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Incidence of HPV related disease detected ≥60 days after cervical surgery or diagnosis of vulvar or vaginal disease among women who did not receive quadrivalent HPV vaccine (that is, placebo recipients)
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To determine the effect of human papillomavirus (HPV) quadrivalent vaccine on the risk of developing subsequent disease after an excisional procedure for cervical intraepithelial neoplasia or diagnosis of genital warts, vulvar intraepithelial neoplasia, or vaginal intraepithelial neoplasia.
Retrospective analysis of data from two international, dou...
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Citations
... 50% vaccine efficacy [2][3][4], with few exceptions showing a smaller if any, effect [5,6]. Most of the studies were under powered [6][7][8], many of them are not randomized [7,9] or provide indirect evidence because the vaccine was administered before treatment to already infected women [6,10,11], finally, the largest study was based on routinely collected data with too few clinical information to exclude major differences between the compared groups [5]. Furthermore, some studies collected different outcomes at different time points making difficult a sound meta-analysis. ...
... To characterize HPV-positive samples, sequence analysis was performed. We used Roche Linear Array HPV Genotyping Test ® , which identifies 32 HPV DNA of the following genotypes: 16,18,31,33,35,39,45,51,52,56,58, 59 and 68 (high-risk genotypes); 26, 53, 66, 70, 73 and 82 (probable high-risk genotypes); and 6,11,40,42,43,44,54, 61, 62, 67, 81, 83 and 89 (low-risk genotypes). ...
... As per certain studies, HPV vaccination has been shown to notably decrease the recurrence of post-surgical disease in individuals with a history of prior HPV infection [39,40]. Joura et al. documented a significant reduction in the occurrence of subsequent CIN, VaIN, VIN and genital warts among women who underwent surgical treatment for HPV-related diseases following HPV vaccination [41,42]. ...
The introduction of human papillomavirus vaccines revolutionized cervical cancer prevention. Our research hypothesis is that HPV vaccination affects the remission of HPV in cervical swabs. We provide a prospective, ongoing, 24-month, non-randomized study in HPV-positive women. We enrolled 60 patients with positive HPV swabs from the cervix (fifty-one vaccinated with the nine-valent vaccine against HPV and nine unvaccinated). Using an enzyme-linked immunosorbent assay, we determined IgG class antibodies of HPV in the patients’ serums. Persistent HPV infection after vaccination was significantly less frequent in the nine-valent vaccinated group (23.5%) compared to the control group (88.9%; p < 0.001). Antibody level after vaccination was significantly higher in the vaccinated patients compared to the control group. The reactive antibody level was seen in the case of all patients in the vaccinated group and one-third of the unvaccinated group (33.3%, n = 3). The vaccination of HPV-positive patients may increase the chance of HPV remission in cervical swabs and may be a worthwhile element of secondary prevention in HPV-positive patients.
... 12 Previous research also has demonstrated a reduction in subsequent high-grade cervical diseases among HIV-negative women undergoing cervical surgery who received HPV vaccine. 13 Our observations imply that there is a window during which youth could receive catch-up HPV vaccination even after initiating sexual activity or having prior HR-HPV infection in order to lower their risk of future anogenital cancers. ...
Background Females with perinatal HIV (PHIV) infection are at elevated risk for anogenital high-risk human papillomavirus (HR-HPV) infection. Limited data are available around the effect of the HPV vaccination after initiation of sexual activity among PHIV youth. This study aims to assess the impact of a bivalent HPV vaccination on the persistence of anogenital HR-HPV among sexually active female PHIV youth and matched HIV-negative controls aged 12–24 years in Thailand and Vietnam. Methods During a 3-year study, prevalent, incident, and persistent HR-HPV infection were assessed at annual visits. A subset of participants received a bivalent HPV vaccine. Samples were taken for HPV testing from the vagina, cervix, and anus. HR-HPV persistence was defined as the detection of the same genotype(s) at any anogenital compartment over ≥ two consecutive visits. Results Of the 93 PHIV and 99 HIV-negative female youth enrolled in this study, 25 (27%) PHIV and 22 (22%) HIV-negative youth received a HPV vaccine. Persistent infection with any HR-HPV type was significantly lower among PHIV youth who received the vaccine compared to those who did not (33% vs 61%, P = 0.02); a difference was not observed among HIV-negative youth (35% vs 50%, P = 0.82). PHIV infection (adjusted prevalence ratio [aPR] 2.31, 95% CI 1.45–3.67) and not receiving a HPV vaccine (aPR, 1.19, 95%CI 1.06–1.33) were associated with persistent anogenital HR-HPV infection. Conclusions Bivalent HPV vaccination after initiation of sexual activity was associated with reduced persistence of anogenital HR-HPV infection in Southeast Asian PHIV female youth, which may be related to vaccine cross-protection. Primary and catch-up HPV vaccinations should be prioritised for children and youth with HIV.
... It has also been hypothesized that surgical treatment may reduce local inflammatory responses, induce higher intensity and longer-lasting local cellular immunity, and restore HPV naive microenvironment. The HPV vaccine is theoretically effective in preventing persistent and recurrent HPV infection, but the potential role of prophylactic HPV vaccination as adjunctive therapy following surgical removal has not been demonstrated [25][26][27][28][29][30]. It is clinically important to explore whether post-treatment HPV vaccination is associated with a reduced risk of CIN. ...
... Does the HPV vaccine benefit women who remain infected after treatment? Although the HPV vaccine stimulates local antibodies in the cervix that prevent the virus from entering the basal layer of the cervix, the effectiveness of prophylactic HPV vaccination in preventing widespread HPV infection has not been proven [28,30,100]. Some studies have suggested that the HPV vaccine may have some benefits in women with prevalent HPV infection [19]. ...
Women with HSIL typically undergo conization/LEEP to remove cervical lesions, but the risk of HSIL lesions returning after surgical treatment remains higher than in the general population. HPV vaccination is essential to prevent cervical cancer. However, the effect of prophylactic HPV vaccination on reducing the risk of recurrent cervical lesions after surgical treatment remains unclear. This review aims to analyze and summarize the latest literature on the role of prophylactic HPV vaccine in reducing the recurrence of cervical lesions after surgery in patients with HSIL, and to review and update the history, efficacy, effectiveness and safety of HPV vaccine, focusing on the current status of global HPV vaccine implementation and obstacles.
... На сегодняшний день вакцинация против ВПЧ является основополагающим методом профилактики и снижения заболеваемости uVIN [46]. В исследованиях показано, что четырехвалентная вакцина предотвращает VIN, связанный с ВПЧ-16 и ВПЧ-18, почти у 100% женщин и приводит к снижению частоты рака вульвы, ассоциированного с ВПЧ [47][48][49]. ...
... (n=17 22) исследовали взаимосвязь развития ВПЧ-ассоциированных заболеваний и вакцинации. Результаты исследования продемонстрировали снижение риска возникновения uVIN и кондилом у вакцинированных от ВПЧ женщин на 35 и 64% соответственно [46]. ...
The analytical review presents data from the world literature, which discusses the relevance of vulvar intraepithelial neoplasia associated with human papillomavirus (uVIN). The incidence of uVIN is steadily increasing, especially in young women, and 1011.2% of cases can progress to vulvar carcinoma. More than 50% of uVIN cases are associated with anogenital diseases associated with the human papillomavirus, which determines the need for a comprehensive assessment and proper treatment of uVIN patients.
... Evidence for vaccinating women peri-treatment for HPV-related cervical disease comes from post hoc analyses of clinical trials [35][36][37], small prospective randomized clinical trials [38][39][40], and realworld cohort studies [13,[41][42][43][44][45][46], which have been the subject of several recent reviews and meta-analyses [47][48][49][50][51][52][53][54] (Supplemental Table S1). ...
... Of particular note, in post hoc analyses of subsets of women who underwent definitive cervical surgery from randomized 2vHPV [35], 4vHPV [36], and 9vHPV [37] vaccine clinical trials, prior vaccination decreased risk of subsequent disease related to vaccine HPV types. ...
... A handful of studies have evaluated peri-treatment vaccination in the context of HPV-related vaginal, vulvar, and anal precancers Table S2) [36,53,[59][60][61]. A recent meta-analysis concluded that evidence was inconclusive for the benefit of HPV vaccination for non-cervical disease, including VaIN, VIN, and AIN, or for incident or persistent HPV infections [53]. ...
... Recent studies [4,[10][11][12][13][14] suggest that HPV vaccination, in women undergoing surgery for HPV linked disease, could impact on disease recurrence. Therefore, it is realistic to discuss the potential benefits of vaccination in this specific target of patients. ...
... Indeed, the vaccine is also safe, welltolerated and is able to determine an antibody response at this age [20,21]. Therefore, HPV vaccine can also induce protection in older women, and its administration to patients previously treated for HPV-related disease can reduce the disease recurrence rate [4,[10][11][12]. ...
... In 2013, Kang et al. [11] demonstrated a significant disease relapse reduction in women vaccinated after highgrade lesions treatment. Similar impact on clinical recurrence was already found in a post hoc analysis from the Future I and II studies [10]. In 2016, Garland and colleagues [12] re-analysed the data on the bivalent vaccine and found that it can have a role in reducing the risk of CIN2+ occurrence in patients already treated. ...
Human Papillomavirus (HPV) vaccination is able to reduce the risk of relapse in women undergoing surgery for HPVrelated lesions. The surgical treatment of these lesions can correlate with a greater risk of preterm parts. The extension of the recommendation of HPV vaccination to patients treated for a previous HPV-related lesion would entail a lower expense for the Health System. Therefore, an increase in the use of HPV vaccination is desirable also in this target population as well as the implementation of a care pathway dedicated to women treated for HPV lesions that includes vaccination in the prevention activities of relapses.
... To the best of our knowledge, this is the first observational study using population based individual level registry data to evaluate VE against recurrent AGW. RCTs have been carried out [31,32,23], but these include a much smaller number of individuals than we had in our study (48 045 women with previous AGW, of whom 3 853 were vaccinated after AGW). Contrary to RCTs, observational studies may have biased VE estimates due to confounding factors. ...
Background:
In 2009, Norway initiated routine quadrivalent HPV (qHPV) vaccination for girls at 12-13 years of age to protect against virus types causing cervical cancer, HPV16/18, and HPV6/11 which cause anogenital warts (AGW). We wanted to investigate qHPV vaccine effectiveness (VE) against AGW in females before and after first AGW episode and to assess the impact of female vaccination in males.
Materials and methods:
QHPV vaccination and AGW episodes were collected for the time period 2006-2016 for birth cohorts 1975-2003. Cox models were applied to age at first, as well as at second AGW episode. Finally, we estimated the impact of the female vaccination program on unvaccinated males.
Results:
The VE against the first episode of AGW was strongly dependent on vaccination age, with hazard ratios (HRs) compared to unvaccinated individuals of 0.2, 0.2, 0.3, 0.5, 1.0, 1.3, and 2.7, for age groups of ⩽13, 14-15, 16-17, 18-19, 20-24, 25-29, and 30+ years at first vaccination, respectively. Among women who had suffered a first episode of AGW, subsequent qHPV vaccination did not protect against a second episode, with HRs of 0.8, 1.0, and 1.4, for age groups of ⩽17, 18-24, and 25+ years at first vaccination. A gradually decreasing AGW risk was seen in unvaccinated male cohorts neighboring the first routinely vaccinated female 1997 cohort.
Conclusions:
When administered before 14 years of age, qHPV vaccination reduced the probability of AGW about fivefold. The effect decreased sharply with vaccination age, and was not significant among women vaccinated after age 20 years. QHPV administered after the first AGW episode did not protect against a second AGW episode. Herd effects were indicated in unvaccinated males, as we observed a gradual decrease in AGW rates from the 1993 male birth cohort and onwards.
... One of the most promising strategies is the development of vaccines. For example, for preventing HPV infections, the HPV vaccine is very successful, and has been demonstrated to significantly lower the risk of cervical cancer [11,12]. Similarly, the hepatitis B vaccine can help prevent HBV infections, and thus reduce the risk of liver cancer. ...
... Types 16 and 18 of this group of high-risk HPV are in charge of 70% of cervical cancer cases globally. Lowrisk HPV types such as 11,42,44,6,43,53,44,61,54,81, and 72 are not that prominent and have a lower potential to cause cancer [17,18]. ...
Viral oncology is focused on understanding the relationship between viruses and cancer. Viruses are known to play a role in the development of certain types of cancers, and approximately 15-20% of human cancers are believed to be caused by oncogenic viruses and as a result, there is significant interest in understanding how these viruses contribute to cancer development. There are several viruses that have been linked to cancer, including human papillomavirus (HPV), hepatitis B and C virus (HBV and HCV) Epstein-Barr virus (EBV), human T-cell lymphotropic virus type 1 (HTLV-1), Kaposi's sarcoma-associated herpesvirus (KSHV), and Merkel cell polyomavirus (MCPyV). Each of these viruses are associated with different types of cancer, and the mechanisms by which they contribute to cancer development are diverse. This article discusses the mechanisms by which these viruses contribute to cancer development, and current and future strategies for preventing and treating viral-associated cancers. The objective is to present a current and thorough review of the current state of knowledge in viral oncology and to highlight the importance of continued research in this field.
... Regarding vulvar or vaginal recurrences, the role of HPV vaccines has been more thoroughly investigated with respect to its use as a prophylactic tool. For example, Joura et al. showed that the incidence of vulvar and vaginal recurrence is lower among women who had received the quadrivalent vaccine before the diagnosis of HPV-related disease [38]. Similar results were obtained in the PATRICIA study on women previously vaccinated with the bivalent vaccine and subsequently undergoing cervical surgery [39]. ...
Vulvar and vaginal cancers are relatively rare cancers, but their incidence is increasing worldwide. Overall, 78% of vaginal cancers and 25% of vulvar cancers are associated with Human papillomavirus (HPV) infection. Immunization could be an option for the management of these cases. We researched and assessed the evidence on the efficacy of HPV vaccination administered to women previously treated with surgery, radiotherapy, or chemotherapy with respect to the recurrence of vulvovaginal disease. From 2006 to November 2022, only one study evaluated the efficacy of HPV vaccination with respect to preventing vulvovaginal recurrences in treated women and showed that a quadrivalent HPV vaccine administered after the surgical treatment of vulvar high-grade squamous intraepithelial lesion (HSIL) can reduce vulvar recurrence of the disease. Therefore, the efficacy of HPV vaccination with respect to vulvovaginal recurrence is still an unexplored field. Further studies are needed to produce stronger evidence in order to appropriately support interventions to protect women’s health.
