HIV-positive puerperal women respond well to the Gardasil vaccine, which works against human papillomavirus HPV, offering them protection against cervical cancer, according to a study published in the 14 Electronic Edition of April Infectious 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 HPV strains - most commonly HPV-16 and HPV-18 - can cause cervical, anal, and other cancers. Most people are infected with HPV soon after they become sexually active, and the Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for girls age 11-26 and boys age 11-21. Studies have shown that people living with HIV, especially those with compromised immune function, are more likely to be infected with various types of HPV and are less likely to heal from 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 / mm3, or <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 participants were infected with all 4 types of HPV covered 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.
O <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.
- Lower CD4 cell count and elevated viral load (greater than 10.000 copies / ml were also associated with a poorer response to the vaccine.
- The vaccine was generally well tolerated and safety issues were not identified.
"A quadrivalent HPV vaccine targeting 6, 11, 16 and 18 was safe and immunogenic in HIV-infected 13-45 women for years," the study authors concluded. "Women with HIV viral load> 10.000 copies / mL and / or counts of CD4 <200 cells / mm 3, had lower seroconversion."
The fact that only 4% of HIV-positive women in the current study had all of the 4 types of HPV covered by the vaccine indicate that the remainder should benefit from vaccination, even though many were above the age cut of 26 years, based on the guidelines. These data support the World Health Organization's recommendation that women with HIV should be vaccinated against HPV.
Gardasil vs Cervarix
In a study described by Lars Toft Niesen and colleagues in the Journal of Infectious Diseases of 15 April 2015 and in a study done in the University Hospital, in Denmark, the immunogenicity of Gardasil and Cervarix was compared in people with HIV. While Gardasil protects against 4 HPV types, Cervarix is a bivalent vaccine designed only to prevent cancer - immunizing against 16 and 18 types.
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 at 1,5 and 6 months later. Immunogenicity was assessed for a maximum period 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 did not observe differences in antibody levels against HPV-16 in participants who received Gardasil or Cervarix. However, antibody numbers against HPV-18 were higher in the Gardasil group than in the group receiving Cervarix. Among women receiving Cervarix, women achieved higher antibody concentrations against HPV-16 and HPV-18 than men; gender differences were not seen among those who received Gardasil. Mild reactions at the site of injection of vaccines were more common in the Cervarix group (91% vs 70%), but there were no serious adverse effects in any arm of the study.
"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 original Human 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.