Vaccination against oncogenic human papillomavirus infection in HIV-infected populations: review of current status and future perspectives
Lars Toft A B , Martin Tolstrup A , Merete Storgaard A , Lars Østergaard A and Ole S. Søgaard A
+ Author Affiliations
- Author Affiliations
A Department of Infectious Diseases, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark.
B Corresponding author. Email: larsnise@rm.dk
Sexual Health 11(6) 511-523 https://doi.org/10.1071/SH14015
Submitted: 14 January 2014 Accepted: 5 August 2014 Published: 9 September 2014
Journal Compilation © CSIRO Publishing 2014 Open Access CC BY-NC-ND
Abstract
Background: Men and women with HIV infection are at increased risk of developing cancers associated with human papillomavirus (HPV). The two licensed prophylactic HPV vaccines protect against de novo infection with HPV-16 and HPV-18, which cause the majority of HPV-associated cancers. Currently, no vaccine efficacy data are available for persons with HIV infection. Nevertheless, some countries have implemented specific HPV vaccination recommendations for HIV-positive populations. To specifically recommend prophylactic HPV vaccination in people with HIV, the vaccines must be safe and immunogenic in immunosuppressed people at a high risk of HPV infection. This review aims to summarise the current knowledge from published HPV vaccine trials in HIV-infected populations, to compile scheduled and ongoing HPV vaccine trials with HIV-positive study populations and to extrapolate the relevant knowledge about HPV vaccine efficacy in HIV-negative populations to an HIV context. Methods: The databases PubMed, Scopus and ClinicalTrials.gov were searched for peer-reviewed articles and scheduled or ongoing clinical HPV vaccine trials enrolling HIV-positive persons. Results: Current data indicate that prophylactic HPV vaccines are safe and immunogenic in different HIV-positive populations (children, female adolescents, adults). Increased immunogenicity has been reported in persons on antiretroviral therapy compared with antiretroviral-naïve persons, whereas no clear association has been found between CD4+ cell count at immunisation and vaccine response. Several scheduled and ongoing HPV vaccine trials aim to determine vaccine efficacy against disease endpoints in HIV-infected study populations. Conclusion: Prophylactic HPV vaccination appears safe, immunogenic and, by extrapolation, likely to reduce HPV-associated cancer development among persons with HIV infection.
Additional keywords: anal cancer, cervical cancer, genital warts, immunisation.
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