Higher Risk Young Women May Be Less Likely to be Offered, Accept HPV Vaccine

MedicalResearch.com Interview with:
Dr Rachel J Sacks
Jefferiss Wing,  St Mary’s Hospital
Imperial College Healthcare NHS Trust,
London UK

MedicalResearch.com: What is the background of this study?

Dr. Sacks: 2247 anonymous questionnaires were completed by young women, aged 13-19 years old, attending sexual health services across England, looking at their HPV vaccination outcomes and prevalence of risk factors associated with HPV acquisition and cervical cancer development, and comparing the survey results with national data where available. Known HPV acquisition and cervical cancer development risk factors include cigarette smoking, early age at first intercourse, increasing number of lifetime partners, co-infection with other sexually transmitted infections.

MedicalResearch.com: What are the main findings of the study

Dr. Sacks:

  •          Young women, aged 13  to 19 years old attending sexual health services across England had higher prevalence of known risk factors associated with HPV acquisition and cervical cancer development, compared with national data.
  •          Survey respondents had lower HPV vaccination offer and lower HPV vaccination completion rates than nationally.
  •          Subgroups within the survey respondents were identified as having a significantly lower offer and significantly lower completion rate of the HPV vaccination. These subgroups included respondents from London, those of non-white ethnicities, 17 to 19 year olds, smokers and those not in education, employment or training (NEETs).
  •          The highest risk individuals, in terms of HPV related risk factors, were the least likely to be offered and additional the least likely to complete the HPV vaccination course.
  •          Currently sexual health services in England are not involved in the delivery of the HPV vaccination programme and this is felt to be a huge missed opportunity for the primary prevention of HPV acquisition and its potential sequelae. Sexual health services should be included as a supplementary HPV vaccination delivery site in order to target these particularly vulnerable young women and to increase the success of the HPV vaccination programme in England.

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HPV Vaccination and Prevention of Cervical Abnormalities

MedicalResearch.com Interview with:
Dr Julia Brotherton
Victorian Cytology Service, Melbourne, Victoria, Australia

Dr Elizabeth Crowe
The University of Queensland, School of Population Health, Brisbane, Australia
NHS Borders, Department of Public Health, Melrose, Scotland, UK

Prof. David Whiteman
Group Leader / Department Coordinator
QIMR Berghofer Medical Research Institute
Royal Brisbane Hospital, QLD 4029

MedicalResearch.com: What are the main findings of the study?

1.       We conducted a case-control study in which we retrieved the HPV vaccination histories of young Australian women who were notified to the Pap smear registry with high-grade cervical lesions or with other types of cervical lesions, and compared them with the vaccination histories of women whose Pap smears showed only normal cytology.

2.       We found that women with high grade cervical lesions were significantly less likely than women with normal cytology to have received 3 doses of the quadrivalent HPV vaccine, equivalent to a vaccine effectiveness of 46%.

3.       The vaccine effectiveness among 15-19 year old women was even higher at 57%. We believe this reflects the fact that HPV16 causes an even higher proportion of high grade disease in young women due to its higher oncogenicity and shorter latent period.

4.       The HPV vaccine had 34% effectiveness against other cervical lesions (i.e. those not proven to be high grade lesions on histology).

5.       We also observed that 2 doses of the vaccine were 21% effective in preventing both high grade lesions and other grade lesions.
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HPV Virus Not Killed by Common Sanitizers

Craig Meyers, Ph.D. Distinguished Professor Department of Microbiology and Immunology H107 The Penn State College of Medicine Hershey, PA 17033MedicalResearch.com Interview with:
Craig Meyers, Ph.D.
Distinguished Professor
Department of Microbiology and Immunology H107
The Penn State College of Medicine
Hershey, PA 17033

MedicalResearch.com: What are the main findings of the study?

Dr. Meyers: The human papillomavirus type 16 (HPV16) is the most common HPV type associated with human cancer. It has always been assumed that HPV16 was susceptible to commonly used disinfectants. However, this has never been tested. We developed the only reproducible method to grow authentic HPV in the laboratory. Our studies show that highly resistant virus; more so than other non-enveloped viruses previously tested. Simply stated that any materials in a healthcare facility that rely on disinfectants (those presently used by healthcare facilities) do absolutely nothing to HPV. This suggests the possibility of risk of infection from inanimate objects, particularly those use in healthcare and dental clinics that depend on disinfectant treatment. Additionally it has been reported that at any one time 20% of individuals with anogenital HPV infections have the virus on their fingertips and the common hand sanitizers do nothing to inactivate the virus.
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Genital Warts: Efficacy of Two Doses of HPV Vaccine

Lisen Arnheim Dahlström Associate Professor (Docent) Institutionen för medicinsk epidemiologi och biostatistik Department of Medical Epidemiology and Biostatistics Karolinska Institutet SwedenMedicalResearch.com Interview with:
Lisen Arnheim Dahlström
Associate Professor (Docent)
Institutionen för medicinsk epidemiologi och biostatistik
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet Sweden

MedicalResearch.com: What are the main findings of the study?

Answer: The main finding, when studying HPV vaccine effectiveness against condyloma by dose level is that 3 doses offered the maximum protection, although 2 doses also offered a substantial protection.
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HPV Vaccine: Adverse Events in Adolescent Girls

Lisen Arnheim Dahlström, Associate Professor (Docent) Institutionen för medicinsk epidemiologi och biostatistik Department of Medical Epidemiology and Biostatistics Karolinska Institutet 171 77 Stockholm, SwedenMedicalResearch.com Interview with:
Lisen Arnheim Dahlström, Associate Professor (Docent)
Institutionen för medicinsk epidemiologi och biostatistik
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet
171 77 Stockholm, Sweden

 

MedicalResearch.com: What are the main findings of the study?

Answer: This is a Swedish/Danish population-based study comparing serious disease outcomes in girls immunized with the quadrivalent HPV vaccine against the unvaccinated population.

The main finding of this study was that none of the 53 outcomes included in the study were more common in the vaccinated population compared to the non-vaccinated population.
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HPV Infections: Race May Influence Natural History

MedicalResearch.com interview with: Matthew B. Schabath, Ph.D

Assistant Member, Department of Cancer Epidemiology
H. Lee Moffitt Cancer Center, 12902 Magnolia Drive
MRC-CANCONT, Tampa, Florida

MedicalResearch.com: What are the main findings of the study?

Dr. Schabath: In this study we found that Asian/Pacific Islander men had the lowest incidence of human papillomavirus (HPV) infection and that they exhibited a lower probability of acquiring new HPV infections.   Furthermore, men of multiple and mixed race had the second lowest incidence of HPV infection and however, while they had a lower probability of acquiring HPV, they also had a lower probability of clearing an HPV infection once acquired.
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Study Reveals High Rate of Anal Cancer in HIV-Positive Women

Newswise — NEW YORK CITY (April 12, 2012) — Anal cancer is on the rise among HIV-positive women, according to a Montefiore Medical Center study entitled, “High Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-Infected Women Screened for Anal Cancer,” to be published in the Journal of Aids on May 1.

“Anal cancer was widely associated with HIV-infected men who have sex with men,” said Mark H. Einstein, MD, MS, Director of Clinical Research, Division of Gynecologic Oncology at Montefiore Medical Center and Professor at Albert Einstein College of Medicine. “But now, this study reveals anal precancerous disease in a high proportion of women with HIV.”

Out of 715 asymptomatic HIV-infected women studied, 10.5% exhibited some form of anal disease and approximately one third of them were found to be true pre-cancerous disease. The researchers determined that this is likely due to the fact that HIV promotes human papillomavirus (HPV) persistence and consequently, which is known to cause nearly all anal cancers. HIV-infected individuals are also at increased risk for the development of many other HPV-associated neoplasms.

The incidence of anal carcinoma (AC) has been increasing despite the implementation of antiretroviral therapy (ART), which has not been shown to consistently alter the course of HPV–associated anogenital disease.

The women studied were Montefiore patients in the Bronx, which has one of the highest HIV prevalence rates in the United States. Data indicates that 1.8% of the Bronx population is known to be HIV infected, representing 3% of the total number of HIV patients in the entire country. Montefiore is the largest provider of medical services for people with HIV in the Bronx and has adopted routine screening for AC with annual anal cytology in all HIV-infected patients.

As a result of these findings, Dr. Einstein and his colleagues recommend that all HIV+ women who have any abnormal anal cytology be referred for high resolution anoscopy, particularly those with poorly controlled HIV who are significantly at even higher risk for harboring a high-grade AIN than women who are well controlled. Also, all HIV infected men and women should be considered for anal cancer screening. Given the lower high-grade anal disease prevalence in women with well-controlled HIV, other strategies to improve disease ascertainment, such as inclusion of HPV testing might be found to be useful for AC screening. This risk stratification might prove to be different for women than it is for men, where prevalence rates seem to be considerably higher. Given the high rate of high-grade anal precancerous lesions in screened HIV-infected women and an aging population of HIV-infected patients, measures to increase routine AC screening should be strongly considered. Depending on the size of the pre-cancerous legion, it can be removed long before it becomes cancer, thus being able to save lives.