Recent advances in understanding and preventing human papillomavirus-related disease.

Karin Hellner,Lucy Dorrell

doi:10.12688/f1000research.9701.1

Karin Hellner, Lucy Dorrell

Open Access

https://doi.org/10.12688/f1000research.9701.1

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Journal: F1000Research	Publication Date: Mar 14, 2017
Citations: 7	License type: CC BY 4.0

Affiliation: John Radcliffe Hospital, University of Oxford

Abstract

High-risk human papillomaviruses (hrHPV) are responsible for anogenital and oropharyngeal cancers, which together account for at least 5% of cancers worldwide. Industrialised nations have benefitted from highly effective screening for the prevention of cervical cancer in recent decades, yet this vital intervention remains inaccessible to millions of women in low- and middle-income countries (LMICs), who bear the greatest burden of HPV disease. While there is an urgent need to increase investment in basic health infrastructure and rollout of prophylactic vaccination, there are now unprecedented opportunities to exploit recent scientific and technological advances in screening and treatment of pre-invasive hrHPV lesions and to adapt them for delivery at scale in resource-limited settings. In addition, non-surgical approaches to the treatment of cervical intraepithelial neoplasia and other hrHPV lesions are showing encouraging results in clinical trials of therapeutic vaccines and antiviral agents. Finally, the use of next-generation sequencing to characterise the vaginal microbial environment is beginning to shed light on host factors that may influence the natural history of HPV infections. In this article, we focus on recent advances in these areas and discuss their potential for impact on HPV disease.

Highlights

Human papillomavirus (HPV) is the most common viral infection of the reproductive tract
The overall burden of HPV-related disease is difficult to estimate, but it is believed that approximately 600,000 annual cases of cervical, anal, penile, vulvar, and vaginal cancers combined are attributable to hrHPV2–4 (Table 1)
Women who die from cervical cancer either have had little or no screening throughout their lifetime or have not accessed appropriate treatment for abnormal cytology, it is not surprising that the majority of the global burden occurs in the lessdeveloped regions with little or no access to screening or prophylactic vaccine programmes[5]

Summary

Introduction

Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. A similar DNA vaccine expressing E6/E7, GX-188E, was tested in a small uncontrolled study: complete regression and virus clearance was observed in seven out of nine women with CIN3, in association with polyfunctional CD8+ T cell responses[66]. It was hypothesised that hrHPV E2, E6, and E7 drive the production of immunosuppressive cytokines, which, in turn, increase cervical microbial diversity and proliferation of Sneathia and Fusobacterium species These studies highlight the need for more longitudinal data and for a combined metagenomics/metatranscriptomics approach in order to better understand the complex interplay between the cervico-vaginal microbiota, sexually transmitted pathogens, and host immune system in determining the outcome of hrHPV infections.

Williamson AL

Findings

10. Syrjanen S