The currently available HPV vaccines are designed as prophylactic vaccines with a type specific vaccine efficacy of almost 100%. No therapeutic effect was found in the phase three trials and no influence on the clearance of HPV infections has been reported yet. However after treatment of HPV related disease a reduction of subsequent HPV related disease was observed.
A review of the literature will be performed.
A post hoc analysis of the phase 3 trials with the quadrivalent vaccine revealed a 65% reduction of recurrent high grade cervical disease of the cervix in vaccinated women ofter conization compared to placebo recipients. In the same trial women with HPV related vulvar disease had a reduction of subsequent HPV related vulvar disease of 35%. A very similar post-hoc analyses with the bivalent HPV vaccine demonstrated a 88% reduction of subsequent CIN2+ and a 43% reduction of CIN1+ following conization in vaccinated women compared with placebo. In the Costa Rica trial with the bivalent vaccine no effect after conization was observed. A retrospective Korean study in >700 women vaccinated after conization with the quadrivalent HPV vaccine found a reduction of two thirds of recurrent disease (7,2% vs 2.5%).
Available data suggest that HPV vaccines have a value as a tool of secondary prevention after treatment of HPV related disease. No direct therapeutic effect has been observed. A prospective study is ongoing and will hopefully strenghten the evidence, real world data from the Nordic countries are awaited.
1. Joura EA, 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.
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2. Kang WD, et al. Is vaccination with quadrivalent HPV vaccine after LEEP procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia? Gynecol Oncol 2013;130:264-8.
3. Garland SM, 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;139:2812-2826.