A Randomized, Placebo-Controlled Trial of the Quadrivalent Human Papillomavirus Vaccine in Human Immunodeficiency Virus-Infected Adults Aged 27 Years or Older: AIDS Clinical Trials Group Protocol A5298

Wilkin, Timothy; Chen, Huichao; Cespedes, Michelle; Leon-Cruz, Jorge; Godfrey, Catherine; Chiao, Elizabeth Y.; Bastow, Barbara; Webster‐Cyriaque, Jennifer; Feng, Qinghua; Dragavon, Joan; Coombs, Robert W.; Presti, Rachel; Saah, Alfred J.; Cranston, Ross D.

doi:10.1093/cid/ciy274

Cited by 116 publications

(155 citation statements)

References 34 publications

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“…As regards HAART, no evidence is currently available that it may play a role in the clearance of HPV infection, in the control of precursor anogenital cancer lesions or in the possible regression of previous high-grade lesions [67]. Moreover, the role of HPV vaccination was not supported by a trial on the prevention of new anal HPV infections and on the outcomes of high-grade anal lesions, conducted in HIVinfected adults [68].…”

Section: Viral Co-infectionsmentioning

confidence: 99%

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

Franzetti

Ricci

Bonfanti

2019

CHR

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: The advent of highly active antiretroviral therapy (HAART) has significantly reduced the incidence of AIDS events, including AIDS-defining malignancies. Nevertheless, several cohort studies conducted in the post-HAART period have reported an increasing risk of non-AIDS-defining cancers (NADC). : Overall, the potential mechanisms leading to an increased risk of developing NADCs probably involve multiple known and unknown factors. In addition to ageing, chronic inflammation and ongoing immune system dysregulation, other contributing factors are co-infection with potentially oncogenic viruses (HBV, HCV, HPV, EBV) and high-risk behaviours such as tobacco smoking. : As a consequence of these risk factors, high standardized incidence ratios have been consistently reported, mainly in cohort studies regarding smoking-related cancers (lung cancer, but also pharyngeal and kidney cancer), due to the far more common cigarette smoking habit in the HIV-population. Also in the setting of infection-related malignancies, the high frequency of liver cancer, as a consequence of HBV and HCV co-infection is well known. Similarly, HPV infection accounts for the higher risk of anal cancer. On the same line, Hodgkin lymphoma is more frequent in the HIV population, due to the dysregulation and proliferation of EBV-infected lymphocytes. : Several studies addressed the direct relationship between immunosuppression and cancer progression, showing that subjects with HIV infection experience higher cancer-specific mortality, as compared to the general population, independently of cancer stage or cancer treatment. : In the HIV population, for many NADCs, the prognosis is still worse as compared to the general population. However, an improvement has been reported over the last decades, mainly thanks to more available and adequate treatment chances.

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Section: Viral Co-infectionsmentioning

confidence: 99%

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

Franzetti

Ricci

Bonfanti

2019

CHR

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“…Good efficacy could be shown for cervical and vulvar neoplasia [58]. However, a recent phase III trial suggested low efficacy for the prevention of HPV infection and HGAIN development in HIV-positive individuals [59]. Altogether, evidence for the discussed treatment options is insufficient, and many small series revealed low efficacy.…”

Section: Treatment Of Ainmentioning

confidence: 99%

HIV-Associated Anal Dysplasia and Anal Carcinoma

Oette¹,

Mosthaf²,

Sautter-Bihl³

et al. 2017

Oncol Res Treat

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Anal carcinoma shows an increasing incidence in people living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in whom it is also much more common compared to the HIV-negative population. Human papillomavirus infection is the etiological basis of malignant development in the anal epithelium. Therefore, adequate diagnosis and treatment of the precursor lesions (anal intraepithelial neoplasia) is of clinical importance. In cases with preserved immune function, anal cancer can be treated according to guidelines issued for HIV-negative patients. This review summarizes the current knowledge regarding anal malignancies in HIV-positive patients.

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“…EA has been shown to be superior to topical immune modulators or chemotherapeutics for the treatment of anal HSIL . In a retrospective study, adding HPV vaccination to HSIL treatment (adjuvant HPV vaccination) improved treatment outcomes among HIV‐uninfected MSM and a mathematical modeling study found adjuvant vaccination to be cost‐effective; however, a recent randomized clinical trial did not confirm such synergy among PLWH …”

Section: Introductionmentioning

confidence: 99%

“…15 In a retrospective study, adding HPV vaccination to HSIL treatment (adjuvant HPV vaccination) improved treatment outcomes among HIV-uninfected MSM and a mathematical Cancer April 1, 2020 modeling study found adjuvant vaccination to be cost-effective 16,17 ; however, a recent randomized clinical trial did not confirm such synergy among PLWH. 18 Studies regarding ablation efficacy have been heterogeneous with regard to cohort characteristics and surveillance strategies, yet HSIL clearance after infrared coagulation (IRC) and/or EA has been consistently high, ranging from 53% to 87% in HIV-infected and HIVuninfected MSM. [19][20][21][22][23][24] However, HSIL recurs frequently after ablation and necessitates ongoing surveillance and repeated treatments.…”

Section: Introductionmentioning

confidence: 99%

Electrocautery ablation of anal high‐grade squamous intraepithelial lesions: Effectiveness and key factors associated with outcomes

Gaisa

Liu

Deshmukh

et al. 2020

Cancer

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Background Electrocautery ablation (EA) is a common treatment modality for patients with anal high‐grade squamous intraepithelial lesions (HSILs), but to the authors' knowledge its effectiveness has been understudied. The objective of the current study was to determine ablation outcomes and to identify clinicopathological factors associated with postablation disease recurrence. Methods A total of 330 people living with HIV with de novo intra‐anal HSIL who were treated with EA from 2009 to 2016 were studied retrospectively. Using long‐term, surveillance high‐resolution anoscopy biopsy data, treatment failures were classified as local recurrence (HSIL noted at the treated site at the time of surveillance) or overall recurrence (HSIL noted at treated or untreated sites). The associations between these outcomes and clinical factors were analyzed using Cox proportional hazards models. Results Approximately 88% of participants were men who have sex with men. The median age of study participants was 45.5 years (range, 35‐51 years) and approximately 49% had multiple index HSILs (range, 2‐6 index HSILs). At a median of 12.2 months postablation (range, 6.3‐20.9 months postablation), approximately 45% of participants had developed local recurrence whereas 60% had developed overall recurrence. Current cigarette smoking, HIV viremia (HIV‐1 RNA ≥100 copies/mL), and multiple index HSILs were found to be predictive of local recurrence. Overall recurrence was more common in current smokers and those with multiple index lesions. In multivariable models that included human papillomavirus (HPV) genotypes, baseline and persistent infections with HPV‐16 and/or HPV‐18 were found to be significantly associated with both local and overall recurrence. Conclusions EA is an effective treatment modality for anal HSIL in people living with HIV, but rates of disease recurrence are substantial. Multiple index HSILs, HIV viremia, current cigarette smoking, and both baseline and persistent infection with HPV‐16 and/or HPV‐18 appear to negatively impact treatment success. Ongoing surveillance is imperative to capture recurrence early and improve long‐term treatment outcomes.

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A Randomized, Placebo-Controlled Trial of the Quadrivalent Human Papillomavirus Vaccine in Human Immunodeficiency Virus-Infected Adults Aged 27 Years or Older: AIDS Clinical Trials Group Protocol A5298

Abstract: NCT01461096.

Cited by 116 publications

References 34 publications

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

The Pattern of Non-AIDS-defining Cancers in the HIV Population: Epidemiology, Risk Factors and Prognosis. A Review

HIV-Associated Anal Dysplasia and Anal Carcinoma

Electrocautery ablation of anal high‐grade squamous intraepithelial lesions: Effectiveness and key factors associated with outcomes

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