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Lepine C, Leboulanger N, Badoual C. Juvenile onset recurrent respiratory papillomatosis: What do we know in 2024 ? Tumour Virus Res 2024; 17:200281. [PMID: 38685530 PMCID: PMC11088349 DOI: 10.1016/j.tvr.2024.200281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
Juvenile onset recurrent respiratory papillomatosis is a lifelong benign squamous lesion associated with HPV infection, particularly HPV6 and HPV11 genotypes. These lesions are rare, but can lead to laryngeal obturations, which can cause disabling dyspnea, or transform into squamous cell carcinoma. The aim here is to provide an epidemiological, biological and clinical overview of this pathology, particularly in children, in order to understand the issues at stake in terms of research and the development of medical and therapeutic management tools.
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Affiliation(s)
- Charles Lepine
- Pathology Department, CHU de Nantes, F-44000 Nantes, France; Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Nicolas Leboulanger
- Otolaryngology - Head and Necker Surgery Department, Necker Enfants Malades University Hospital, 149 Rue de Sèvres 75015 Paris, France; Université Paris Cité, France
| | - Cécile Badoual
- Université Paris Cité, France; Pathology Department, European George Pompidou Hospital, APHP, 20 Rue Leblanc 75015 Paris, France.
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2
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Erickson EL, Freeman TE, Sun S, Koch B, Allen DZ, Sethia R, deSilva B, Matrka L. Recurrent respiratory papillomatosis disease course in immunosuppressed populations. J Laryngol Otol 2024; 138:576-580. [PMID: 37877153 DOI: 10.1017/s0022215123001470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Recurrent respiratory papillomatosis is a benign manifestation of human papillomavirus types 6 and 11 in the respiratory tract. Disease is recurrent, and factors predicting these recurrences and severity of disease are incompletely characterised. This retrospective cohort study examined the relationship of immunosuppression with recurrent respiratory papillomatosis morbidity. METHODS A retrospective cohort of 97 adult patients with recurrent respiratory papillomatosis treated at a tertiary referral centre from 2005 to 2020 was conducted. Measures assessed included inter-surgical interval, Voice Handicap Index ('VHI-10') and anatomical Derkay scores. RESULTS Bivariate analyses comparing average inter-surgical interval, Voice Handicap Index and Derkay scores in immunosuppressed and healthy patients were insignificant. When controlling for diabetes mellitus and comparing immunosuppressed to healthy patients, inter-surgical interval and Voice Handicap Index change were insignificant (p = 0.458 and p = 0.465, respectively). CONCLUSION Recurrent respiratory papillomatosis morbidity for immunosuppressed patients did not significantly differ from that of immunocompetent patients.
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Affiliation(s)
| | | | - Shuai Sun
- Ohio State University Department of Public Health, Columbus, OH, USA
| | - Brandon Koch
- Ohio State University Department of Public Health, Columbus, OH, USA
| | - David Z Allen
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rishabh Sethia
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brad deSilva
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura Matrka
- Ohio State University Wexner Medical Center, Columbus, OH, USA
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3
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Matsuzaki H, Makiyama K, Hasegawa H, Asai R, Morita M, Oshima T. Human Papillomavirus Vaccination as an Adjuvant Therapy for Recurrent Respiratory Papillomatosis: Additional Case Series. J Voice 2024; 38:204-209. [PMID: 34600799 DOI: 10.1016/j.jvoice.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
Prevention of the recurrence of recurrent respiratory papillomatosis (RRP), a neoplasm of the respiratory tract, is a challenge. Human papillomavirus (HPV) vaccine has been expected to suppress the aggressiveness of RRP. However, there has been insufficient data to verify whether HPV vaccination can serve as an adjuvant therapy option for RRP. The aim of this study was to add our data on the efficacy of HPV vaccination for RRP to the academic discipline. Twenty-four RRP patients were treated with a combination therapy of surgery and three sessions of quadrivalent HPV vaccine. The patients' clinical courses, which were HPV infection status changes, intersurgical interval, and disease severity score (Derkay's site score), were statistically analyzed before and after combination therapy. Twelve of the 24 (52.5%) RRP patients who were HPV-DNA positive turned negative after the combination therapy. The mean of intersurgical interval was significantly extended from 6.85 ± 4.49 months to 30.5 ± 27.6 months after the therapy (P <0.01). The median of Derkay's score of the participants also significantly decreased from 7.5 (interquartile range, 5-12) to 1 (interquartile range, 0-4.25) after the therapy (P <0.01). Thus, combination therapy comprising of surgery and HPV vaccination can postpone the recurrence and lessen the severity of RRP.
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Affiliation(s)
- Hiroumi Matsuzaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan.
| | - Kiyoshi Makiyama
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Hasegawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Ryohei Asai
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masato Morita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Oshima
- Department of Otorhinolaryngology, Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
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Freeman T, Erickson E, Koch B, Young T, Allen D, Kim B, deSilva B, Matrka L. Smoking and Carcinoma Trends in Recurrent Respiratory Papillomatosis Patients. Ann Otol Rhinol Laryngol 2023; 132:1380-1385. [PMID: 36879422 DOI: 10.1177/00034894231158459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Recurrent respiratory papillomatosis (RRP) is a chronic disease of the upper respiratory tract caused by human papillomavirus types 6 and 11. The disease course is characteristically unpredictable, ranging from spontaneous remission to aggressive, recurrent disease. Thus, management is often challenging and requires unique approaches tailored to each individual patient. While recent literature has described risk factors for more aggressive disease, few sources have investigated the impact of smoking on RRP disease course and risk for malignant transformation. METHODS A retrospective chart review was conducted for adult RRP patients evaluated at an academic tertiary care center between 2005 and 2020. A total of 188 patients were identified. Demographic and clinical data were collected, including smoking and alcohol history, HPV subtype, history of dysplasia and/or carcinoma, voice handicap index scores, Derkay scores, debulkings (in office and operating room), and days to papilloma recurrence. RESULTS Malignant degeneration in RRP occurred in 16.3% of smokers and 3.6% of nonsmokers. Smokers who developed carcinoma had less debulkings per years of evaluation than those not developing carcinoma (0.21 vs 0.92, P = .004). Additionally, patients that either presented with or developed carcinoma during their course had a higher pack-year smoking history (18.0 vs 12.21, P = .0002). No difference in days to recurrence or inter-surgical interval was demonstrated between smokers and nonsmokers. CONCLUSIONS The report demonstrates that smoking can increase the risk of malignant transformation in RRP patients.
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Affiliation(s)
- Taylor Freeman
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ericka Erickson
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Brandon Koch
- Department of Public Health, The Ohio State University, Columbus, OH, USA
| | - Tyler Young
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - David Allen
- University of Texas Houston Health Science Center, Houston, TX, USA
| | - Brandon Kim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brad deSilva
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura Matrka
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Reuschenbach M, Doorbar J, Del Pino M, Joura EA, Walker C, Drury R, Rauscher A, Saah AJ. Prophylactic HPV vaccines in patients with HPV-associated diseases and cancer. Vaccine 2023; 41:6194-6205. [PMID: 37704498 DOI: 10.1016/j.vaccine.2023.08.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
Individuals with human papillomavirus (HPV)-related disease remain at risk for subsequent HPV infection and related disease after treatment of specific lesions. Prophylactic HPV vaccines have shown benefits in preventing subsequent HPV-related disease when administered before or soon after treatment. Based on our understanding of the HPV life cycle and vaccine mechanism of action, prophylactic HPV vaccination is not expected to clear active persistent HPV infection or unresected HPV-associated dysplastic tissue remaining after surgery. However, vaccination may reasonably be expected to prevent new HPV infections caused by a different HPV type as well as re-infection with the same HPV type, whether from a new exposure to an infected partner or through autoinoculation from an adjacent or distant productively infected site. In this review, we describe the evidence for using prophylactic HPV vaccines in patients with HPV-associated disease before, during, or after treatment and discuss potential mechanisms by which individuals with HPV-associated disease may or may not benefit from prophylactic vaccines. We also consider how precise terminology relating to the use of prophylactic vaccines in this population is critical to avoid the incorrect implication that prophylactic vaccines have direct therapeutic potential, which would be counter to the vaccine's mechanism of action, as well as considered off-label. In other words, the observed effects occur through the known mechanism of action of prophylactic HPV vaccines, namely by preventing virus of the same or a different HPV type from infecting the patient after the procedure.
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Affiliation(s)
- Miriam Reuschenbach
- Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, USA; MSD Sharp & Dohme GmbH, Levelingstraße 4a, 81673 Munich, Germany.
| | - John Doorbar
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, United Kingdom
| | - Marta Del Pino
- Hospital Clínic de Barcelona, Universitat de Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain
| | - Elmar A Joura
- Medical University of Vienna, Department of Gynecology and Obstetrics, Comprehensive Cancer Center, BT86/E 01, Spitalgasse 23, 1090 Vienna, Austria
| | - Caroline Walker
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, United Kingdom
| | | | | | - Alfred J Saah
- Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, USA
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Ponduri A, Azmy MC, Axler E, Lin J, Schwartz R, Chirilă M, Dikkers FG, Yang CJ, Mehta V, Gangar M. The Efficacy of Human Papillomavirus Vaccination as an Adjuvant Therapy in Recurrent Respiratory Papillomatosis. Laryngoscope 2023; 133:2046-2054. [PMID: 36651338 PMCID: PMC10859188 DOI: 10.1002/lary.30560] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To characterize the efficacy of human papillomavirus (HPV) vaccination as an adjuvant therapy in recurrent respiratory papillomatosis (RRP). DATA SOURCES PubMed, Embase, Cochrane, Google Scholar, ClinicalTrials.gov, and Web of Science databases were queried for articles published before April 2021. REVIEW METHODS All retrieved studies (n = 870) were independently analyzed by two reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement using predefined inclusion and exclusion criteria. 13 studies met inclusion criteria. A random-effects meta-analysis was performed to study intersurgical interval (ISI) and number of surgical procedures per year before and after vaccination. RESULTS The systematic review included 13 studies, comprising 243 patients. All studies utilized the Gardasil® quadrivalent vaccine, and one study (Yiu et al. 2019) utilized both the quadrivalent and Gardasil® 9-valent vaccines. Our meta-analysis included 62 patients with ISI data across 4 studies, and 111 patients with data on the number of surgical procedures per month across 7 studies. The mean number of surgical procedures decreased by 4.43 per year after vaccination (95% CI, -7.48 to -1.37). Mean ISI increased after vaccination, with a mean difference of 15.73 months (95% CI, 1.46-29.99). Two studies reported on HPV sero-conversion, with HPV seropositivity of 100% prior to vaccination and 25.93% after vaccination. CONCLUSION The addition of HPV vaccination was associated with an increase in time between surgeries and reduction in the number of surgical procedures required. HPV vaccination may be a beneficial adjuvant treatment for RRP. LEVEL OF EVIDENCE NA Laryngoscope, 133:2046-2054, 2023.
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Affiliation(s)
- Anusha Ponduri
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Monica C Azmy
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Eden Axler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Lin
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Magdalena Chirilă
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Frederik G Dikkers
- Department of Otorhinolaryngology/Head and Neck Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Christina J Yang
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Vikas Mehta
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
| | - Mona Gangar
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, United States
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7
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Muacevic A, Adler JR, Gomes J, Xará S. Recurrent Respiratory Papillomatosis Presenting as Worsening Dyspnea in an HIV-infected Patient. Cureus 2022; 14:e32908. [PMID: 36699756 PMCID: PMC9870301 DOI: 10.7759/cureus.32908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
Recurrent respiratory papillomatosis (RRP) is a rare manifestation of human papillomavirus (HPV) infection. It is characterized by relapsing bulky papillomas in the respiratory tract, which are usually benign in nature. We describe a challenging case of RRP in an HIV-infected patient with extensive pulmonary disease, presenting with worsening dyspnea. The interaction between HPV with HIV as a coinfection is still not completely understood, particularly the role of HIV-associated immunosuppression in RRP. Our main goal is to raise awareness of this clinical entity and to promote further studies on its management, particularly in specific populations such as HIV-infected individuals. A brief review of the theme is also presented.
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Human Papillomavirus Vaccine Impact and Effectiveness in Six High-Risk Populations: A Systematic Literature Review. Vaccines (Basel) 2022; 10:vaccines10091543. [PMID: 36146620 PMCID: PMC9503207 DOI: 10.3390/vaccines10091543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Specific adult populations known to be at high risk for human papillomavirus (HPV)-related disease, such as men who have sex with men, are inconsistently included in national immunization programs. No compilation of the evidence on the real-world impact and effectiveness of HPV vaccines across these populations exists. This systematic literature review identifies and synthesizes the evidence of the real-world impact and effectiveness of the quadrivalent and nonavalent HPV vaccines in high-risk populations: women with prior/current HPV-related anogenital disease, men who have sex with men, immunocompromised/immunosuppressed individuals, female sex workers, transgender and non-binary individuals, and patients with recurrent respiratory papillomatosis (RRP). The outcomes included anogenital precancers/cancers, head and neck cancers, genital warts, and RRP recurrence. From the 2216 records identified, 30 studies (25 effectiveness and 5 impact studies) were included in this systematic literature review. The results, quantity, and quality of these studies were highly variable. The evidence for effectiveness was of high quality only in women with prior/current cervical disease and in individuals with RRP, the most frequently studied populations. No studies of transgender/non-binary individuals or female sex workers were identified. The real-world evidence supports HPV vaccination among women with prior cervical disease and individuals with RRP. Significant real-world data gaps remain in these high-risk populations.
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9
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Smahelova J, Hamsikova E, Ludvikova V, Vydrova J, Traboulsi J, Vencalek O, Lukeš P, Tachezy R. Outcomes After Human Papillomavirus Vaccination in Patients With Recurrent Respiratory Papillomatosis: A Nonrandomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2022; 148:654-661. [PMID: 35653138 DOI: 10.1001/jamaoto.2022.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Recurrent respiratory papillomatosis (RRP) is a rare benign chronic disease of the larynx etiologically linked with the infection of low-risk human papillomavirus (HPV). Combination of surgical and immunomodulatory therapy has limited success. Possible use of prophylactic HPV vaccine that includes HPV-6 and HPV-11 antigens has been studied. Objective To evaluate if the HPV vaccination is associated with a lower number of recurrences requiring surgical intervention in patients with new and recurrent RRP. Design, Setting, and Participants This was a non-placebo-controlled intervention study. Enrollment data were collected from October 2011 to August 2013. The patients were followed up at 1 month, 12 months, and 5 years after the third dose of the vaccine and clinically monitored until December 31, 2018. Data were analyzed from 2019 to 2021. Altogether, 50 adults with active RRP were enrolled and followed up in referral centers. For the final outcome, follow-up data for 42 patients were available. Eight patients who did not fulfill the protocol were excluded. Interventions All patients received HPV vaccine as an adjuvant treatment and were clinically followed up. When RRP progression or a significant recurrent lesion was detected, surgical removal via direct laryngoscopy was indicated. No adjuvant therapy with antiviral or biological agents was used. Main Outcomes and Measures This study compared the prevaccination and postvaccination positivity for HPV-specific antibodies. The main outcome was the difference in the frequency of RRP recurrences in the prevaccination and postvaccination period. Results A total of 50 patients with RRP were enrolled (median [SD] age, 41.5 [12.3] years [range, 21-73 years]; 39 [78%] men and 11 [22%] women). After HPV vaccination, patients with previously no HPV-specific antibodies showed seroconversion, and all patients developed 100-fold higher levels of HPV vaccine type-specific antibodies compared with the prevaccination period. In patients with recurrent RRP, decreased frequency of recurrences requiring surgical treatment was present after vaccination (from 0.85 to 0.36 recurrences/y). No difference in postvaccination recurrences was found between patients with newly diagnosed and recurrent RRP. Conclusions and Relevance In this nonrandomized clinical trial, the frequency of RRP recurrences was significantly lower after HPV vaccination, and patients with RRP thus had a reduced burden of disease. Because no difference was detected in the frequency of recurrent postvaccination lesions in patients with new and recurrent disease, it appears that both groups showed equal benefit following HPV vaccination. These findings suggest that the earlier that patients with RRP receive HPV vaccine, the sooner they may show reduced burden of disease. Trial Registration EudraCT Identifier: 2011-002667-14; ClinicalTrials.gov Identifier: NCT01375868.
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Affiliation(s)
- Jana Smahelova
- Department of Genetics and Microbiology, Faculty of Science, BIOCEV, Charles University, Prague, Czech Republic.,Institute of Hematology and Blood Transfusion, National Reference Laboratory for Papillomaviruses and Polyomaviruses, Prague, Czech Republic
| | - Eva Hamsikova
- Institute of Hematology and Blood Transfusion, National Reference Laboratory for Papillomaviruses and Polyomaviruses, Prague, Czech Republic
| | - Viera Ludvikova
- Institute of Hematology and Blood Transfusion, National Reference Laboratory for Papillomaviruses and Polyomaviruses, Prague, Czech Republic
| | - Jitka Vydrova
- Prague Voice Centre/Medical Healthcom, Prague, Czech Republic
| | - Joseph Traboulsi
- Department of ENT/Head and Neck Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Ondrej Vencalek
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacky University, Olomouc, Czech Republic
| | - Petr Lukeš
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Ruth Tachezy
- Department of Genetics and Microbiology, Faculty of Science, BIOCEV, Charles University, Prague, Czech Republic.,Institute of Hematology and Blood Transfusion, National Reference Laboratory for Papillomaviruses and Polyomaviruses, Prague, Czech Republic
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HPV and Recurrent Respiratory Papillomatosis: A Brief Review. Life (Basel) 2021; 11:life11111279. [PMID: 34833157 PMCID: PMC8618609 DOI: 10.3390/life11111279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Recurrent Respiratory Papillomatosis (RRP) is a rare but severe manifestation of human papillomavirus (HPV). As our knowledge about HPV infections has expanded, it has become possible to understand the course of RRP disease and unravel plausible efficient methods to manage the disease. However, the surge in reports on HPV has not been accompanied by a similar increase in research about RRP specifically. In this paper, we review the clinical manifestation and typical presentation of the illness. In addition, the pathogenesis and progression of the disease are described. On the other hand, we discuss the types of treatments currently available and future treatment strategies. The role of vaccination in both the prevention and treatment of RRP will also be reviewed. We believe this review is essential to update the general knowledge on RRP with the latest information available to date to enhance our understanding of RRP and its management.
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11
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Simoens S, Bento-Abreu A, Merckx B, Joubert S, Vermeersch S, Pavelyev A, Varga S, Morais E. Health Impact and Cost-Effectiveness of Implementing Gender-Neutral Vaccination With the 9-Valent Human Papillomavirus Vaccine in Belgium. Front Pharmacol 2021; 12:628434. [PMID: 33912045 PMCID: PMC8072375 DOI: 10.3389/fphar.2021.628434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Routine human papillomavirus (HPV) immunization in Belgium is currently regionally managed, with school-aged girls receiving the 9-valent HPV (9vHPV) vaccine in Flanders and Wallonia-Brussels with a national catch-up program for females only. This study will assess whether expanding these programs to gender-neutral vaccination (GNV) with the 9vHPV vaccine is a cost-effective strategy in Belgium. Methods: A validated HPV-type transmission dynamic model estimated the potential health and economic impact of regional vaccination programs, comparing GNV versus female-only vaccination (FOV) with the 9vHPV vaccine in individuals aged 11-12 years in Flanders, GNV with the 9vHPV vaccine versus FOV with the 2-valent HPV (2vHPV) vaccine in individuals aged 12-13 years in Wallonia-Brussels, and national catch-up GNV versus FOV with the 9vHPV vaccine for those aged 12-18 years. Vaccination coverage rates of 90, 50, and 50% in both males and females were used in the base cases for the three programs, respectively, and sensitivity analyses were conducted. All costs are from the third-party payer perspective, and outcome measures were reported over a 100-year time horizon. Results: GNV with the 9vHPV vaccine was projected to decrease the cumulative incidence of HPV 6/11/16/18/31/33/45/52/58-related diseases relative to FOV in both Flanders and Wallonia-Brussels. Further reductions were also projected for catch-up GNV with the 9vHPV vaccine, including reductions of 6.8% (2,256 cases) for cervical cancer, 7.1% (386 cases) and 18.8% (2,784 cases) for head and neck cancer in females and males, respectively, and 30.3% (82,103 cases) and 44.6% (102,936 cases) for genital warts in females and males, respectively. As a result, a GNV strategy would lead to reductions in HPV-related deaths. Both regional and national catch-up GNV strategies were projected to reduce cumulative HPV-related disease costs and were estimated to be cost-effective compared with FOV with incremental cost-effectiveness ratios of €8,062, €4,179, and €6,127 per quality-adjusted life-years in the three programs, respectively. Sensitivity analyses were consistent with the base cases. Conclusions: A GNV strategy with the 9vHPV vaccine can reduce the burden of HPV-related disease and is cost-effective compared with FOV for both regional vaccination programs and the national catch-up program in Belgium.
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Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | | | | | | | | | - Andrew Pavelyev
- Merck & Co., Inc., Kenilworth, NJ, United States
- HCL America, Inc., Sunnyvale, CA, United States
| | - Stefan Varga
- Merck & Co., Inc., Kenilworth, NJ, United States
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12
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Welschmeyer A, Berke GS. An updated review of the epidemiological factors associated with recurrent respiratory papillomatosis. Laryngoscope Investig Otolaryngol 2021; 6:226-233. [PMID: 33869755 PMCID: PMC8035934 DOI: 10.1002/lio2.521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To identify studies evaluating the epidemiology of recurrent respiratory papillomatosis (RRP), including patient demographics, human papillomavirus (HPV) immunology, clinical course, surgical and medical treatments, and psychosocial factors. METHODS A systematic literature search through PubMed was performed to identify studies evaluating the epidemiological factors associated with RRP. All studies were screened through a priori selection criteria using the titles and abstracts. RESULTS A total of 208 studies were identified, of which 54 met eligibility criteria and were included in the review. CONCLUSIONS RRP is a rare disease most commonly caused by HPV 6 and 11. It is characterized by recurring benign papillomatous lesions in the respiratory tract, particularly the larynx. Existing evidence about disease risk factors is limited but includes both maternal HPV infection and patient smoking and sexual behaviors. Disease management involves a combination of routine surgical and medical treatment. Surgical techniques include CO2-laser, sharp dissection, coblation, microdebridement, and photoangiolytic laser. Medical treatments which have been found to facilitate disease control off-label include interferon-alpha (IFN-α), indole-3-carbinol, acyclovir, bevacizumab, retinoids, and the Gardasil and mumps vaccines. Many patients suffer from additional psychosocial challenges related to their diagnosis. Current disease knowledge remains limited, and more robust controlled trials about risk factors, medical therapies, and surgical options are needed. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Gerald S. Berke
- Department of Head and Neck SurgeryRonald Reagan UCLA Medical CenterLos AngelesCaliforniaUSA
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Nyirjesy S, Osmundson P, Matrka L. Spontaneous Regression of Recurrent Respiratory Papillomatosis with HPV Vaccination: A Case Study. J Voice 2020; 36:587.e21-587.e25. [PMID: 32891477 DOI: 10.1016/j.jvoice.2020.08.013] [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] [Received: 04/11/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Recurrent respiratory papillomatosis (RRP) is characterized by recurrent laryngeal papillomas and treated with repeated surgical excision. The human papillomavirus (HPV) vaccine prevents infection with strains of HPV unrelated to RRP, and has recently been shown to increase the interval between surgeries when used as an adjuvant. The objective of this study was to report one case from our institution in which HPV vaccination was found to induce spontaneous regression of disease, absent of surgical intervention or use of other adjuvants. STUDY DESIGN Retrospective case study. METHODS Records of one patient with RRP receiving partial HPV vaccination was reviewed with attention to videolaryngostroboscopic findings, Derkay score, need for surgical intervention, and voice quality. RESULTS Spontaneous regression of disease after vaccination was seen in this patient, as evidenced by reduced tumor burden and decreased voice handicap index. The patient was a 30-year old female, who had improved disease burden and voice quality after one dose and total resolution of disease following the second dose. Vaccine administration was the sole therapeutic mechanism. CONCLUSIONS These findings suggest that HPV vaccination can treat RRP without surgical intervention. Further studies are needed to investigate the underlying mechanism of disease regression and which patients may benefit most. We believe that HPV vaccination for all patients with RRP, even over the age of 45 years, may decrease treatment costs for individuals and the healthcare system overall.
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Affiliation(s)
- Sarah Nyirjesy
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | | | - Laura Matrka
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Mercuri G, Rodrigues SA, Martins RHG. An estimate of the incidence and prevalence of laryngeal papillomatosis in São Paulo State (Brasil). Rev Assoc Med Bras (1992) 2020; 66:1247-1251. [DOI: 10.1590/1806-9282.66.9.1247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/15/2020] [Indexed: 11/22/2022] Open
Abstract
SUMMARY BACKGROUND: Recurrent laryngeal papillomatosis, caused by the Human Papilloma Virus, has a significant economic impact worldwide and there are no epidemiological data of this disease in Brasil. OBJECTIVE: The objective of the study was to estimate the incidence and prevalence of laryngeal papillomatosis of some otorhinolaryngology centers in São Paulo State (Brasil). METHODS: A questionnaire containing data on the number of new and follow-up cases diagnosed with laryngeal papillomatosis was sent to the Otorhinolaryngology services (n=35) of São Paulo State (Brasil). RESULTS: A total of 20 otorhinolaryngology centers answered the questionnaire. Of these, the five largest regional health centers were selected as follows: Campinas (42 cities – 4,536,657 inhabitants), Sao Jose do Rio Preto (102 cities – 1,602,845 inhabitants), Ribeirão Preto (26 cities – 1,483,715 inhabitants), Bauru (68 cities – 1,770,427 inhabitants), and Sorocaba (47 cities – 2,478,208 inhabitants). The incidence and prevalence of each regional health centers were, respectively: Campinas (5.51;7.27), Sorocaba (2.02;6.86), São José do Rio Preto (1.87;7.49), Ribeirão Preto (11.46;22.92), and Bauru (3.95;7.91). CONCLUSION: The incidence and prevalence of the laryngeal papillomatosis of the five largest regional health centers of the interior of São Paulo State (Brasil) varied between 1.87 to 11.46 and 6.86 to 22.92 per 1,000,000 inhabitants, respectively for a total population of 11,871,852 inhabitants.
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Zhang Q, Li H, Shao Y, Wang Y. A New Cu(I)‐Based Coordination Polymer: Crystal Structure, Molecular Docking and Protective Effect in
Streptococcus‐pneumoniae‐
Infected Mice by Promoting Immune Cell Response. ChemistrySelect 2019. [DOI: 10.1002/slct.201901967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Qiang Zhang
- Department of Chinese PediatricsAffiliated Hospital of ChangchunUniversity of Chinese Medicine, Changchun, Jilin China
| | - Heng Li
- Department of Chinese PediatricsAffiliated Hospital of ChangchunUniversity of Chinese Medicine, Changchun, Jilin China
| | - Yue Shao
- Department of Chinese PediatricsAffiliated Hospital of ChangchunUniversity of Chinese Medicine, Changchun, Jilin China
| | - Yong‐Ji Wang
- Department of Chinese PediatricsAffiliated Hospital of ChangchunUniversity of Chinese Medicine, Changchun, Jilin China
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