Vaccination against oncogenic human papillomavirus infection in HIV-infected populations: review of current status and future perspectives

Abstract

Abstract. Background: Men and women with HIV infection are at increased risk of developing cancers associated with human papillomavirus (HPV). The two licensed prophylactic HPV vaccines protect against de novo infection with HPV-16 and HPV-18, which cause the majority of HPV-associated cancers. Currently, no vaccine efficacy data are available for persons with HIV infection. Nevertheless, some countries have implemented specific HPV vaccination recommendations for HIV-positive populations. To specifically recommend prophylactic HPV vaccination in people with HIV, the vaccines must be safe and immunogenic in immunosuppressed people at a high risk of HPV infection. This review aims to summarise the current knowledge from published HPV vaccine trials in HIV-infected populations, to compile scheduled and ongoing HPV vaccine trials with HIV-positive study populations and to extrapolate the relevant knowledge about HPV vaccine efficacy in HIV-negative populations to an HIV context. Methods: The databases PubMed, Scopus and ClinicalTrials.gov were searched for peer-reviewed articles and scheduled or ongoing clinical HPV vaccine trials enrolling HIV-positive persons. Results: Current data indicate that prophylactic HPV vaccines are safe and immunogenic in different HIV-positive populations (children, female adolescents, adults). Increased immunogenicity has been reported in persons on antiretroviral therapy compared with antiretroviral-naïve persons, whereas no clear association has been found between CD4+ cell count at immunisation and vaccine response. Several scheduled and ongoing HPV vaccine trials aim to determine vaccine efficacy against disease endpoints in HIV-infected study populations. Conclusion:Prophylactic HPV vaccination appears safe, immunogenic and, by extrapolation, likely to reduce HPVassociated cancer development among persons with HIV infection.

Vaccines against human papillomavirus in low and middle income countries: a review of safety, immunogenicity and efficacy

“…In this study, it was also found that HPV18 was higher and HPV45 lower in HIV endemic areas. However, the significance of this finding remains to be understood in light of emerging evidence that HPV vaccines are immunogenic even in HIV infected individuals despite need for more long term data [41]. Further, Ndiaye et al highlighted the importance of HPV-45 as an important candidate for future vaccines, despite the fact that varying degrees of cross protection against HPV45 have been described for the current bivalent and quadrivalent vaccines [38].…”

HIV-associated malignancies in children

“…Vaccinations are recommended for girls and women aged 9 years up to 25 years old prior to HPV exposure [29]. There are few studies investigating the immunogenicity and safety of the HPV-vaccination in HIV-infected populations [30]. However, from the available evidence, both the bi- and quadrivalent HPV-vaccines have demonstrated high seroconversion rates and acceptable safety profiles in various HIV-infected populations (children, female adolescents and adults).…”

“…Antibody titres were 50% and 70% lower at 7 and 12 months in the HIV-infected group compared to the HIV-uninfected group [30,34]. However, HPV-16 and HPV-18 geometric mean titres in the HIV-infected group remained 26- and 16-fold higher at one year than those reported in healthy women (15–25 years) who cleared a natural infection.…”

“…While the immunogenicity and safety of HPV-vaccination in HIV-infected children and young women has been demonstrated [30,32–34], no long-term follow-up of HIV cohorts receiving HPV-vaccination have been reported. Therefore the duration of vaccine-induced immunogenicity and the clinical significance of the lower antibody titre in HIV-infected children and young women receiving the bi- or quadrivalent HPV-vaccination remain unknown.…”

Brief Report: Antibody Responses to Quadrivalent HPV Vaccination in HIV-Infected Young Women as Measured by Total IgG and Competitive Luminex Immunoassay

“…8,9 HPV vaccine trials among HIV-infected young women and men demonstrated that HPV type-specific immune responses to vaccination are generally robust. 10–16 However, studies have demonstrated substantially lower seropositivity rates for HPV18 compared to HPV6, 11, and 16. In one study, 32.4% of those not on antiretroviral therapy (ART) and 13.3% of those on ART became (or remained) seronegative for HPV18 at 48 weeks after vaccination.…”