A delayed dose of quadrivalent human papillomavirus vaccine demonstrates immune memory in HIV-1-infected men

Ellsworth, Grant; Lensing, Shelly; Ogilvie, Colin B.; Lee, J. Y.; Goldstone, Stephen E.; Berry-Lawhorn, J. Michael; Jay, Naomi; Stier, Elizabeth A.; Logan, Jeffrey; Einstein, Mark H.; Saah, Alfred J.; Mitsuyasu, Ronald T.; Aboulafia, David M.; Palefsky, Joel M.; Wilkin, Timothy

doi:10.1016/j.pvr.2018.05.001

Cited by 12 publications

(13 citation statements)

References 22 publications

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“…Our work also complements international epidemiological literature that has found limited awareness of HPV vaccine availability for men [17, 25], the belief that HPV is predominately a risk for cervical cancer among cisgender women [38], and a limited understanding of anal cancer risks [17–18, 20], as persistent barriers to vaccination. This quantitative research has also underscored that the costs of the HPV vaccine are major impediments to vaccine uptake [17–18, 24, 39].…”

Section: Discussionmentioning

confidence: 64%

“…A post-hoc analysis of vaccine benefit in a cohort study of GBM aged 26 years and older demonstrated efficacy in preventing anal condylomas [14]. Studies with HIV-positive adult males [15] and boys [16] suggest that it is both immunogenic and safe in these populations, with a subsequent study in the same HIV-positive adult male population demonstrating persistent immunity over two years later [17]. One fundamental question that has remained unanswered is the utility of HPV vaccination for those who are older (i.e., >26 years) and those with known prior exposure to HPV.…”

Section: Introductionmentioning

confidence: 99%

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HIV-positive gay men’s knowledge and perceptions of Human Papillomavirus (HPV) and HPV vaccination: A qualitative study

et al. 2018

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The human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. Gay, bisexual, and other men who have sex with men (GBM) living with HIV are disproportionately impacted by HPV-associated anal cancer, with rates about 100-fold that of the general population. Fortunately, HPV vaccination has proven efficacy in preventing both anogenital warts (condyloma) in males and anal pre-cancers (anal intraepithelial neoplasia; AIN) in GBM up to the age of 26. We conducted in-depth, semi-structured interviews with 25 HIV-positive gay men in Toronto to gain an understanding of their knowledge and experiences related to HPV and the HPV vaccine. These participants were part of The HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, and received invitations to have anal cancer screening from their primary care doctors. Interviews were analyzed following a Grounded Theory Approach. Most participants had not received the HPV vaccine. Men described a lack of prior knowledge of the health consequences of HPV for GBM living with HIV and financial barriers to vaccine access. Participants did not articulate concerns about vaccine safety. Men frequently reported initial beliefs that HPV was predominantly—or exclusively—a risk for females or young girls, and thus they had not considered the vaccine to be necessary. Some participants remained uncertain if the current availability of the vaccine, and their newly acquired knowledge of its importance, was “too little, too late” because of their age and/or HPV exposure. Improving access and uptake of HPV vaccination requires addressing both financial barriers to access as well as increasing HPV health literacy levels, particularly by reframing the long-standing gendered associations of HPV. Physicians should provide clear, tailored messages regarding HPV vaccination.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

HIV-positive gay men’s knowledge and perceptions of Human Papillomavirus (HPV) and HPV vaccination: A qualitative study

et al. 2018

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“…Better immunogenicity is seen when HIV viral replication is controlled, and when there is no overt immunodeficiency [2,12]. Longitudinal data suggests somewhat reduced antibody persistence [13,14], although modest memory B cell responses after G4 out to 4–5 years have been reported [13], and vaccinated HIV + ve subjects respond to late boosting with a 4th dose [14,15].…”

Section: Hpv Vaccines In Hivmentioning

confidence: 99%

HPV vaccination in HIV infection

Lacey

2019

Papillomavirus Research

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Persons with HIV are at increased risk of HPV infection, HPV disease, and HPV-related cancers compared to HIV negative persons. In persons with HIV, immune responses to vaccination are often sub-optimal, and while these improve with ART, they often remain lower and decline more rapidly than in HIV-negative individuals. Although the evidence base to support the immunogenicity of HPV vaccines in HIV + ve persons is reasonable, the evidence base to support the efficacy of HPV vaccines in HIV + ve individuals is inconsistent. There is one study in HIV + ve men who have sex with men (MSM) which showed no effect , and two other studies, one in HIV + ve women and one in HIV + ve adolescents that showed reduced effectiveness . All these effectiveness studies used Gardasil 4 (G4). Two studies in HIV + ve persons have shown superior immunogenicity of Cervarix (which uses a TLR4 agonist adjuvant) compared to G4. Studies of Hepatitis B vaccines in HIV + ve persons have shown that either (i) increased number of doses (ii) increased vaccine dose, or (iii) TLR agonist adjuvanted vaccines, all produce increased immunogenicity compared to standard vaccine regimes. Therefore, questions remain as to optimal HPV vaccine regimes in HIV and further clinical trials with different HPV vaccine regimes are needed.

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“…Then we used the systematic literature search strategy, and 1369 potential relevant studies were identified. After duplication checking, title and abstract screening and full-text review, 24 full-text studies 20–43 were included in the final analysis (see Figure 1), involving 11 RCTs, 12 non-RCTs and 1 cohort study, among which, 9 studies reached high quality. The main characteristics of the 24 studies were described in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…55 Therefore, a few studies suggested PLWH should receive a four-dose regimen of HPV vaccine. 39,41 The current meta-analysis has the following limitations which should be taken into account. First, due to insufficient data, the occurrence of HPV-related cancers such as cervical cancer were not taken into account as the outcome indicator, so it could not provide evidence for HPV vaccine to reduce HPV-related cancer incidence and mortality.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of human papillomavirus vaccination for people living with HIV: A systematic review and meta-analysis

Zhan

Feng

et al. 2019

Int J STD AIDS

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The current evidence regarding the safety and immunogenicity of human papillomavirus (HPV) vaccinations for people living with HIV (PLWH) is unclear. We searched PubMed, Embase, Cochrane Library and Web of Science databases from inception to 23 November 2018. The pooled proportion, relative risk (RR) and the standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated. Twenty-four studies consisting of 7507 participants were identified. The pooled proportion of adverse events in HIV-infected vaccinees was 60% and the antibody seroconversion rates in HPV-6, -11, -16, -18 subtypes were all above 90%. When compared with the placebo groups, the risk of adverse events was not different except for the injection site reactions (RR: 2.63, 95% CI: 1.72–4.01, p < 0.001), and the level of CD4 was relatively lower (SMD: −0.17, 95% CI: −0.29 to −0.04, p = 0.01) in the HIV-positive vaccinees groups. When compared with HIV-negative vaccinees, the risk of adverse events was not different, but the pooled RR and SMD indicated that antibody seroconversion and geometric mean titer for HPV-18 in HIV-positive groups was lower (RR: 0.91, 95% CI: 0.87–0.95, p < 0.001; SMD: −0.43, 95% CI: −0.62 to −0.24, p < 0.001). The study proves that HPV vaccine is safe and efficacious for PLWH and has important implications for international guidelines and strategies for HPV vaccination.

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A delayed dose of quadrivalent human papillomavirus vaccine demonstrates immune memory in HIV-1-infected men

Cited by 12 publications

References 22 publications

HIV-positive gay men’s knowledge and perceptions of Human Papillomavirus (HPV) and HPV vaccination: A qualitative study

HIV-positive gay men’s knowledge and perceptions of Human Papillomavirus (HPV) and HPV vaccination: A qualitative study

HPV vaccination in HIV infection

Safety and efficacy of human papillomavirus vaccination for people living with HIV: A systematic review and meta-analysis

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