Prophylactic HPV vaccinations are now being offered to young girls in many countries, and other countries are on the verge of starting vaccination in girls an/or boys. Despite catch up vaccination of adolescent en young adult women at the start of the vaccination campaign, a large cohort of older women remains unvaccinated and at risk of HPV related disease/cancer. This presentation will highlight women and men at increased risk of HPV related disease later in life, who may benefit from prophylactic HPV vaccination.
In the literature many studies have shown increased risk of HPV related disease in women and men who are imunosuppressed. The literature was searched in order to find articles reporting on immunosuppression and HPV related disease, as well as articles reporting on vaccination of groups at supposed increased risk of HPV related disease.
Several different groups could be identified in the literature that have an increased risk of HPV related disease. Two large cohort studies showed that women who have ever been treated for a high grade cervical intraepithelial neoplasia grade 2-3 (CIN 2-3) are at increased risk of developing HPV related disease at any site (cervix, vagina, vulva, anus and oropharyngeal). This risk is still increased, 20-25 years after having been treated. Additionally, several studies have shown that prophylactic HPV vaccination around the period of treatment of HPV related disease may prevent recurrent disease in 55-65% of cases, although one other study could not confirm these results. In men, one study (not yet published) showed benefit of HPV vaccination in men having sex with men, who were treated for anal dysplasia.
Other studies have shown that women who are immunosuppressed due to Human Immunodeficiency Virus (HIV) infections, or due to immunosuppressive drugs (Organ transplant patients, Systemic lupus erythematodus patients, other autoimmune disease patients), are at increased risk of HPV related disease. However, no studies on vaccine efficacy in these groups have been reported yet.
Several groups of women may be identified that have an increased risk of HPV related disease. These men/women did not receive any prophylactic HPV vaccination yet, and studies are emerging indicating vaccine efficacy in these groups. In order to further decrease HPV related diseases, these groups must be studied urgently, in order to be able to offer them prophylactic HPV vaccination on a risk based strategy.
Ebisch R. et al. Long-lasting increased risk of HPV-related carcinomas and premalignancies after cervical intraepithelial neoplasia grade 3: a population-based cohort study. JCO 2017 (accepted for publication)
Garland S. et al. Prior human papillomavirus-16/18 AS04-adjuvanted vaccination prevents recurrent high grade cervical intraepithelial neoplasia after definitive surgical therapy: Post-hoc analysis from a randomized controlled trial. Int J cancer 2016 Dec 15;139(12):2812-2826.
Joura E. et al. Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data. BMJ 2012 March 27;344e
Kang WD et al. Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)? Gynecol Oncol 2013 Aug;130(2):264-8.
Edgren G et al. Risk of anogenital cancer after diagnosis of cervical intraepithelial neoplasia: a prospective population-based study. Lancet Oncology 8:311-6, 2007
Hildesheim A. et al. Impact of human papillomavirus (HPV) 16 and 18 vaccination on prevalent infections and rates of cervical lesions after excisional treatment. Am J Obstet Gynecol. 2016 Aug;215(2):212