Human Papillomavirus Related Diseases Research Articles

Human papillomavirus-related disease in people with HIV.

The incidence of human papillomavirus (HPV)-related cancers has increased among people with HIV infection compared with the general population. This review will describe recent findings in HPV-associated cancer incidence since the introduction of antiretroviral therapy, HPV/disease prevalence at sites other than cervix and anus, and recent data on screening and treatment of anal intraepithelial neoplasia. Consistent with high prevalence of anogenital HPV infection, new data on cervical intraepithelial neoplasia and anal intraepithelial neoplasia in HIV-positive men and women show that the incidence of cervical cancer has not declined since the introduction of antiretroviral therapy and that the incidence of anal cancer is rising. Several studies also highlight high rates of HPV infection and HPV-associated disease at sites other than the cervix and anus, including the penis and the mouth. Treatment methods for anal intraepithelial neoplasia have been described and show reasonable efficacy. New data imply that the problem of HPV-related cancers will not decline among HIV-positive men and women in the antiretroviral therapy era, highlighting the need to perform studies to determine if screening and treatment of anal intraepithelial neoplasia will prevent development of anal cancer. Recent data show progress in both these areas.

Topical 5‐aminolevulinic acid photodynamic therapy for recalcitrant facial flat wart in Chinese subjects

The facial flat wart (verruca plana) is not only a contagious viral disease, but also causes a disturbing cosmetic problem. Because 5-aminolevulinic acid photodynamic therapy has successfully treated human papilloma virus-related diseases, we employed 20% 5-aminolevulinic acid and a light emitting diode on three recalcitrant facial flat wart patients. Most lesions achieved complete remission after three or four sessions. However, a few non-elevated lesions did not respond to this method. An ablative therapeutic mode is required in addition to 5-aminolevulinic acid photodynamic therapy in such lesions. Therefore, we utilized an Er:YAG laser and 20% 5-aminolevulinic acid photodynamic therapy for one session and achieved an excellent result. Patients should be informed of the possible side-effects of this treatment, such as erythema, exfoliation and post-inflammatory hyperpigmentation, and the requirement for sun protection.

Quelles données épidémiologiques sont nécessaires pour la mise en place de la vaccination contre le papillomavirus humain?

Genital human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide. Two HPV vaccines are now available in many countries: (i) the first vaccine is quadrivalent and indicated in the prevention of CIN 2/3, cervical cancers, VIN 2/3, VaIN 2/3 and genital warts associated with the HPV types 6, 11, 16 and 18, (ii) the second vaccine is bivalent and indicated in the prevention of CIN 2+ and cervical cancers associated with the HPV types 16 and 18.To critically review all epidemiological aspects of the HPV infection and its relation with preneoplasic lesions of the cervix and cervical cancer to assist the relevant public health authorities to make plans for the introduction of HPV vaccines that have been recently commercialized.Only articles published in English in peer reviewed journals have been selected in Date base PubMed (National Library of Medicine - National Institutes of Health) with Keywords HPV, risk factor, cervical cancer, CIN2/3, incidence, prevalence, transmission, prevention, genital cancer, HPV vaccines, screening. A critical review of most papers published during the last 10 years was made. The topics covered included: diseases caused by HPV, prevalence, incidence and transmission of HPV, risk factors for the acquisition of HPV, natural history of HPV infection, risk factors determining the progression from HPV to cancer, protective factors blocking the progression from infection to cancer (screening) and primary prevention of HPV by vaccines and other methods. The information was interpreted and summarized.It was concluded that HPV infection is one of the most common sexually transmitted infections, that it is the necessary cause of cervical cancer and the cause of other genital cancers and cancers of the upper aerodigestive tract. Fortunately most infections regress, but those infections that persist are the ones leading to cancer. Primary prevention by the introduction of prophylactic vaccines is the ideal means of preventing cervical cancer and other cancers associated to HPV.This review is to my knowledge, the most comprehensive and up-to date review to be published in French on HPV epidemiology and related diseases. It will be of great value to educate medical and paramedical personnel on HPV infection and associated diseases and it will be of great help to public health authorities and decision makers when they have to evaluate the convenience of introducing HPV vaccination in a given population.

Human papillomavirus-related diseases in HIV-infected individuals

To present recent publications in human papillomavirus-associated diseases and their relationship to HIV-infected patients. Studies assessing geographic variations in human papillomavirus types and prevalence in cervical dysplasia and cancer in HIV-infected women suggest that although human papillomavirus types 16 and 18 dominate, multiple other human papillomavirus types may play a role in carcinogenesis. Anal dysplasia and cancer incidence continues to rise in the highly active antiretroviral therapy era; however, data on outcomes following therapy for anal dysplasia (infrared coagulator, high-resolution anoscopy-guided ablation) and anal cancer (chemoradiation and possibly intensity-modulated radiation therapy) have been encouraging. Oral human papillomavirus may be associated with lower genital tract human papillomavirus infection and may have implications in the development of oropharyngeal cancer. As HIV-infected patients in the highly active antiretroviral therapy era continue to have high rates of cervical and anal cancer, it is important to continue screening efforts and treatment of preinvasive disease. Treatment options for anal dysplasia and anal cancer in HIV-infected individuals are expanding and may lead to decreased morbidity and mortality. Trials assessing safety and immunogenicity of the human papillomavirus quadrivalent vaccine in people with HIV have started enrollment, and if successful, may prevent many human papillomavirus-associated cancers.

Epidemiology of Human Papillomavirus Infection in Men, Cancers other than Cervical and Benign Conditions

Human papillomavirus (HPV) infection is commonly found in the genital tract of men and women with or without any clinical lesion. The association of HPV DNA with several different ano-genital cancers other than cervical has been reported for the vulva, vagina, anus and penis. HPV DNA has also been identified in head and neck cancers in the oral cavity, the oropharynx and the larynx in both sexes. In men, 80-85% of anal cancers and close to 50% of penile cancers are associated with HPV infection. In women, HPV DNA is prevalent in 36–40% vulvar cancer cases and close to 90% of vaginal cancers. There is limited data available on the natural history and HPV-related diseases in the genital tract in men, although studies are ongoing. Efficacy of HPV vaccines in the prevention of HPV infection and disease among men also remains unknown. Among HPV DNA positive ano-genital cancer cases, HPV-16 is the most frequently found followed distantly by HPV-18. In benign HPV-related diseases such as genital warts or recurrent respiratory papillomatosis HPV-6 and 11, the two most frequent non-oncogenic types, are the predominant types detected. Oncogenic types are rarely detected. In this article we summarize and review studies describing the natural history of HPV infections among men and its impact on HPV related disease in women. We summarize the evidence linking HPV in the epidemiology and etiology of cancers of the vulva, vagina, anus and oropharynx and present recent estimates of the burden of and HPV type distribution in genital warts and in cases of HPV infection of the airways.

New Approaches to Cervical Cancer Screening in Latin America and the Caribbean

Cervical cancer remains an important public health problem in the Latin America and Caribbean region (LAC), with an expected significant increase in disease burden in the next decades as a result of population ageing. Prophylactic human papillomavirus (HPV) vaccine is currently unaffordable in LAC countries. However, even if vaccination was implemented, an additional two decades will be required to observe its impact on HPV related disease and cancer. With some exceptions, cytology-based screening programs have been largely ineffective to control the problem in the region, and there is a need for new approaches to the organization of screening and for use of newly developed techniques. Several research groups in LAC have conducted research on new screening methods, some of which are summarized in this paper. A recommendation to reorganize screening programs is presented considering visual inspection for very low resource areas, improvement of cytology where it is operating successfully and HPV DNA testing followed by visual inspection with acetic acid (VIA) or cytology as soon as this method becomes technically and economically sustainable. This could be facilitated by the incorporation of new, low-cost HPV DNA testing methods and the use of self-collected vaginal specimens for selected groups of the population. An important requisite for screening based on HPV testing will be the quality assurance of the laboratory and the technique by validation and certification measures.

Population Benefit of a Quadrivalent Human Papillomavirus (Types 6, 11, 16, and 18) L1 Viruslike Particle Vaccine for Prevention of Human Papillomavirus-related Disease

Population Benefit of a Quadrivalent Human Papillomavirus (Types 6, 11, 16, and 18) L1 Viruslike Particle Vaccine for Prevention of Human Papillomavirus-related Disease

Emerging Preventative Strategies for Cervical Cancer and Other Human Papillomavirus-Related Diseases

Emerging Preventative Strategies for Cervical Cancer and Other Human Papillomavirus-Related Diseases

Emerging Preventive Strategies for Cervical Cancer and Other Human Papillomavirus-Related Diseases

Emerging Preventive Strategies for Cervical Cancer and Other Human Papillomavirus-Related Diseases

A five‐year audit of anal cancer in Wales

A retrospective audit has been undertaken of Squamous (epidermoid) type of anal cancer diagnosed and treated in the principality of Wales over a five-year period (1995-99) with follow-up until 2005. The referral pattern, distribution, presenting symptoms, predisposing conditions, clinical findings and staging modalities were documented. The surgical and oncological treatment together with their outcome was analysed. Patients were identified from the Welsh Cancer Registry and the pathology databases of the 17 acute hospitals in Wales. Data was collected from the clinical and oncology case notes onto a purpose designed Microsoft access database. There was a wide variation in data quality from the individual units. Twenty-six anal cancers were diagnosed per year in the region. Median age was 69 years. Ten percent had documented perianal Human Papilloma Virus related disease. Radiology was inconsistently used for staging. Eighty percent were referred for an oncology opinion; 50% had chemo-radiotherapy with a curative intent. The over-all Stoma rate was 35% and of these 18% had an abdomino perineal resection. The overall five-year survival was 45%. This is a unique regional audit of anal cancer. Improvements need to be made in documentation particularly of staging, treatment, pathology reporting and outcome. This study concurs that Human Papilloma Virus appears to predispose to Squamous anal cancer. Radiological staging needs to be standardized according to best clinical practice. As recommended by NICE all patients should be referred to a multidisciplinary anal cancer team, which can provide individual treatment plans. Increased specialization could mean specialist regional MDTs for anal cancer.

Advances in Prevention of Cervical Cancer and Other Human Papillomavirus-Related Diseases

In theory, recognition that a pandemic infection is responsible for more than half a million cancer cases each year would attract huge media attention, and infection control would become the subject of preventative efforts from all global health agencies. Media attention would likely be particularly acute if the majority of deaths was among women rearing families in the developing world and if the disease were sexually transmitted. A vaccine capable of preventing the disease would be diligently pursued and, once available, promptly distributed for the health and welfare of humankind. Human papillomavirus (HPV) infection fits this scenario; however, HPV has yet to make an impact on either the media or public thinking as outlined in the previous paragraph, even though the link between HPV infection and cervical cancer has been recognized for more than 20 years. It is possible that the delay between acquisition of HPV infection and death, on average 20 years, or the asymptomatic nature of acute infection, greatly diminishes the immediacy of the public impact of this epidemic. Although apparently safe vaccines capable of preventing 90% of HPV infections are in the offing, focus on prevention of HPV associated deaths is being diverted by debates about the morality of vaccination against a sexually transmitted infection and its hypothesized impact on human sexual behavior. A roundtable discussion was held in Vancouver, British Columbia to consider and develop a consensus statement among informed clinicians about HPV infection, the role of HPV in cervical cancer, the role of HPV in other anogenital malignancies, the role of HPV in genital warts and the prospects for control of the global HPV pandemic through vaccination. The consensus statements outlined within have been agreed upon and represent the informed opinions of this expert working group.

CME Posttest: Pediatric Infectious Disease Journal?? Supplement: Advances in Prevention of Cervical Cancer and Other Human Papillomavirus-Related Diseases

CME Posttest: Pediatric Infectious Disease Journal?? Supplement: Advances in Prevention of Cervical Cancer and Other Human Papillomavirus-Related Diseases

CME Overview: Pediatric Infectious Disease Journal?? Supplement: Advances in Prevention of Cervical Cancer and Other Human Papillomavirus-Related Diseases

CME Overview: Pediatric Infectious Disease Journal?? Supplement: Advances in Prevention of Cervical Cancer and Other Human Papillomavirus-Related Diseases

Psychological Impact of Human Papillomavirus and Pap Testing in Adolescents and Young Women

HUMAN PAPILLOMAVIRUS (HPV) INFECTION is common in adolescents and young adult women yet the vast majority of HPV-related cervical diseases in this population are low-grade lesions that regress spontaneously. Compared with conventional Papanicolaou (Pap) screening methods new cervical cancer screening technologies such as liquid-based Pap smear testing and HPV DNA testing have improved sensitivity to detect HPV infection and related disease. Although improved sensitivity increases the potential to better diagnose precancerous cervical lesions many adolescents and young women who will ultimately clear their HPV infection without long-term clinical sequelae will have to face the psychological burden of a positive HPV related test result. Studies have demonstrated the potential negative psychological impacts of positive HPV-related test results in adult women but few have addressed these issues in adolescents and young adults. The study in the Journal of Women’s Health by Kahn et al. addresses important deficits in our understanding of the psychological behavioral and interpersonal impacts of Pap and HPV testing in this population. (excerpt)

Progress towards a vaccine for cervical cancer

The aim of this review is to present for gynaecologists new information on human papillomavirus infections, their spontaneous evolution, and their consequences on the transformation of target tissues. It emphasizes the need for vaccination, both as a preventive tool and therapeutic agent, and reports the progress made so far. Human papillomavirus infection is often transient and spontaneously reversible. High-risk human papillomavirus persistence is the major cause of cancerous transformation in several tissues. Preventive vaccination has already demonstrated remarkable efficacy against the development of some human papillomavirus type related anogenital lesions. Therapeutic vaccination has now also been developed to cure pre-existing lesions. Some new screening protocols can be derived from these experiments. Both preventive and therapeutic human papillomavirus vaccinations will probably change our approach to the screening and therapy of human papillomavirus-related diseases in the next few years. The mass vaccination of adolescent patients should lower the frequency of these very frequently lethal infections.

Therapy for genital human papillomavirus-related disease

Genital human papillomavirus (HPV) infection is very common, and often sub-clinical and usually resolves without any treatment. Genital warts are caused by HPV 6/11 infection and are one of the commonest clinically recognised disease manifestations of genital HPV. Subjects with genital warts usually perceive them as cosmetically disfiguring, often leading to adverse psychological symptoms, and most subjects with genital warts will present requesting treatment. A wide variety of treatments are available including both provider- and patient-applied therapies. Various individual subject and disease factors mediate appropriate therapy choice. Some of the treatments that are used for genital warts can also be used for some cases of intraepithelial neoplasia caused by high-oncogenic risk HPVs occurring at vulval, anal or penile sites. Specific treatment considerations apply to genital warts in pregnancy and laryngeal papillomatosis and these are also discussed.

Vulvar Cancer in Human Immunodeficiency Virus-Seropositive Premenopausal Women: A Case Series and Review of the Literature

This review describes three cases of human immunodeficiency virus-infected women who were diagnosed with vulvar cancer before age 40 years. A retrospective chart review was performed for three patients who were younger than 40 years of age and who had histologically confirmed invasive squamous cell carcinoma of the vulva diagnosed between 1999 and 2002. Demographic, clinical, and laboratory data were recorded. Three human immunodeficiency virus-seropositive women were diagnosed with invasive squamous cell carcinoma of the vulva, stages IA, IB1, and III. All cases were characterized by extensive surrounding vulvar, vaginal, and cervical intraepithelial neoplasia. CD4 cell counts were 250, 330, and 900 cells/uL. Two patients experienced previous acquired immune deficiency syndrome-defining illnesses: toxoplasmosis and cervical cancer. Vulvar cancer in young human immunodeficiency virus-seropositive women may be associated with other human papillomavirus-related diseases and immunosuppression, as evidenced by low CD4 counts and the presence of antecedent acquired immune deficiency syndrome-defining illnesses.

Assessing the Annual Economic Burden of Preventing and Treating Anogenital Human Papillomavirus-Related Disease in the US

The anogenital human papillomavirus (HPV) is estimated to be the most commonly occurring sexually transmitted infection in the US. Comprehensive estimates of the annual economic burden associated with the prevention and treatment of anogenital HPV-related disease in the US population are currently unavailable. The purpose of this paper is to (i) outline an analytic framework from which to estimate the annual economic burden of preventing and treating anogenital HPV-related disease in the US; (ii) review available US literature concerning the annual economic burden of HPV; and (iii) highlight gaps in current knowledge where further study is particularly warranted. Among eight US studies identified that describe the annual economic burden pertaining to one or more aspects of anogenital HPV-related disease, three met the review eligibility criteria (published between 1990 and 2004, examined multiple facets of annual anogenital HPV-related economic burden, and clearly articulated the data and methods used in the estimation process). All costs were adjusted to 2004 US dollars. Estimates of the annual direct medical costs associated with cervical cancer were comparable across studies (range 300-400 million US dollars). In contrast, there was a wide range across studies for estimates of the annual direct medical costs associated with cervical intraepithelial neoplasia (range 700 million US dollars-2.3 billion US dollars). Only one study reported direct medical costs for anogenital warts (200 million US dollars) and routine cervical cancer screening (2.3 billion US dollars). No studies examined direct medical costs attributable to HPV-related anal, penile, vaginal or vulvar cancers, or the work and productivity losses resulting from time spent receiving medical care, morbidity or mortality. Current economic burden estimates would suggest annual direct medical costs associated with the prevention and treatment of anogenital warts and cervical HPV-related disease of at least 4 billion US dollars. This figure would likely rise to at least 5 billion US dollars per year if direct medical costs associated with other disease entities caused by the sexual transmission of HPV were included, with further additions to the economic burden totalling in the billions of dollars if work and productivity losses were incorporated, a research priority for future studies.

The health care costs of cervical human papillomavirus–related disease

Objective The purpose of this study was to examine the health care costs of cervical human papillomavirus–related disease in a US health care setting. Study design We conducted an observational cohort study using 1997 through 2002 administrative and laboratory records from 103,476 female enrollees of the Kaiser Permanente Northwest health plan (Portland, Ore). We examined the cost per case and annual cost per 1000 enrollees for cervical human papillomavirus–related events. Results A cervical examination with a normal routine papanicolaou smear incurred costs of $57 (95% CI, 57-57). Costs that were associated with abnormal routine screening diagnoses ranged from $299 for atypical squamous cells (95% CI, 245-352) to $2349 for high-grade squamous intraepithelial lesion (95% CI, 1,047-3,650). The costs of histologically confirmed cervical intraepithelial neoplasia ranged from $1026 for cervical intraepithelial neoplasia 1 (95% CI, 862-1191) to $3235 for cervical intraepithelial neoplasia 3 (95% CI, 2051-4419); a cost of $376 (95% CI, 315-436) was associated with false-positive test results. At the level of the health plan, overall annual cervical cancer prevention and treatment costs were $26,415 per 1000 female enrollees, with routine cervical cancer screening accounting for expenditures of $16,746 per 1000 female enrollees, cervical intraepithelial neoplasia accounting for expenditures of $4535 per 1000 female enrollees, cervical cancer accounting for expenditures of $2629 per 1000 female enrollees, and false-positive test results accounting for expenditures of $2394 per 1000 female enrollees. Conclusion These are the first direct estimates of both individual and population level costs of cervical human papillomavirus–related disease in a general US health care setting. Routine cervical cancer screening comprises nearly two thirds of total annual cervical human papillomavirus–related health care costs, with 10% of expenditures dedicated to the treatment of invasive cervical cancer, 17% to the management of cervical precancers, and 9% to dealing with false-positive Papanicolaou test results.

Medical therapy of genital human papilloma virus-related disease.

Medical therapy of genital human papilloma virus-related disease.