HIV-positive mothers for HIV respond well to the vaccine Gardasil, which acts against human papillomavirus HPV, offering them protection against cervical cancer, according to a study published in theElectronic edition 14 AprilInfectious Disease Clinic. Recent research related discovered that both Gardasil and Cervarix, are effective in people with HIV.Translator's Note: [Puerperium is the name given to postpartum phase, in which women experience physical and psychological changes. This is the time that elapses from the dequitadura until the reproductive organs of the mother return to their pre-pregnancy state. At this stage, the woman is called postpartum.]
High-risk strains of HPV - more commonly HPV-16 and 18-HPV - can cause cervical, anal cancer and other cancers. Most people are infected with HPV soon after becoming sexually active, and the Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for girls aged 11-26 and 11-21 age boys. Studies have shown that people living with HIV, particularly those with impaired immunity, are more likely to be infected with several HPV types and is less likely to cure this infection.
Erna Milunka Kojic, Susan Cu-Uvin and colleagues at Brown University conducted a study among women with HIV in the US, Brazil and South Africa to determine the safety and immunogenicity - or the ability to stimulate an immune response - of Gardasil, the HPV quadrivalent vaccine designed to protect against HPV types 6, 11, 16 and 18 (the 6 and 11 types cause genital warts).
The group Clinical Trials 5240, 319 which included HIV positive women were stratified by age group 13 45 the years with T-cell count CD4. Greater than 350 cells / mm3, 200-350 cells / mm3Or<200 cells/ Mm3. Most (56%) were black, 31% were Hispanic or Latino, 11% were white and the average age was 36 years. The median score of CD4 was 310 cells / mm3- Indicating the need for antiretroviral therapy (ART) - but only 40% had detectable HIV viral load.
- At baseline, 4% of the participants were infected with 4 all HPV types targeted by the vaccine.
- In 28 weeks after immunization, seroconversion rates - or the development of protective antibodies against HPV types 6, 11, 16 and 18, among women not already infected with each HPV type were:
The> 350 cells / mm3:96% 98% 99% and 91%, respectively.
The 200-350 cells / mm3: 100% 98% 98% and 85%, respectively.
The <200 cells / mm3:84% 92% 93% and 75%, respectively.
- At all levels of CD4 cell counts, the response was better for HPV types 6, 11 and 16 compared with 18 type.
- Minor CD4 cell count and high viral load (greater than 10.000 copies / ml have also been associated with a worse response to the vaccine.
- The vaccine was generally well tolerated and safety issues were identified.
"HPV quadrivalent vaccine directed to types 6, 11, 16 and 18, was safe and immunogenic in HIV-infected women 13-45 years," concluded the authors of the study. "Women with HIV viral load> 10.000 copies / mL and / or CD4 counts <200 cells / mm 3, had lower seroconversion."
The fact that only 4% of HIV positive women in this study had all 4 types of HPV covered by the vaccine indicate that the rest should benefit from vaccination, even though many were above the cutoff age of 26 years, based on CDC guidelines. These data support the recommendation of the World Health Organization that women with HIV should be vaccinated against HPV.
Gardasil vs Cervarix
In a study described byLars Toft Niesenand colleagues atJournal of Infectious Diseases of 15 April 2015and a study on University Hospital, Denmark, was compared the immunogenicity of Gardasil and Cervarix in people with HIV. While Gardasil protects against HPV types 4, Cervarix is a bivalent vaccine designed only to prevent cancer - immunizing against types 16 and 18.
This double-blind randomized study included 92 HIV positive women and men who were randomly assigned to receive 3 doses of Gardasil, Cervarix, at baseline and 1,5 and 6 months later. Immunogenicity was evaluated by a maximum of 12 months. [Translator's note: a double-blind study is one where doctors and patients do not know who is receiving placebo or active therapeutic element, which, in theory, brings greater reliability to the study - in this case those involved did not know what kind of vaccine were prescribing or receiving, as the position of each of the study]
The researchers found no differences in the levels of antibodies against HPV-16 in participants who received Gardasil or Cervarix. However, the numbers of antibodies against HPV-18 Gardasil were higher in the group than in the group receiving Cervarix. Among people receiving Cervarix, women reached antibody concentrations against HPV and HPV-16-18 higher than men; Gender differences were not seen among those who received Gardasil. Mild reactions at the injection site of the vaccines were more common in Cervarix group (91 70%% vs), but there were no serious adverse events in any study arm.
"Both vaccines were immunogenic and well tolerated," the authors concluded. "In comparison to Gardasil, Cervarix vaccine was superior because it induced best immunogenic responses among HIV-infected women, whereas in HIV-infected men the difference in immunogenicity was less marked."
The originalHuman Papillomavirus Vaccine Is Effective for Women with HIV. Translated by Claudio Souza and reviewed by Mara Macedo in August 08 2015
Kojic MS, M Kang MS Cespedes, Cu-S Uvin, et al. Safety and immunogenicity of a quadrivalent Human Papillomavirus Vaccine in HIV-Infected Women-1. Clinical Infectious Diseases. April 14, 2014 (Epub).
Toft L, M Storgaard, Müller M, et al. Comparion of the immunogenicity and reactogenicity of Cervarix and Gardasil human papillomavirus vaccines in HIV-infected adults: a randomized, double-blind clinical trial. Journal of Infectious Diseases 209 (8): 1165-1173. April 15, 2014.
Brown University. HIV + Women Respond Well to HPV Vaccine.Press release. April 16, 2014.