Non-Vaccine Oncogenic HPV Genotypes Persist in HPV-Vaccinated Women With HIV

By Will Boggs MD

February 07, 2020

NEW YORK (Reuters Health) - Women living with HIV who received quadrivalent human papillomavirus (HPV) vaccination still face the risk of infection with non-vaccine oncogenic HPV genotypes, researchers from Canada report.

"These findings suggest that regardless of prior HPV vaccination status, it is particularly important to continue regular cervical cancer screening in women living with HIV to prevent development of pre-cancer or cancer caused by oncogenic HPV types not contained in vaccines," Dr. Deborah Money of the University of British Columbia, in Vancouver, Canada, told Reuters Health by email.

The prevalence of HPV infection is twice as high among women living with HIV (WLWH) as among women without HIV, and the disparity in invasive cervical cancer incidence rates is equally wide - 16 per 100,000 person-years in WLWH versus 5 per 100,000 person-years in women without HIV.

Dr. Money and colleagues assessed rates of new persistent infection with oncogenic HPV types not contained in the quadrivalent HPV vaccine among 284 WLWH who received that vaccine (the only one available when the study started).

The most frequently documented persistent infections were with HPV51 (1.4 cases per 100 person-years), followed by HPV52 (1.2/100 PY), HPV39 (1.1/100 PY), HPV45 (0.9/100 PY) and HPV35 (0.7/100 PY), the team reports in the Journal of Acquired Immune Deficiency Syndromes.

Of these, only types HPV45 and HPV52 are included in the newer nonavalent HPV vaccine, leaving an incidence of 3.6/100 PY for persistent infection with HPV types not contained within either vaccine.

"This implies that the nonavalent vaccine could further assist in the protection of WLWH, but gaps in protection for this population would remain," the authors note.

"We hope that physicians will vaccinate their patients who are living with HIV with the highest valency HPV vaccine available to them, as they do benefit from vaccination," Dr. Money said. "We also hope that they will continue to regularly engage women living with HIV in cervical cancer screening, regardless of their HPV-vaccination status."

"The WHO has recently announced a global goal of cervical cancer elimination," she said. "Women living with HIV will be a critical population to consider due to their increased risk of HPV infection and cervical cancer. The countries with the highest burden of cervical cancer are the same countries with high rates of HIV. In order to achieve this global goal, multiple strategies for cervical-cancer prevention, including vaccination and screening, will need to be employed both in women with and without HIV."

"There remain unanswered questions about HPV and HPV vaccines in women living with HIV, and we need to continue to do further studies to achieve the global goal of cervical cancer elimination," Dr. Money said.

SOURCE: Journal of Acquired Immune Deficiency Syndromes, online January 8, 2020.