Natural History Of Human Papillomavirus Infection Research Articles

P1-229 Diet quality of male adult participants him study- Brazil (natural history of hpv infection in men): multicentric study

IntroductionThe study “Natural History of HPV Infection in Men” (HIM study) is an international multicenter prospective cohort study that seeks to determine the incidence, persistence and remission of human papillomavirus...

Prognostic Implication of High Risk Human Papillomavirus E6 and E7 mRNA in Patients with Intraepithelial Lesions of the Cervix in Relationship to Age

Since the introduction of the cytological screening programs, a significant reduction in the incidence of cervical cancer has been achieved. Almost all of these cancers are related to high-risk (HR) Human Papillomavirus (HPV) cervical infections. However, the natural history of HPV infection seems to be different in younger patients, resulting in a higher rate of regression. There is, therefore, the need to identify HPV-related biomarkers in order to enhance the effectiveness of screening of high-risk cytological lesions, in particular in women over 35 years of age. This study aims to evaluate the prognostic value of the HR HPV E6 and E7 mRNA expression in women with intraepithelial lesions of the cervix, older or younger than 35 years of age. One hundred and eighty-four HR HPV DNA positive patients with a low squamous intraepithelial lesion (LSIL) were tested for mRNA expressions, included in an observational study, and evaluated at follow-up with standard cytology up to 24 months from the mRNA test. The frequency of HSIL/LSIL cytology in the older cohort of mRNA positive patients was significantly higher compared to mRNA-negative patients, both at 1 and 2 years of follow-up (Chi-square: p 0.007 and p 0.009), but this difference was not found in the younger cohort. According to our results, the E6/E7 mRNA test could be a biomarker for viral activity, useful in identifying patients at higher risk of abnormal cytology, and in implementing the management of HR HPV DNA-positive women over 35 years of age.

Anal Warts and Anal Intradermal Neoplasia

For the last five millennia we have been dealing with the annoyance of verrucas. Anogenital human papillomavirus (HPV) infection is the most common sexually transmitted disease in the United States and is increasing in incidence. As in other gastrointestinal conditions, HPV infection can lead to a stepwise transition from normal cells to dysplastic cells and then to invasive anal cancer. Knowledge of the natural history of HPV infection, risk factors, diagnostic tools, and therapeutic methods gives us the tools to adequately prevent, evaluate, treat, and counsel our patients. In this review, the authors detail the diagnosis, management, and treatment of anal condyloma and anal intraepithelial neoplasia with a focus on prevention, early detection, and treatment using current data and technology.

Is human papillomavirus screening preferable to current policies in vaccinated and unvaccinated women? A cost-effectiveness analysis

Italy was the first European nation to offer free vaccination against human papillomavirus (HPV) types 16 and 18. The vaccination is actively encouraged and is available free of charge to 11-year-old girls. The introduction of new technologies such as HPV DNA testing and HPV vaccination requires cost-effectiveness analysis of cervical cancer strategies in Italy for both vaccinated and unvaccinated women. A calibrated Markov model was developed to describe the natural history of HPV infection and cervical carcinogenesis. We performed a microsimulation generating the life histories of 10 million women. Changes in these life histories occur as consequences of prevention strategies. We estimated costs of screening activities using an activity-based costing analysis. We assessed lifetime risk due to cervical cancer, lifetime costs and quality-adjusted life-expectancy (QALE) for 18 scenarios. Strategies varied by screening interval (three and five years), primary and triage test (Pap test and HPV DNA test), and HPV 16 and 18 vaccination. The current screening policy (Pap test every three years) is more costly and less effective than HPV DNA test and Pap test triage every five years. For unvaccinated women an HPV DNA test every five years with a Pap test triage was cost-effective (ICER €5753/QALE). Vaccination followed by the same screening strategy was cost-effective (ICER €23,951/QALE) for women who are eligible to be vaccinated. Our findings strongly support changing the Pap screening policy to the use of HPV DNA as a primary test with Pap test triage for both vaccinated and unvaccinated women.

The association of hormonal contraceptive use and HPV prevalence

Women diagnosed with cervical cancer report longer duration and more recent use of combined oral contraceptives (COCs). It is unclear whether COC use is associated with upstream events of human papillomavirus (HPV) infection prior to development of clinical disease. The objective of our study was to assess the association of contraceptive use on the risk for prevalent HPV infection in a cohort of long-term hormonal contraceptive (HC) users. One thousand and seventy (n = 1,070) HIV-negative women aged 20-37 from Thailand enrolled in a prospective study of the natural history of HPV. Baseline HPV genotype information, recency and duration of HC use, sexual behavior, other sexually transmitted infection (STI) information and cervical cytology and histology were assessed. At enrollment, 19.8% and 11.5% of women were infected with any HPV or any high-risk (HR)-HPV, respectively. After adjustment for age, current and past sexual risk behaviors, STI history and cytology, the use of COCs for >6 years was found to be associated with an increased risk of infection with any HPV [prevalence ratio (PR): 1.88 (1.21, 2.90)] and any HR-HPV [PR: 2.68 (1.47, 4.88)] as compared to never users. Recent, long-term COC use was associated with an increased risk for prevalent HPV infection independent of sexual behavior and cervical abnormalities. No similar association was observed for recent or long duration use of progestin-only contraceptives (i.e., depomedroxyprogesterone acetate). These data suggest that COC use may impact early upstream events in the natural history of HPV infection.

Genotype‐Specific Persistence of Genital Human Papillomavirus (HPV) Infections in Women Followed for 6 Years in the Finnish Family HPV Study

Persistent human papillomavirus (HPV) infection is the most important risk factor for cervical cancer, and understanding genotype-specific HPV persistence is essential for elucidating the natural history of HPV infections. In the Finnish Family HPV Study, 329 pregnant women (mean age, 25.5 years) were recruited during the third trimester of pregnancy and were followed up for 6 years. Multiplex HPV genotyping for 27 low- and high-risk HPV types was used to define genotype-specific prevalence at each visit. Generalized estimating equation models were constructed to estimate predictors of type-specific persistence (positive results at 2 consecutive visits) of species 7 and 9 HPV genotypes. HPV16 was the most common type, followed by HPV types 18, 31, 35, 45, 58, 70, and 6. Prevalence of multiple infections ranged from 21% to 45%. Persistence was most prolonged for HPV types 35, 58, and 52, with durations of 38.7, 32.1, and 24.2 months, respectively, and was equal for multiple-type infections and HPV16, with durations of 21 and 24 months, respectively. Independent predictors of type-specific persistence of species 7 and 9 HPV genotypes were age (odds ratio, 1.13 [95% confidence interval, 1.02-1.25]; P=.017), oral sex (odds ratio, 0.37 [95% confidence interval, 0.17-0.81]; P=.013), and young age (<13 years) at initiation of smoking (odds ratio, 0.51 [95% confidence interval, 0.27-0.98]; P=.046). HPV16 was the most frequent persisting HPV genotype followed by multiple infections. Early initiation of smoking, practicing oral sex and older age increase the risk for persistence of species 7 and 9 HPV genotypes.

Cost-effectiveness analysis of HPV vaccination alongside cervical cancer screening programme in Slovenia

The objective of the present study is to evaluate the cost-effectiveness of human papillomavirus (HPV) vaccination alongside cervical cancer screening programme in Slovenia. A previously published Markov model representing natural history of HPV infection was adapted to Slovenian context. The model followed a cohort of 12-year-old girls to 85-year-old women. Two strategies were compared: HPV vaccination alongside conventional cytological screening versus screening alone. Analysis was performed from the health care payer perspective. Vaccination with screening compared with screening alone was associated with an incremental cost-effectiveness ratio (ICER) of 23,178 EUR per quality adjusted life-year (QALY) gained and 54,536 EUR per life-year gained (LYG) at the discounting rate of 5%. Sensitivity analyses demonstrated that the ICER was most sensitive to the need for booster dose and to different values of discount rates. In case the booster dose was assumed 10 years after initial vaccination, the ICER value was increased to 58,690 EUR per QALY. On the other hand, using lower values of discount rates than the base case 5% significantly reduced the ICER value. According to the cost-effectiveness thresholds of 30,000 EUR per QALY which was adopted by the Health Council in Slovenia, HPV vaccination alongside screening programme can be regarded as cost-effective. However, cost-effectiveness of HPV vaccination would become questionable in case a booster dose was needed to provide lifetime protection.

Modelling the economic value of cross- and sustained-protection in vaccines against cervical cancer

Objective: Two human papillomavirus (HPV) vaccines are on the market. Based on expected differences in sustained- and cross-protection between the two vaccines, their long-term economic value is modelled and compared for France, Ireland and Italy.Methods: A Markov cohort model reproducing the natural history of HPV infections, screening and vaccination, is adapted to country-specific data. Two hypothetical HPV vaccines (VA and VB) are compared. At baseline VA provides lifetime protection against HPV‐16 and 10-year protection against HPV‐18 before waning. VB is the same as VA with a 10-year protection against HPV‐6 and 11. Sustained- and cross-protection is varied over wide ranges in VA to define the levels that could make VA cost-effective or dominant compared with VB.Results: Under baseline conditions VB dominates VA. VA becomes cost-effective when the difference in cross-protection alone reaches 13–15% (undiscounted), and 22–44% (discounted). A combination of sustained- and cross-protection is required for VA to dominate VB (discounted). The results are dependent upon country, the base-case value and the discount applied.Conclusion: Realistic additional sustained- and cross-protection in one HPV vaccine may confer benefits that offset the economic value of protection against low-risk HPV in the other. The results are country specific.

Decision-analytic modeling to evaluate the long-term effectiveness and cost-effectiveness of HPV-DNA testing in primary cervical cancer screening in Germany.

BackgroundPersistent infections with high-risk types of human papillomavirus (HPV) are associated with the development of cervical neoplasia. Compared to cytology HPV testing is more sensitive in detecting high-grade cervical cancer precursors, but with lower specificity. HPV based primary screening for cervical cancer is currently discussed in Germany. Decisions should be based on a systematic evaluation of the long-term effectiveness and cost-effectiveness of HPV based primary screening.Research questionsWhat is the long-term clinical effectiveness (reduction in lifetime risk of cervical cancer and death due to cervical cancer, life years gained) of HPV testing and what is the cost-effectiveness in Euro per life year gained (LYG) of including HPV testing in primary cervical cancer screening in the German health care context? How can the screening program be improved with respect to test combination, age at start and end of screening and screening interval and which recommendations should be made for the German health care context?MethodsA previously published and validated decision-analytic model for the German health care context was extended and adapted to the natural history of HPV infection and cervical cancer in order to evaluate different screening strategies that differ by screening interval, and tests, including cytology alone, HPV testing alone or in combination with cytology, and HPV testing with cytology triage for HPV-positive women. German clinical, epidemiological and economic data were used. In the absence of individual data, screening adherence was modelled independently from screening history. Test accuracy data were retrieved from international meta-analyses. Predicted outcomes included reduction in lifetime-risk for cervical cancer cases and deaths, life expectancy, lifetime costs, and discounted incremental cost-effectiveness ratios (ICER). The perspective of the third party payer and 3% annual discount rate were adopted. Extensive sensitivity analyses were performed in order to evaluate the robustness of results and identify areas of future research.ResultsIn the base case analysis screening resulted in a 53% to 97% risk reduction for cervical cancer with a discounted ICER between 2,600 Euro/LYG (cytology alone every five years) and 155,500 Euro/LYG (Annual cytology age 20 to 29 years, and annual HPV age 30 years and older). Annual cytology, the current recommended screening strategy in Germany, was dominated. In sensitivity analyses variation in the relative increase in the sensitivity of HPV testing as compared to cytology, HPV test costs, screening adherence, HPV incidence, and annual discount rate influenced the ICER results. Variation in the screening start age also influenced the ICER. All cytology strategies were dominated by HPV screening strategies, when relative sensitivity increase by HPV testing compared to cytology was higher (scenario analysis with data for test accuracy from German studies). HPV testing every one, two or three years was more effective than annual cytology. With increased screening adherence a longer screening interval and with low screening adherence a shorter interval would be more cost-effective. With a reduction in HPV incidence of more than 70% triennial HPV screening in women aged 30 years and older (and biennial Pap screening in women aged 20 to 29 years) is cost-effective. The discounted ICER increases with increasing annual discount rate. Increasing screening start age to 25 years had no relevant loss in effectiveness but resulted in lower costs. An optimal strategy may be biennial HPV testing age 30 years and older with biennial cytology at age 25 to 29 years (ICER of 23,400 Euro/LYG).ConclusionsBased on these results, HPV-based cervical cancer screening is more effective than cytology and could be cost-effective if performed at intervals of two years or greater. Increasing the age at screening start to 25 years causes no relevant loss in effectiveness but saves resources. In the German context an optimal screening strategy could be biennial HPV testing at age 30 years and older with biennial cytology at the age of 25 to 29 years. An extension to a three-yearly screening interval requires substantially improved screening adherence or a higher relative increase in the sensitivity of HPV testing as compared to cytology. The implementation of an organised screening program for quality-controlled introduction of HPV-screening and -vaccination with continued systematic outcome evaluation is recommended.

Epidemiologic Factors Associated with Seropositivity to Human Papillomavirus Type 16 and 18 Virus–Like Particles and Risk of Subsequent Infection in Men

Our understanding of humoral response to human papillomavirus (HPV) infection has been mainly derived from studies in women. The role of serum antibodies in the natural history of HPV in men has yet to be investigated. Data from 285 male participants of a natural history study were used to determine the epidemiologic factors associated with HPV 16/18 seropositivity and explore the role of HPV 16 and 18 serum antibodies in subsequent HPV infections. Serum antibodies were detected by use of HPV 16- and 18 virus-like particles enzyme-linked immunoassay. Logistic regression and Generalized Estimating Equation was used for the evaluation of risk factors. The risk of subsequent HPV infection by baseline antibody status was assessed by incidence rate ratio and its confidence intervals. Men ages 36 to 44 years compared with men ages 18 to 25 years were four times more likely to be seropositive to HPV 16/18. In addition, being divorced, separated, or widowed; being a former smoker; and having sex with men was positively and independently associated with HPV 16/18 seropositivity. Our findings on the potential role of HPV 16 or 18 serum antibodies in subsequent infection were inconclusive. Large prospective studies are warranted to adequately address questions on the role of natural immunity in the natural history of HPV infections in men.

Epidemiology and prevention of human papillomavirus and cervical cancer in sub‐Saharan Africa: a comprehensive review

To identify the gaps of knowledge and highlight the challenges and opportunities for controlling cervical cancer in sub-Saharan Africa (SSA). A comprehensive review of peer-reviewed literature to summarize the epidemiological data on human papillomavirus (HPV) and invasive cervical cancer (ICC) by HIV status, to review feasible and effective cervical screening strategies, and to identify barriers in the introduction of HPV vaccination in SSA. ICC incidence in SSA is one of the highest in the world with an age-standardized incidence rate of 31.0 per 100,000 women. The prevalence of HPV16/18, the two vaccine preventable-types, among women with ICC, does not appear to differ by HIV status on a small case series. However, there are limited data on the role of HIV in the natural history of HPV infection in SSA. Cervical screening coverage ranges from 2.0% to 20.2% in urban areas and 0.4% to 14.0% in rural areas. There are few large scale initiatives to introduce population-based screening using cytology, visual inspection or HPV testing. Only one vaccine safety and immunogenicity study is being conducted in Senegal and Tanzania. Few data are available on vaccine acceptability, health systems preparedness and vaccine cost-effectiveness and long-term impact. Additional data are needed to strengthen ICC as a public health priority to introduce, implement and sustain effective cervical cancer control in Africa.

The Risks and Benefits of HPV Vaccination

HEN DO PHYSICIANS KNOW ENOUGH ABOUT THE beneficial effects of a new medical interventiontostartrecommendingorusingit?When istheavailableinformationaboutharmfuladverse effects sufficient to conclude that the risks outweigh the potential benefits? If in doubt, should physicians err on the side of caution or on the side of hope? These questions are at the core of all medical decision making. It is a complicated process because medical knowledge is typically incomplete and ambiguous. It is especially complex to make decisions about whether to use drugs that may prevent disease in the future, particularly when these drugs are given to otherwise healthy individuals. Vaccines are examples of such drugs, and the human papillomavirus (HPV) vaccine is a case in point. zur Hausen, winner of the Nobel Prize in Physiology or Medicine in 2008, discovered that oncogenic HPV causes cervical cancer. 1-4 His discovery led to characterization of the natural history of HPV infection, an understanding of mechanisms of HPV-induced carcinogenesis, and eventuallytothedevelopmentofprophylacticvaccinesagainstHPV infection.

Chronic Periodontitis−Human Papillomavirus Synergy in Base of Tongue Cancers

To assess whether chronic periodontitis history predicts human papillomavirus (HPV) status in patients with base of tongue cancers. Case-control study using existing patient data. Roswell Park Cancer Institute. Thirty patients newly diagnosed with base of tongue squamous cell carcinoma between 1999 and 2005 for whom both tumor samples and periodontal records were available. Patients younger than 21 years, edentulous, immunocompromised, and those with a history of cancer were excluded. Periodontitis history was assessed on the basis of alveolar bone loss (in millimeters) from panoramic radiographs by one examiner who was blinded to cancer status. HPV-16 and HPV-18 DNA were identified on paraffin-embedded tumor samples by polymerase chain reaction. Multiple logistic regression was used to estimate odds ratios and 95% confidence intervals. The prevalence of tumors positive for HPV-16 DNA was 21 of 30 (70%). None of the samples were positive for HPV-18 DNA. Compared with participants with HPV-negative tumors, patients with HPV-positive tumors had significantly higher mean alveolar bone loss (3.90 mm vs 2.85 mm, P = .01). After adjustment for age at diagnosis, sex, race/ethnicity, alcohol use, smoking status, and number of missing teeth, every millimeter of alveolar bone loss was associated with an approximately 4-fold (odds ratio, 3.96; 95% confidence interval, 1.18-13.36) increased risk of HPV-positive tumor status. Number of missing teeth was not associated with tumor HPV status (odds ratio, 0.95; 95% confidence interval, 0.74-1.21). Chronic periodontitis may be a significant factor in the natural history of HPV infection in patients with base of tongue cancers. Additional confirmation in larger studies is required.

Molecular mechanisms of cervical carcinogenesis by high‐risk human papillomaviruses: novel functions of E6 and E7 oncoproteins

Over the last two decades, since the initial discovery of human papillomavirus (HPV) type 16 and 18 DNAs in cervical cancers by Dr. Harald zur Hausen (winner of the Nobel Prize in Physiology or Medicine, 2008), the HPVs have been well characterised as causative agents for cervical cancer. Viral DNA from a specific group of HPVs can be detected in at least 90% of all cervical cancers and two viral genes, E6 and E7, are invariably expressed in HPV-positive cervical cancer cells. Their gene products are known to inactivate the major tumour suppressors, p53 and retinoblastoma protein (pRB), respectively. In addition, one function of E6 is to activate telomerase, and E6 and E7 cooperate to effectively immortalise human primary epithelial cells. Though expression of E6 and E7 is itself not sufficient for cancer development, it seems to be either directly or indirectly involved in every stage of multi-step carcinogenesis. Epidemiological and biological studies suggest the potential efficacy of prophylactic vaccines to prevent genital HPV infection as an anti-cancer strategy. However, given the widespread nature of HPV infection and unresolved issues about the duration and type specificity of the currently available HPV vaccines, it is crucial that molecular details of the natural history of HPV infection as well as the biological activities of the viral oncoproteins be elucidated in order to provide the basis for development of new therapeutic strategies against HPV-associated malignancies. This review highlights novel functions of E6 and E7 as well as the molecular mechanisms of HPV-induced carcinogenesis.

Sexual Behaviour and HPV Infections in 18 to 29 Year Old Women in the Pre-Vaccine Era in the Netherlands

BackgroundInfection with Human Papillomavirus (HPV) is a necessary event in the multi-step process of cervical carcinogenesis. Little is known about the natural history of HPV infection among unscreened young adults. As prophylactic vaccines are being developed to prevent specifically HPV 16 and 18 infections, shifts in prevalence in the post vaccine era may be expected. This study provides a unique opportunity to gather baseline data before changes by nationwide vaccination occur.Methods and Principal FindingsThis cross-sectional study is part of a large prospective epidemiologic study performed among 2065 unscreened women aged 18 to 29 years. Women returned a self-collected cervico-vaginal specimen and filled out a questionnaire. All HPV DNA-positive samples (by SPF10 DEIA) were genotyped using the INNO-LiPA HPV genotyping assay. HPV point prevalence in this sample was 19%. Low and high risk HPV prevalence was 9.1% and 11.8%, respectively. A single HPV-type was detected in 14.9% of all women, while multiple types were found in 4.1%. HPV-types 16 (2.8%) and 18 (1.4%) were found concomitantly in only 3 women (0.1%). There was an increase in HPV prevalence till 22 years. Multivariate analysis showed that number of lifetime sexual partners was the most powerful predictor of HPV positivity, followed by type of relationship, frequency of sexual contact, age, and number of sexual partners over the past 6 months.Conclusions and SignificanceThis study shows that factors independently associated with HPV prevalence are mainly related to sexual behaviour. Combination of these results with the relative low prevalence of HPV 16 and/or 18 may be promising for expanding the future target group for catch up vaccination. Furthermore, these results provide a basis for research on possible future shifts in HPV genotype prevalence, and enable a better estimate of the effect of HPV 16-18 vaccination on cervical cancer incidence.

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.

Oral HPV complications in HIV-infected patients

Human papillomavirus (HPV) infection and disease, including that of the oral cavity, has not dramatically declined since the introduction of potent combination therapy to control HIV. Two manifestations of HPV in the oral cavity that may be on the rise are HPV-32-associated oral warts and HPV-16-associated oral cancers. A current research focus is the natural history of HPV infections in the oral cavity. A better understanding of the natural history of oral HPV infections could lead to improved diagnosis and treatment for oral HPV complications in HIV-positive patients.

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.

Cost-effectiveness analysis of adding a quadrivalent HPV vaccine to the cervical cancer screening programme in Switzerland

ABSTRACTObjective: Based on positive safety and efficacy data, a quadrivalent Human PapillomaVirus (HPV) vaccine has been approved in Switzerland to prevent HPV types 6, 11, 16 and 18 infections. The objective of this study was to explore the cost-effectiveness of an HPV vaccination in Switzerland.Design and methods: A Markov model of the natural history of HPV infection was adapted to the Swiss context and followed a hypothetical cohort of 41 200 girls aged 11 years over their lifetime. Main epidemiological and economic parameters were extracted from the literature. Two strategies were compared: conventional cytological screening only and HPV vaccination followed by conventional cytological screening. A coverage rate of 80% was used and the vaccine was assumed to provide a lifelong protection. Analyses were performed from the direct health care cost perspective including only direct medical costs.Results: Compared to screening only, adding a quadrivalent HPV vaccine could prevent over lifetime 62% of cervical cancers and related deaths, 19% of Cervical Intraepithelial Neoplasia (CIN 1), 43% of CIN 2, 45% of CIN 3 and 66% of genital warts per cohort. Incremental cost-effectiveness ratios (ICER) were estimated to be CHF 45 008 per Life Year Gained (LYG) and CHF 26 005 per Quality Adjusted Life Year (QALY) gained. Sensitivity analyses demonstrated that the ICER was robust to all parameters, but was most sensitive to the need for a booster and discount rates.Conclusions: Compared to commonly accepted standard thresholds in Europe and other vaccination strategies implemented in Switzerland, adding a quadrivalent HPV vaccine alongside the current cervical cancer screening programme is likely to be cost-effective in Switzerland.

Prevalence of human papillomavirus (HPV) infection in a cohort of young women in Delhi, India

Introduction: HPV is strongly associated with cervical cancer and is highly prevalent in sexually active women. In Indian women, it affects nearly 132,000 and kills 76,000 annually. Geographical variations in the epidemiological aspects of HPV such as incidence, prevalence, age and type distribution are seen and knowledge of these variables in a region‐specific context is necessary for designing effective interventional strategies.Objective: To determine the prevalence of HPV infection and associated genotypes in cervical samples in Northern India.Methodology: 800 exfoliated cervical swab samples were collected from unscreened married women aged 16–24 years. HPV testing was done by Hybrid Capture assay 2 and PCR using PGMY L1 consensus primers. HPV genotyping was done for positive samples by Reverse Line blot array.Results: HPV DNA was detected in 69 (8.6%) samples. In HPV positive samples, type 16 was seen in 36.2% and HPV 51 and 59, 13% each. A single HPV type was found in 40 (58%) cases and mixed infection seen in 29 (42%).Conclusions: Multiple high‐risk HPV infections were most prevalent in young women and HPV‐16 was the dominant type. Etiologic role and persistence are being studied by doing 6 monthly follow up. HPV incidence, prevalence and type can give an indication of the natural history of HPV infection in the younger age group. This study was supported by the Department of Biotechnology, Government of India.