 and E7, 12 high-risk and 2 low-risk HPV types together with the human control gene HBB, using real-time PCR. The Aptima HPV assay was used for mRNA analysis of 14 high-risk HPV types. Results With Aptima there was 84% agreement between results before and after biobanking. The sensitivity and specificity were 0.79 (95% CI, 0.68-0.88) and 0.94 (95% CI, 0.80-0.99), respectively. With the DNA-based method, the agreement between results was 87%, the sensitivity 0.85 (95% CI, 0.75-0.92) and the specificity 0.95 (95% CI, 0.77-1.00). Both methods presented a significant difference between positive results before and after biobanking; McNemar test: p = 0.004, p = 0.003, Cohen's kappa: 0.67 (95% CI, 0.53-0.81), 0.68 (95% CI, 0.52-0.84). Cycle threshold values for the DNA method were higher for all genotypes after biobanking, except for HPV-59. Some loss of sensitivity was seen after biobanking but the concordance between HPV detection before and after biobanking was good for both evaluated methods. Conclusions Biobanking of LBC vaginal samples offers a good platform for HPV testing and could be extended to further molecular analyses. However, in order to ensure a valid test result a larger portion needs to be analyzed from the biobanked sample.
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Arbyn M, Broeck DV, Benoy I, Bogers J, Depuydt C, Praet M, Sutter PD, Hoorens A, Hauben E, Poppe W, Van Ranst M, Delvenne P, Gofflot S, Pétein M, Engelen F, Vanneste A, Beeck LOD, Damme PV, Temmerman M, Weyers S. Surveillance of effects of HPV vaccination in Belgium. Cancer Epidemiol 2016; 41:152-8. [PMID: 26895623 DOI: 10.1016/j.canep.2015.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/19/2015] [Accepted: 12/22/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Early effects of HPV (human papillomavirus) vaccination are reflected by changes observable in young women attending cervical cancer screening. SUBJECT AND METHODS The SEHIB study included HPV geno-typing of ∼6000 continuous and 650 pathological cervical cell specimen as well as biopsies, collected from women in Belgium in 2010-2014. Data were linked to vaccination status. RESULTS HPV vaccination offered protection among women aged <30years against infection with HPV16 (vaccine effectiveness [VE]=67%, 95% CI: 48-79%), HPV18 (VE=93%, 95% CI: 52-99%), and high-risk HPV (VE=16%, 95% CI: 2-29%). Vaccination protected also against cytological lesions. Vaccination protected against histologically confirmed lesions: significantly lower absolute risks of CIN1+ (risk difference [RD]=-1.6%, 95% CI: -2.6% to -0.7%) and CIN3+ associated with HPV16/18 (RD=-0.3%, 95% CI -0.6% to -0.1%). Vaccine effectiveness decreased with age. Protection against HPV16 and 18 infection was significant in all age groups, however no protection was observed against cytological lesions associated with these types in age-group 25-29. CONCLUSION The SEHIB study demonstrates the effectiveness of HPV vaccination in Belgian young women in particular in age group 18-19. Declining effectiveness with increasing age may be explained by higher tendency of women already exposed to infection to get the vaccine.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology/Belgian Cancer Centre, Scientific Institute of Public Health, J. Wytsmanstreet 14, B1050 Brussels, Belgium.
| | - Davy Vanden Broeck
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium; Algemeen Medisch Labo, Sonic Healtcare, Antwerp, Belgium; AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
| | - Ina Benoy
- Algemeen Medisch Labo, Sonic Healtcare, Antwerp, Belgium; AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
| | - Johannes Bogers
- Algemeen Medisch Labo, Sonic Healtcare, Antwerp, Belgium; AMBIOR, Laboratory for Cell Biology & Histology, University of Antwerp, Antwerp, Belgium
| | | | - Marleen Praet
- N. Goormachtigh Institute for Pathology, Ghent University, Ghent, Belgium
| | - Philippe De Sutter
- Department of Gynaecology & Oncology, UZ Brussel, Free University of Brussels, Brussels, Belgium
| | | | | | - Willy Poppe
- Department of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - Marc Van Ranst
- Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven, Belgium
| | | | | | - Michel Pétein
- Institut de Pathologie et de Génétique, Charlerloi, Belgium
| | | | | | | | - Pierre Van Damme
- Vaccine & Infectious Disease Institute (VAXINFECTIO), Antwerp University, Antwerp, Belgium
| | - Marleen Temmerman
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium; Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Department of Gynaecology and Obstetrics, Ghent University, Ghent, Belgium
| | - Steven Weyers
- Department of Gynaecology and Obstetrics, Ghent University, Ghent, Belgium
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Molecular diagnosis and phylogenetic analysis of human papillomavirus type-16 from suspected patients in Pakistan. Infect Agent Cancer 2016; 11:1. [PMID: 26766963 PMCID: PMC4711104 DOI: 10.1186/s13027-016-0047-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 01/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background Human Papillomavirus (HPV) is well known pathogen that can cause benign and malignant tumors in humans, yet there is very little information regarding HPV types prevalent in Pakistan. Methods A total of 92 cervical secretions were collected from suspected married female patients and used for DNA isolation using a novel isolation method. The samples were tested through Polymerase Chain Reaction (PCR) using already reported primers MY09/MY11, GP5/GP6, GP5+/GP6+, CP65/CP70, CP66/CP69 and SPF1/SPF2 and with those developed in this study including HRT1 and HRT2 primer sets for typing HPV types and HACTB primer set for human beta actin gene as internal positive control. Sequencing and phylogenetic analyses were performed for two isolates to determine circulating HPV types. Results PCR with HRT1 and HRT2 indicated 2 (2.17 %) patients were positive for HPV type- 16 while 1 (1.08 %) with HPV type 18. Sequencing and phylogenetic analysis of isolates confirmed HPV type-16 in genus alpha 9 which have 99 % homology with already reported HPV from Japan and Costa Rica. Conclusion This is the first report of HPV type-16 genus alpha 9 in Pakistan and the reported assay and sequence data will serve as valuable tools in further epidemiological studies for HPV surveillance to improve public health, especially of females in Pakistan.
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Molecular Detection of Human Papillomaviruses. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hortlund M, Sundström K, Lamin H, Hjerpe A, Dillner J. Laboratory audit as part of the quality assessment of a primary HPV-screening program. J Clin Virol 2015; 75:33-6. [PMID: 26748032 DOI: 10.1016/j.jcv.2015.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/02/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND As primary HPV screening programs are rolled out, methods are needed for routine quality assurance of HPV laboratory analyzes. OBJECTIVE To explore the use of similar design for audit as currently used in cytology-based screening, to estimate the clinical sensitivity to identify women at risk for CIN 3 or worse (CIN3+). STUDY DESIGN Population-based cohort study conducted within the cervical screening program in Stockholm, Sweden, in 2011-2012. All women with histopathologically confirmed CIN3+ in the following two years were identified by registry analysis. Primary HPV and cytology screening results were collected. For women who had not been HPV tested, biobanked cytology samples were HPV-tested. If the original HPV result had been negative, the sample and subsequent biopsies were analyzed with broad HPV typing (general primer PCR and Luminex). RESULTS 154 women had a biobanked prediagnostic cytology sample taken up to 2 years before a histopathologically confirmed CIN3+. The high-risk HPV-positivity was 97% (148/154 women), whereas 143/154 (94%) women had had a cytological abnormality. Among the six HPV-negative samples, one sample was HPV 33 positive in repeat testing whereas the other five cases were HPV-negative also on repeat testing, but HPV-positive in the subsequent tumor tissue. CONCLUSIONS A sensitivity of the HPV test that is higher than the sensitivity of cytology suggests adequate quality of the testing. Regular audits of clinical sensitivity, similar to those of cytology-based screening, should be used also in HPV-based screening programs, in order to continuously monitor the performance of the analyzes.
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Affiliation(s)
- Maria Hortlund
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Helena Lamin
- Department of Laboratory Medicine, Karolinska University Hospital, Sweden
| | - Anders Hjerpe
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Sweden.
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Kumar S, Biswas M, Jose T. HPV vaccine: Current status and future directions. Med J Armed Forces India 2015; 71:171-7. [PMID: 25859081 PMCID: PMC4388981 DOI: 10.1016/j.mjafi.2015.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 02/19/2015] [Indexed: 02/08/2023] Open
Abstract
HPV Vaccine was introduced to prevent cervical cancer known to be caused by infection with one or more of the high risk subtypes of the Human papilloma virus (HPV). Since introduction, trials have proven its efficacy in preventing Cervical intraepithelial neoplasia (CIN) beyond doubt and its effectiveness in preventing cervical cancer though presumptive is reasonably certain as per mathematical modelling. It also prevents other HPV related anogenital and oropharyngeal malignancies in both sexes. HPV vaccines have courted many controversies related to its efficacy, safety, ideal age of vaccination, use in HPV infected individuals and use in males. The currently available vaccines are based on L1 Viral like particles (VLP) and hence highly species specific, thermolabile, costly and are purely prophylactic. The quest for a cheaper, thermostable and broad spectrum vaccine has led to many newer prophylactic vaccines. Therapeutic vaccines were born out of the inescapable necessity considering high HPV related morbidity projected in the non HPV naïve population. Therapeutic vaccines would immediately reduce this burden and also help in the management of HPV related cancers alone or as part of combination strategies. Ongoing research is aimed at a total control over HPV related malignancies in the near future.
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Affiliation(s)
- Sushil Kumar
- Director and Commandant, Armed Forces Medical College, Pune 411040, India
| | - Manash Biswas
- Professor and Head, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune 411040, India
| | - Tony Jose
- Associate Professor, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune 411040, India
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Rosales R, Rosales C. Immune therapy for human papillomaviruses-related cancers. World J Clin Oncol 2014; 5:1002-1019. [PMID: 25493236 PMCID: PMC4259927 DOI: 10.5306/wjco.v5.i5.1002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 04/08/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Human papillomaviruses (HPVs) are a large family of double strand DNA viruses comprising more than 180 types. Infection with HPV is very common and it is associated with benign and malignant proliferation of skin and squamous mucosae. Many HPVs, considered low-risk such as HPV 6 and 11, produce warts; while high-risk viruses, such as HPVs 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, and 58, induce tumors. About 5% of all cancers in men and women are associated with HPV infection. Because there are not antiviral drugs for HPV infection, current therapies for low-risk HPV infections involve physical removal of the lesion by cryotherapy, trichloracetic acid, laser, or surgical removal. Surgical procedures are effective in the treatment of pre-cancerous lesions, however after these procedures, many recurrences appear due to new re-infections, or to failure of the procedure to eliminate the HPV. In addition, HPV can inhibit recognition of malignant cells by the immune system, leading to the development of cancer lesions. When this occurs, radiotherapy and chemotherapy are then used. Unfortunately, about 50% of the HPV-cancer patients still die. In the past decade, a better knowledge of the natural history of the virus-host interaction and of the immune response against this viral infection has brought new therapeutic strategies geared to modulate the immune system to generate an efficient virus-specific cytotoxic response. Novel HPV protein-expressing vaccines have shown some significant clinical efficacy and systemic HPV-specific cytotoxic T cell responses. This review will describe the current status of the several therapeutic strategies used to treat HPV-induced lesions, and discuss the various new therapies now being tested.
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Rosales R, López-Contreras M, Rosales C, Magallanes-Molina JR, Gonzalez-Vergara R, Arroyo-Cazarez JM, Ricardez-Arenas A, del Follo-Valencia A, Padilla-Arriaga S, Guerrero MV, Pirez MA, Arellano-Fiore C, Villarreal F. Regression of human papillomavirus intraepithelial lesions is induced by MVA E2 therapeutic vaccine. Hum Gene Ther 2014; 25:1035-49. [PMID: 25275724 PMCID: PMC4270165 DOI: 10.1089/hum.2014.024] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 09/23/2014] [Indexed: 01/07/2023] Open
Abstract
Human papilloma viruses can induce warts, condylomas, and other intraepithelial cervical lesions that can progress to cancer. Cervical cancer is a serious problem in developing countries because early detection is difficult, and thus proper early treatment is many times missing. In this phase III clinical trial, we evaluated the potential use of MVA E2 recombinant vaccinia virus to treat intraepithelial lesions associated with papillomavirus infection. A total of 1176 female and 180 male patients with intraepithelial lesions were studied. They were injected with 10(7) MVA E2 virus particles directly into their uterus, urethra, vulva, or anus. Patients were monitored by colposcopy and cytology. Immune response was determined by measuring the antibody titer against MVA E2 virus and by analyzing the cytotoxic activity against cancer cells bearing papillomavirus DNA. Papillomavirus was determined by the Hybrid Capture method or by polymerase chain reaction analysis. By histology, 1051 (89.3%) female patients showed complete elimination of lesions after treatment with MVA E2. In 28 (2.4%) female patients, the lesion was reduced to CIN 1. Another 97 (8.3%) female patients presented isolated koilocytes after treatment. In men, all lesions were completely eliminated. All MVA E2-treated patients developed antibodies against the MVA E2 vaccine and generated a specific cytotoxic response against papilloma-transformed cells. Papillomavirus DNA was not detected after treatment in 83% of total patients treated. MVA E2 did not generate any apparent side effects. These data suggest that therapeutic vaccination with MVA E2 vaccine is an excellent candidate to stimulate the immune system and generate regression in intraepithelial lesions when applied locally.
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Affiliation(s)
| | | | - Carlos Rosales
- Instituto de Investigaciones Biomédicas, CP 04510 Universidad Nacional Autónoma de México, Mexico City, Mexico
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26
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Söderlund-Strand A, Uhnoo I, Dillner J. Change in population prevalences of human papillomavirus after initiation of vaccination: the high-throughput HPV monitoring study. Cancer Epidemiol Biomarkers Prev 2014; 23:2757-64. [PMID: 25380734 DOI: 10.1158/1055-9965.epi-14-0687] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Organized human papillomavirus (HPV) vaccination was introduced in Sweden in 2012. On-demand vaccination was in effect from 2006 to 2011. We followed the HPV prevalences in Southern Sweden from 2008 to 2013. METHODS Consecutive, anonymized samples from the Chlamydia trachomatis screening were analyzed for HPV DNA for two low-risk types and 14 high-risk types using PCR with genotyping using mass spectrometry. We analyzed 44,146 samples in 2008, 5,224 in 2012, and 5,815 in 2013. RESULTS Registry-determined HPV vaccination coverages of the population in Southern Sweden increased mainly among 13- to 22-year-old women. Most analyzed samples contained genital swabs from women and the HPV6 prevalence in these samples decreased from 7.0% in 2008 to 4.2% in 2013 [-40.0%; P < 0.0005 (χ(2) test)]. HPV16 decreased from 14.9% to 8.7% (-41.6%; P < 0.0005) and HPV18 decreased from 7.9% to 4.3% (-45.6%; P < 0.0005) among 13- to 22-year-old women. There were only small changes in vaccination coverage among 23- to 40-year-old women. In this age group, HPV18 decreased marginally (-19.6%; P = 0.04) and there were no significant changes for HPV6 or HPV16. Two nonvaccine HPV types (HPV52 and HPV56) were increased among 13- to 22-year-old women, both in 2012 and 2013. CONCLUSIONS A major reduction of HPV6, 16, and 18 prevalences is seen in the age groups with a concomitant increase in HPV vaccination coverage. The minor changes seen for nonvaccine types will require further investigation. IMPACT Monitoring of type-specific HPV prevalences may detect early effects of HPV vaccination.
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Affiliation(s)
| | - Ingrid Uhnoo
- Department of Monitoring and Evaluation, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden.
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Soubeyrand B, Greenberg M, Tibayrenc M, Louis J, Dutel C, Simondon F, Saadatian-Elahi M. Vaccination: an evolutionary engine for pathogens? Conference report. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2014; 27:137-141. [PMID: 25050487 DOI: 10.1016/j.meegid.2014.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/05/2014] [Indexed: 06/03/2023]
Affiliation(s)
- B Soubeyrand
- Medical Affairs, Sanofi Pasteur MSD, 162 Avenue Jean Jaurès CS 50712, 69367 Lyon Cedex 07, France
| | - M Greenberg
- Department of Epidemiology, Sanofi Pasteur, 2 Avenue du Pont Pasteur, 69367 Lyon Cedex 07, France
| | - M Tibayrenc
- Maladies Infectieuses et Vecteurs Ecologie, Génétique, Evolution et Contrôle - MIVEGEC (IRD 224-CNRS 5290-UM1-UM2), Centre IRD, Montpellier Cedex 5, France
| | - J Louis
- Fondation Mérieux, 17 rue Bourgelat, 69002 Lyon, France
| | - C Dutel
- Fondation Mérieux, 17 rue Bourgelat, 69002 Lyon, France
| | - F Simondon
- Department of Epidemiology, Sanofi Pasteur MSD, 162 Avenue Jean Jaurès CS 50712, 69367 Lyon Cedex 07, France
| | - M Saadatian-Elahi
- Groupement Hospitalier Edouard Herriot, Service d'Hygiène, Epidémiologie et Prévention, Bâtiment 1, 5, place d'Arsonval, 69437 Lyon Cedex 03, France.
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Dochez C, Bogers JJ, Verhelst R, Rees H. HPV vaccines to prevent cervical cancer and genital warts: an update. Vaccine 2014; 32:1595-601. [DOI: 10.1016/j.vaccine.2013.10.081] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/24/2013] [Accepted: 10/24/2013] [Indexed: 12/12/2022]
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Murall CL, McCann KS, Bauch CT. Revising ecological assumptions about Human papillomavirus interactions and type replacement. J Theor Biol 2014; 350:98-109. [PMID: 24412334 DOI: 10.1016/j.jtbi.2013.12.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 12/12/2013] [Accepted: 12/29/2013] [Indexed: 12/25/2022]
Abstract
The controversy over whether vaccine-targeted HPV types will be replaced by other oncogenic, non-vaccine-targeted types remains unresolved. This is in part because little is known about the ecology of HPV types. Patient data has been interpreted to suggest independence or facilitative interactions between types and therefore replacement is believed to be unlikely. With a novel mathematical model, we investigated which HPV type interactions and their immune responses gave qualitatively similar patterns frequently observed in patients. To assess the possibility of type replacement, vaccination was added to see if non-vaccine-targeted types increased their 'niche'. Our model predicts that independence and facilitation are not necessary for the coexistence of types inside hosts, especially given the patchy nature of HPV infection. In fact, independence and facilitation inadequately represented co-infected patients. We found that some form of competition is likely in natural co-infections. Hence, non-vaccine-targeted types that are not cross-reactive with the vaccine could spread to more patches and can increase their viral load in vaccinated hosts. The degree to which this happens will depend on replication and patch colonization rates. Our results suggest that independence between types could be a fallacy, and so without conclusively untangling HPV within-host ecology, type replacement remains theoretically viable. More ecological thinking is needed in future studies.
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Affiliation(s)
- Carmen Lía Murall
- Department of Integrative Biology, University of Guelph, Canada; Department of Mathematics and Statistics, University of Guelph, Canada.
| | - Kevin S McCann
- Department of Integrative Biology, University of Guelph, Canada
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, Canada
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30
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Tota JE, Ramanakumar AV, Jiang M, Dillner J, Walter SD, Kaufman JS, Coutlée F, Villa LL, Franco EL. Epidemiologic approaches to evaluating the potential for human papillomavirus type replacement postvaccination. Am J Epidemiol 2013; 178:625-34. [PMID: 23660798 DOI: 10.1093/aje/kwt018] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Currently, 2 vaccines exist that prevent infection by the genotypes of human papillomavirus (HPV) responsible for approximately 70% of cervical cancer cases worldwide. Although vaccination is expected to reduce the prevalence of these HPV types, there is concern about the effect this could have on the distribution of other oncogenic types. According to basic ecological principles, if competition exists between ≥2 different HPV types for niche occupation during natural infection, elimination of 1 type may lead to an increase in other type(s). Here, we discuss this issue of "type replacement" and present different epidemiologic approaches for evaluation of HPV type competition. Briefly, these approaches involve: 1) calculation of the expected frequency of coinfection under independence between HPV types for comparison with observed frequency; 2) construction of hierarchical logistic regression models for each vaccine-targeted type; and 3) construction of Kaplan-Meier curves and Cox models to evaluate sequential acquisition and clearance of HPV types according to baseline HPV status. We also discuss a related issue concerning diagnostic artifacts arising when multiple HPV types are present in specific samples (due to the inability of broad-spectrum assays to detect certain types present in lower concentrations). This may result in an apparent increase in previously undetected types postvaccination.
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Affiliation(s)
- Joseph E Tota
- Division of Cancer Epidemiology, Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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31
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Eriksson T, Torvinen S, Woodhall SC, Lehtinen M, Apter D, Harjula K, Hokkanen M, Rissanen P, Paavonen J, Lehtinen M. Impact of HPV16/18 vaccination on quality of life: a pilot study. EUR J CONTRACEP REPR 2013; 18:364-71. [PMID: 23768267 DOI: 10.3109/13625187.2013.801953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Genital human papillomavirus (HPV) infections and associated precancerous lesions adversely affect health-related quality of life (HRQoL). HPV vaccines provide effective protection against these conditions. We therefore investigated the impact of HPV vaccination on HRQoL in young women five years after participation in a phase III HPV vaccination trial. METHODS A total of 4808 originally 16- to 17-year-old Finnish girls had participated in the PATRICIA trial and received either bivalent HPV 16/18 vaccine or hepatitis A-virus (HAV) vaccine in 2004 to 2005. Unvaccinated girls (n = 9602), from adjacent birth cohorts, had participated in the control cohort in 2005. From 2009 to 2011, at 22 to 23 years of age, all participants received a questionnaire consisting of two generic HRQoL instruments (RAND36 and EQ VAS) and a disease-specific questionnaire (CECA10). RESULTS We analysed responses of 1143 HPV 16/18-vaccinated, 980 HAV-vaccinated, and 3753 unvaccinated young women. The unadjusted mean outcome measures of the different HRQoL estimates were similar in the three different responder cohorts. CONCLUSIONS Five years after vaccination the health-related quality of life of HPV 16/ 18- vaccinated young women did not differ from those of HAV-vaccinated or unvaccinated controls representing the general population.
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Affiliation(s)
- Tiina Eriksson
- * School of Health Sciences, University of Tampere , Tampere , Finland
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Changes in Incidence of Anogenital Warts Diagnoses After the Introduction of Human Papillomavirus Vaccination in Germany—An Ecologic Study. Sex Transm Dis 2013; 40:28-31. [DOI: 10.1097/olq.0b013e3182756efd] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Söderlund-Strand A, Dillner J. High-Throughput Monitoring of Human Papillomavirus Type Distribution. Cancer Epidemiol Biomarkers Prev 2012; 22:242-50. [DOI: 10.1158/1055-9965.epi-12-1003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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34
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Peakman M. Broadening the translational immunology landscape. Clin Exp Immunol 2012; 170:249-53. [DOI: 10.1111/j.1365-2249.2012.04671.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SummaryIt is just over 5 years sinceClinical and Experimental Immunology came under the direction of a new team of Editors and made a concerted effort to refresh its approach to promoting clinical and applied immunology through its pages. There were two major objectives: to foster papers in a field which, at the time, we loosely termed ‘translational immunology’; and to create a forum for the presentation and discussion of immunology that is relevant to clinicians operating in this space. So, how are we doing with these endeavours? This brief paper aims to summarize some of the key learning points and successes and highlight areas in which translational gaps remain.
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Affiliation(s)
- M Peakman
- Department of Immunobiology, King's College London
- NIHR Comprehensive Biomedical Research Centre, Guy's and St Thomas’ NHS Foundation Trust and King's College London, London, UK
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35
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Poljak M. Prophylactic human papillomavirus vaccination and primary prevention of cervical cancer: issues and challenges. Clin Microbiol Infect 2012; 18 Suppl 5:64-9. [DOI: 10.1111/j.1469-0691.2012.03946.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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36
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El Emam K, Samet S, Hu J, Peyton L, Earle C, Jayaraman GC, Wong T, Kantarcioglu M, Dankar F, Essex A. A Protocol for the secure linking of registries for HPV surveillance. PLoS One 2012; 7:e39915. [PMID: 22768321 PMCID: PMC3388071 DOI: 10.1371/journal.pone.0039915] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 06/04/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In order to monitor the effectiveness of HPV vaccination in Canada the linkage of multiple data registries may be required. These registries may not always be managed by the same organization and, furthermore, privacy legislation or practices may restrict any data linkages of records that can actually be done among registries. The objective of this study was to develop a secure protocol for linking data from different registries and to allow on-going monitoring of HPV vaccine effectiveness. METHODS A secure linking protocol, using commutative hash functions and secure multi-party computation techniques was developed. This protocol allows for the exact matching of records among registries and the computation of statistics on the linked data while meeting five practical requirements to ensure patient confidentiality and privacy. The statistics considered were: odds ratio and its confidence interval, chi-square test, and relative risk and its confidence interval. Additional statistics on contingency tables, such as other measures of association, can be added using the same principles presented. The computation time performance of this protocol was evaluated. RESULTS The protocol has acceptable computation time and scales linearly with the size of the data set and the size of the contingency table. The worse case computation time for up to 100,000 patients returned by each query and a 16 cell contingency table is less than 4 hours for basic statistics, and the best case is under 3 hours. DISCUSSION A computationally practical protocol for the secure linking of data from multiple registries has been demonstrated in the context of HPV vaccine initiative impact assessment. The basic protocol can be generalized to the surveillance of other conditions, diseases, or vaccination programs.
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Affiliation(s)
- Khaled El Emam
- Electronic Health Information Laboratory, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
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