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Dr Caroline Foster

3 rd Annual Conference of the Children’s HIV Association ‘ Young People and HIV: Back to the Future’. Dr Caroline Foster. Imperial College Healthcare NHS Trust. Friday 15 May, The Bridgewater Hall, Manchester. CHIVA/HYPNet Statement on HPV Vaccination. Who?.

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Dr Caroline Foster

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  1. 3rd Annual Conference of the Children’s HIV Association ‘Young People and HIV: Back to the Future’ Dr Caroline Foster Imperial College Healthcare NHS Trust Friday 15 May, The Bridgewater Hall, Manchester

  2. CHIVA/HYPNet Statement on HPV Vaccination

  3. Who? • Quadrivalent vaccination of perinatally infected girls and boys When? • Age 10-12 with catch up offered to all perinatally infected adolescents/young adults Why? • Protection against anogenital cancers and genital warts

  4. Human Papillomavirus (HPV) • 100+ types of HPV • >40 infect genital area • Commonest STI • Categorized “high” or “low” risk on association with cervical cancer • Majority of infections are asymptomatic and self limiting • “low risk”- genital warts, low grade cervical cell changes, respiratory papillomatosis • “high risk”- 16, 18 -cervical cell changes and anogenital cancers

  5. HPV Epidemiology & Natural history • Modeling: >80% of sexually active women will have genital HPV by 50yrs Myers et al Am J Epi 2000;151:1158-71 • 50% within 3yrs of sexual debut Winer et al Am J Epi 2003;157:218-26 • 70% clear infection within 1yr, 90% in 2 yrs • Median duration 8/12 Ho et al N Engl J Med 1998;338:423-8 • Not all infected women produce Abs: 54-69% women with HPV 16, 6, 18 had Abs Carter et al JID 2000;181:1911-9

  6. HPV and Cancer • High risk HPV types detected in 99% cervical cancers • 70% with types 16 and 18 (sl lower in African cohorts) • Persistence of “high risk” HPV required • Other risk factors: smoking, parity, STIs, OCP, immune status • High risk HPV in majority vaginal cancers ~ 50% vulval cancers ~ 90% anal squamous cell cancers ~ 25% oral cancers % head and neck cancers Parkin et al Vaccine 2006;24:S11-25

  7. Genital Warts • 90+% associated with HPV types 6 and 11 Greer et al J Clin Micro 1995;33:2058-63 • 1% population have clinical genital warts

  8. HPV and HIV • prevalence of HPV- persistence and reactivation • prevalence of CIN, higher grade of CIN (2,3) • Perinatal- BROGLY et al • cervical cancer • anogenital cancers • unchanged by HAART?

  9. HPV vaccination in immunocompetent hosts • virus-like particle (VLPs) vaccine: VLPs + adjuvant not live • 3 Intramuscular injections months 0, 1 or 2, 6 • Quadrivalent (HPV 16/18/6/11) Merck’s “Gardasil” UK Girls 9-26, boys 9-15 • Bivalent (HPV 16/18) GSK’s “Cervarix” • Can be given concomitantly with Hepatitis B vaccination

  10. VPLs versus VLPs

  11. HPV vaccination in HIV negative individuals: • Safe and well tolerated • Immunogenic out to 7yrs • Booster interval unknown • Efficacious in preventing: 1. Persistent HPV infection 2. Low and high grade cervical and genital lesions 3. Genital warts 4. Boys 16-26: 90% effective against HPV infection and warts due to 6,11,16,18 In vaccine HPV types prior to viral strain acquisition

  12. HPV vaccination in HIV infected individuals Trials (soon to report): 1. Phase II safety and immunogenicity study of quadrivalent vaccine: HIV+ve age 7-12, CD4 >15% Placebo controlled (n=120) 1º Safety: gd 3/4 adverse events Immunogenicity: anti-HPV 6/11/16/18 responses + Ab titres 4/52 after 3rd vaccination http://clinicaltrials.gov/ct/show/NCT00339040

  13. Who? 1500 children in UK with perinatal HIV • When? 10-12 prior to UK routine schedule with HBV vaccination if not immune • Why…. • BASSH • BHIVA • Funding HIV- part of HIV standard care Company- Merc SP

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