Postpartum women with positive HIV serology respond well to the human Gardasil papillomavirus (HPV) vaccine, offering them protection against cervical cancer, according to a study published in the April 14 electronic edition of Clinical Infectious Diseases. Related recent research found that both Gardasil, Cervarix are effective in people with HIV.
HPV-high risk HPV-more commonly HPV-16 and HPV-18 - can cause cervical, anal, and other types of cancer. 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 old boys. 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 eliminate the virus.
Erna Milunka Kojic, Susan Cu-Uvin and colleagues at Brown University conducted a women study with HIV in the US, Brazil and South Africa to determine the safety and immunogenicity - or the ability to stimulate an immune response - the Gardasil vaccine HPV quadrivalent designed to protect against HPV types 6, 11, 16 and 18 (6 and 11 types cause genital warts).
The AIDS Clinical Trials Group researched 5240 individuals, which included 319 HIV positive women who were stratified by age 13-45 and céluas count T-CD4. > 350 cells / mm3, 200-350 cells / mm3, or <200 cells/ Mm3. Most (56%) were black, 31% were Hispanics or Latinos, 11% were white and the average age was 36 years. The median CD4 count was 310 cells / mm3- Indicating the need for anti-retroviral therapy (ART) - but only 40% had detectable HIV viral load.
- At baseline, 4% of the participants were infected with 4 all HPV types covered by the vaccine.
- At 28 weeks after immunization, rates of seroconversion - or development of protective antibodies against HPV types 6, 11, 16 and 18 among women, and not already infected with the virus of each 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 cells, the response was better for HPV types 6, 11 and 16 compared with 18 type.
- And lower cell count CD4 high viral load (> 10.000 copies / mL) was also associated with a poor response to the vaccine.
- The vaccine was generally well tolerated and no safety issues were identified.
"HPV quadrivalent vaccine directed to 6 types, 11, 16 and 18, was safe and immunogenic in HIV-infected women of 13-45 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 this study had all 4 types of HPV covered by the vaccine indicate that the rest should take advantage of it, since many were above the cutoff age of 26 years, as CDC's guidelines. These data support the recommendation of the World Health Organization that women with HIV should be vaccinated against HPV.
Gardasil vs Cervarix
In one study, it was described in April 15 Journal of Infectious DiseasesLars Toft Aarhus University Hospital in Denmark and colleagues compared the immunogenicity of Gardasil, Cervarix in people with HIV. While Gardasil protects against HPV types 4 Cervarix a bivalent vaccine is designed only to prevent cancer - making immunogenicity with the types and 16 18.
This randomized double-blind 92 included 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.
The researchers did not observe differences in antibody levels against HPV-16 in participants who received Gardasil or Cervarix. However, antibodies against HPV-18 were higher in the Gardasil group. Among people receiving Cervarix, women achieved high antibody titers against HPV-16 and HPV-18 than in men; there were no gender differences seen among recipients of Gardasil. Mild reaction at the injection site were more common in the Cervarix group (91% vs 70%), but there were no serious adverse effects in either arm.
"Both vaccines were immunogenic and well tolerated," the authors concluded. "In comparison to Gardasil, Cervarix vaccine produces higher response induced among HIV-infected women, whereas in HIV-infected men the difference in immunogenicity was less marked."
Translated by Original Claudio Souza in human Papillomavirus Vaccine Is Effective for Women with HIV Reviewed by Mara Macedo
MS Kojic, M Kang, MS Céspedes, S Cu-Uvin, et al. Safety and immunogenicity of the quadrivalent vaccine Human papillomavirus vaccine in HIV-1-infected women. Clinical picture Infectious Diseases. 14 2014 OF APRIL (Epub).
L Toft, M Storgaard, M Müller, et al. Fellow immunogenicity and reatogenicity of Cervarix and Gardasil human papillomavirus vaccines in HIV-infected adults: a randomized, double-blind clinical trial. Infectious Disease Officer 209 (8): 1165-1173. 15 2014 OF APRIL.
Brown University. HIV + women respond well to the HPV vaccine.Press release16 de Abril OF 2014.