Human Papillomavirus Research: Where Should We Place Our Bets?

Abstract

Background: Massive strides have been made with respect to primary and secondary prevention of human papillomavirus (HPV)-associated disease as a result of prophylactic vaccination and cervical screening based on molecular HPV testing. However, cervical cancer continues to be an important clinical and societal burden. Additionally, other HPV-associated cancers, for which there are no screening programmes, are rising. Finally, the optimal combination of vaccination and screening strategies will require careful thinking. Considering this unprecedented and important time, we were keen to solicit the views of the expert community to determine what they perceived were the key priorities for HPV research. Our objective was to identify consensus and key priorities for HPV-based research through provision of a questionnaire disseminated to a multidisciplinary group of key opinion leaders (KOLs). Summary: A structured survey composed of 46 HPV research “categories” was sent to 73 KOLs who were invited to “rank” the categories according to priority. The invitees represented clinical and public health disciplines as well as basic scientists. Scores were weighted according to the number of responses. Invitees also had the opportunity to comment on barriers to the research and suggest other research areas that required attention not reflected in the survey. We received 29 responses in total; overall, the 3 highest-ranked categories were “optimal cervical screening in low and middle-income countries (LMICs),” “primary disease prevention in LMICs” and “impact of vaccine on HPV infection and associated disease.” “HPV and the microbiome” and “mechanisms of transformation” were the highest-ranked categories with respect to basic research. Consistent barriers to research were around governance on the use of samples and data and funding, particularly in an era of vaccination. Key Messages: Research to support the management of disease in LMICs is clearly perceived as a priority in the international community in addition to other diverse areas which necessitate an improved basic understanding of viral mechanisms and interactions. International, multidisciplinary efforts which articulate the broader HPV research agenda will be important when seeking funding in addition to international endeavours to support the efficient use of existing samples and cohorts to facilitate such research.

Clinical performance of methylation as a biomarker for cervical carcinoma in situ and cancer diagnosis: A worldwide study

“…The proportion of rare histological subtypes in our study was also small, so this element would benefit from further investigation. Moreover, much more emphasis was placed on cancers FIGO stage I and II as previously published data indicate that aberrant methylation is an early event in cervical carcinogenesis 14,29 . An intentional limitation of our study is that we excluded CIN1 and CIN2 which would be present in a real‐world setting.…”

The state of human papillomavirus research in Africa

“…Over 100 known types of HPVs, and they are grouped into non-carcinogenic and carcinogenic types [2]. The common noncarcinogenic types include HPV types 6,11,40,42,43,44 and 54; these HPV types atypically cause cancers [2,3], and typical examples of the diseases caused by them are papilloma, verruca, condyloma and focal epithelial hyperplasia (Heck's disease) [4]. On the other hand, the common carcinogenic types include HPV types 16,18,31,33,35,39 and 45 [2,3], and they are known for causing oropharyngeal, anal and genital cancers [1][2][3][4][5].…”

“…F I G U R E 5 Network visualisation of author keyword co-occurrence.research is sacrosanct in designing appropriate people-centred interventions. More so, multidisciplinary efforts will broaden HPV research agenda to have a better understanding in implementing best practices[40]. Based on the above, it will be plausible if research groups or centres of excellence on HPV can be established across multiple research organisations in Africa to boost HPV research productivity in the Social Science discipline as well as other disciplines having low outputs on HPV.…”

A systematic review of the barriers to implementing human papillomavirus vaccination programs in low‐ and middle‐income countries in the Asia‐Pacific

“…Literature supporting the importance and cost effectiveness of cervical cancer prevention programs and HPV vaccination is becoming more robust through the years. 25,26 A strong evidence base could also help win high-level nongovernmental advocacy, which in turn could mobilize resources toward implementation and sustainment of a national HPV vaccination program.…”