People living with HIV

Seroprevalence of HPV vaccine types 6, 11, 16 and 18 in HIV-infected women from South Africa, Brazil and Botswana

Firnhaber C, Evans D, Friedman-Khalili R, Willliams S, Michelow P, Matlhagela K, Wester C, Grinsztejn B, Lockman S. J Clin Virol. 2011 Nov;52(3):265-8. Epub 2011 Sep 9

Many resource limited settings suffer from high rates of both cervical cancer and HIV. Limited HPV serology data are available from resource limited settings; such data could help describe local patterns of Human Papilloma Virus infection and predict vaccine efficacy. To determine seropositivity to HPV types 6, 11, 16 and 18 in HIV-infected women from South Africa, Botswana, and Brazil. HPV serotyping for high-risk types 6, 11, 16 and 18 was performed on samples collected from HIV-infected women from 2003-2010 using competitive Luminex Immuno Assay (HPV-4cLIA). Firnhaber and colleagues examined the association between seropositivity to these HPV types and country of enrollment, CD4, HIV-1 RNA level, and Pap smear. HPV serology results were available for 487 HIV-infected women (157, 170 and 160 from South Africa, Botswana, and Brazil respectively). Approximately 65% of women had serum antibodies to one of the 4 HPV types and less than 3% of women had antibodies to all 4 serotypes. Approximately 30% women demonstrated antibodies to type 16 HPV. Rates of seropositivity to HPV 11, and HPV 16+18 varied significantly between countries. Statistical difference was also shown in women in different age categories in the different countries. There was no difference in serology results compared by CD4 count, HIV viral load or Pap smear results. These data suggest that the quadrivalent vaccine may be effective in preventing HPV infection in these countries.

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Editor’s note: Cervical cancer is the third most common cancer in women with an estimated 85% of the global burden experienced in resource-constrained settings. Lack of access to services that provide early diagnosis of cervical abnormalities through visual screening with acetic acid or PAP tests means that HPV (human papilloma virus) infection that is persistent can develop undetected into cervical cancer. WHO reports that in 2007, 275,000 women died of cervical cancer, a cancer that can be cured if caught early and that is now vaccine-preventable. The two vaccines now available prevent cervical cancer from developing from HPV infection. As this article reveals, it is incorrect to assume that women living with HIV in countries as diverse as South Africa, Brazil, and Botswana have already had HPV infection. Only 3% of women had antibodies to all four of the types included in the quadrivalent vaccine, meaning that only they would not benefit from vaccination. Fully 35% had no evidence in their serum of previous HPV infection and 60% had no evidence of previous infection with the high-risk HPV subtypes 16 and 18. A number of trials are now underway assessing the safety and immunogenicity of HPV vaccination among women with HIV who have varying CD4 count levels and their results will inform policy and programming. In the meantime, preventing HPV infection in the first place through vaccination before sexual debut makes most sense for girls and now for boys worldwide.

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