Human Papilloma Virus Research - Prevention

Wiley DJ, Harper DM, Elashoff D, Silverberg MJ, Kaestle C, Cook RL, Heilemann M, Johnson L. Division of Primary Care, School of Nursing, UCLA, Los Angeles, CA 90095-6919, USA. dwiley@ucla.edu

Few analytic opportunities have allowed us to evaluate the role that specific sexual acts and male latex condoms play in the acquisition of external anal warts (EAW) using longitudinal data. The acquisition of EAWs occurs from epithelial contact with other HPV-infected surfaces, and hence is dependent upon sexual behaviour. Our objectives were to classify the relative importance of condom use, receptive anal intercourse (RAI) and prior history of EGWs on acquisition of EAWs. The observational Multicenter AIDS Cohort Study followed 2925 men over nine semiannual study visits for behavioural and physical examinations with laboratory testing. The main outcome measure was the occurrence of examiner-diagnosed EAWs in a homosexual population. EAWs were diagnosed among 10% of men studied across 22,157 visits reviewed for this study. Men with history of EGWs were more likely than those previously unaffected to have developed EAWs (cOR = 2.4 (2.0, 2.9)), as were men who reported multiple anoreceptive intercourse partners (e.g., compared with men who reported no RAI partners, men with 1, 2-5, > or = 6 RAI partners had crude risk ratios 1.0 (0.8, 1.3), 1.6 (1.2, 2.1), 3.9 (2.7, 5.8), respectively). These relations persisted after other demographic and sexual risk factors were controlled for in the analyses. Consistent condom usage showed no protective effect for EAWs in our crude or adjusted analyses. Patient education messages should be tailored to reflect our uncertainty about the protective nature of condoms for the development of anal warts, but to continue to assert the protective effects of a limited lifetime number of sexual partners and the heightened risk for wart recurrence once infected.

Infect Dis Obstet Gynecol. 2004 Sep-Dec;12(3-4):127-33.

Gynecologists' attitudes regarding human papilloma virus vaccination: a survey of Fellows of the American College of Obstetricians and Gynecologists.

Raley JC, Followwill KA, Zimet GD, Ault KA. Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.

BACKGROUND: Human papilloma virus (HPV) is the causative agent of cervical neoplasia and genital warts. A vaccine has recently been developed that may prevent infection with HPV. Vaccination for HPV may become a routine part of office gynecology. We surveyed members of the American College of Obstetricians and Gynecologists (ACOG) to determine their attitudes to HPV vaccination. METHODS: A survey was sent to Fellows of ACOG to evaluate gynecologists' attitudes. Vaccine acceptability was analyzed using 13 scenarios with the following dimensions and respective attributes: age of patient (13, 17 and 22 years); efficacy of vaccine (50% or 80%); ACOG recommendation (yes or no); and disease targeted (cervical cancer, warts or both). Each scenario was rated by means of an 11-point response format (0 to 100). Responses were evaluated using conjoint analysis. RESULTS: Of 1200 surveys that were sent out, 181 were returned and included in our analysis. ACOG recommendation was considered the most important variable in vaccine distribution (importance score = 32.2), followed by efficacy (24.5), age (22.4) and, lastly, disease targeted (20.9). Of these variables, higher efficacy was favored; preference was given to age 17 years, with a strong disinclination to vaccinate at age 13 years; and protection against cervical cancer, or genital warts, or both, was significantly favored over a vaccine against genital warts alone. Demographic characteristics of the gynecologists (i.e., age of physician, gender, practice setting and community size) did not play an important role in the decision to recommend vaccination. CONCLUSION: Professional society recommendation is important for acceptability of a potential HPV vaccine. Gynecologists are willing to include this vaccine in their office practice.

Expert Rev Anticancer Ther. 2005 Feb;5(1)^:97-107.

Vaccination strategies for the prevention of cervical cancer.

Maclean J, Rybicki EP, Williamson AL. University of Cape Town, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, Observatory Cape Town 7925, South Africa. jmaclean@science.uct.ac.za

Infection with high-risk human papillomaviruses (HPVs) is an essential step in the multistep process leading to cervical cancer. There are approximately 120 different types of HPV identified: of these, 18 are high-risk types associated with cervical cancer, with HPV-16 being the dominant type in most parts of the world. The major capsid protein of papillomavirus, produced in a number of expression systems, self assembles to form virus-like particles. Virus-like particles are the basis of the first generation of HPV vaccines presently being tested in clinical trials. Virus-like particles are highly immunogenic and afford protection from infection both in animal models and in Phase IIb clinical trials. A number of Phase III trials are in progress to determine if the vaccine will protect against cervical disease and, in some cases, genital warts. However, it is predicted that these vaccines will be too expensive for the developing world, where they are desperately needed. Another problem is that they will be type specific. Novel approaches to the production of virus-like particles in plants, second-generation vaccine approaches including viral and bacterial vaccine vectors and DNA vaccines, as well as different routes of immunization, are also reviewed.

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2004 Oct;26(5):558-61.

Correlation between DNA load of human papillomavirus and recurrence of condyloma acuminata

Human Papilloma Virus Research - Article in Chinese

OBJECTIVE^: To determine the correlation between DNA load of human papillomavirus (HPV) and recurrence of condyloma acuminata (CA). METHODS: The HPV6/11 and HPV16/18 DNA load of 31 cases of primary CA and 32 cases of recurrent CA were detected by real-time fluorogenic quantitative PCR. RESULTS: Among the 63 CA patients, 62 cases were HPV6/11 DNA positive. The positive rate was 98.4%. The ranges of HPV6/11 DNA load in primary and recurrent CA were 1.4x10(3)-6.7x10(7) copies/ml and 1.2x10(4)-3.6x10(8) copies/ml respectively. Of 62 cases with HPV6/11 DNA positive, 7 cases were HPV16/18 DNA positive (11.3%). The ranges of HPV16/18 DNA load in primary and recurrent CA were 1.9x10(3)-1.6x10(4) copies/ml and 1.4x10(5)-1.7x10(7) copies/ml respectively. The HPV6/11 and HPV16/18 DNA load in recurrent CA were higher than in primary CA (P < 0.05). The DNA load of HPV6/11 was positively correlated with times of recurrence and course of disease (r=0.37 and 0.30 respectively). CONCLUSION: Certain correlation exists between DNA load of HPV and recurrence of CA.

Vaccine. 2004 Aug 13;22(23-24):3004-7.

A phase I study to evaluate a human papillomavirus (HPV) type 18 L1 VLP vaccine.

Ault KA, Giuliano AR, Edwards RP, Tamms G, Kim LL, Smith JF, Jansen KU, Allende M, Taddeo FJ, Skulsky D, Barr E. Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA. kevin-ault@uiowa.edu

Human papillomavirus (HPV) infection can cause genital warts and cervical cancer. HPV types 6 and 11 cause >90% of genital wart cases; HPV16 and 18 cause 70% of cervical cancers. A prophylactic HPV (types 6, 11, 16, 18) L1 virus-like particle (VLP) vaccine may substantially reduce the incidence of these lesions. This report describes the results of a phase I study of the HPV18 component of such a vaccine. Forty women were randomized to receive either HPV18 L1 VLP vaccine or placebo. Anti-HPV18 responses were measured using a competitive radioimmunoassay (cRIA). Tolerability was evaluated using vaccination report cards (VRC). The study showed that the HPV18 L1 VLP vaccine was generally well-tolerated and highly immunogenic. Peak anti-HPV18 geometric mean titers (GMT) in vaccines were 60-fold greater than those observed in women following natural HPV18 infection. Further studies of a multivalent HPV L1 VLP vaccines are warranted.

Publication Types:
• Clinical Trial
• Clinical Trial, Phase I
• Randomized Controlled Trial

Human Papilloma Virus Research - Prevention of HPV Links

Cancer Prevention Bibliography - Annotated bibliography on the topic.

Cervical Cancer Prevention: Key Issues - This section provides brief summaries of some of the major research areas related to cervical cancer control in low-resource settings.

National HPV and Cervical Cancer Prevention Resource Center - Read information about HPV and cervical cancer prevention, support group referrals, and hotline information.