Human papillomaviruses (HPVs) represent a large collection of viral types
associated with significant clinical disease of cutaneous and mucosal
epithelium. HPV-associated cancers are found in anogenital and oral mucosa, and
at various cutaneous sites. Papillomaviruses are highly species and tissue
restricted, and these viruses display both mucosotropic, cutaneotropic or dual
tropism for epithelial tissues. A subset of HPV types, predominantly mucosal,
are also oncogenic and cancers with these HPV types account for more than
200,000 deaths world-wide. Host control of HPV infections requires both innate
and adaptive immunity, but the viruses have developed strategies to escape
immune detection. Viral proteins can disrupt both innate pathogen-sensing
pathways and T-cell based recognition and subsequent destruction of infected
tissues. Current treatments to manage HPV infections include mostly ablative
strategies in which recurrences are common and only active disease is treated.
Although much is known about the papillomavirus life cycle, viral protein
functions, and immune responsiveness, we still lack knowledge in a number of key
areas of PV biology including tissue tropism, site-specific cancer progression,
codon usage profiles, and what are the best strategies to mount an effective
immune response to the carcinogenic stages of PV disease. In this review,
disease transmission, protection and control are discussed together with
questions related to areas in PV biology that will continue to provide
productive opportunities of discovery and to further our understanding of this
diverse set of human viral pathogens.