Can quadrivalent human papillomavirus prophylactic vaccine be an effective alternative for the therapeutic management of genital warts? an exploratory study

ABSTRACT Objective: To evaluate the treatment effect of genital warts, we investigated the quadrivalent HPV vaccine injection compared with surgical excision. Materials and Methods: This prospective study included 26 patients (M:F = 24:2) who received HPV vaccine or surgical excision. After explanation of surgical excision or HPV vaccine, 16 patients underwent surgical excision and the others received HPV vaccine injections. Based on gross findings of genital warts, treatment outcomes were classified as complete response (no wart), partial response, and failed treatment. Results: Among enrolled patients, 42% (11 / 26) patients had recurrent genital warts. In vaccination group, complete response rates of genital wart were 60% following 3 times HPV vaccine. Partial response patients wanted to excise the genital lesions before the 3 times injection, because they worried about sexual transmission of disease to their sexual partners. One patient underwent surgical excision after 3 times injection. Excision sites included suprapubic lesions, but other sites including mid-urethra and glans showed complete response after injection. At a mean follow-up period of 8.42 ± 3.27 months, 10 patients (100%) who received HPV vaccine did not show recurrence. Conclusion: The response rates after HPV vaccine injection were 90% (complete and partial). Our results suggested that HPV vaccines could be effective in management of genital warts.

Human papillomavirus vaccine efficacy in the prevention of anogenital warts: systematic review and meta-analysis / Eficacia de la vacuna contra el virus del papiloma humano en la prevención de verrugas anogenitales: revisión sistemática y metanálisis

Abstract: Objective: To review evidence on the efficacy of HPV vaccines in the prevention of non-cancer lesions (anogenital warts [AGW], recurrent laryngeal papillomatosis and oral papillomatosis). Materials and methods: We conducted a systematic review of randomized trials. We performed random effect models and effects were reported as relative risks (RR) and their confidence intervals (95%CI) following both intention to treat (ITT) and per protocol (PP) analyses. Results: We included six studies (n=27 078). One study was rated as high risk of bias. One study could not be included in the meta-analysis because it provided combined results. We found that quadrivalent vaccine reduced the risk of AGW by 62% (RR: 0.38, 95%CI:0.32-0.45, I2:0%) in the ITT analysis and by 95% (RR: 0.05, 95%CI:0.01-0.25, I2:66%) in the PP analysis. Subgroup analyses of studies in women or with low-risk of bias provided similar results. Conclusion: HPV quadrivalent vaccine is efficacious in preventing AGW in men and women.

Resumen: Objetivo: Revisar la evidencia sobre la eficacia de las vacunas contra el virus del papiloma humano en la prevención de lesiones no oncológicas (verrugas anogenitales [VAG], papilomatosis recurrente respiratoria y papilomatosis oral). Material y métodos: Realizamos una revisión sistemática de ensayos clínicos aleatorizados. Empleamos modelos de efectos aleatorios, calculando riesgos relativos (RR) y sus intervalos de confianza al 95% (IC95%), utilizando el análisis por intención a tratar (ITT) y por protocolo (PP). Resultados: Seleccionamos seis estudios (n=27 078). Un estudio tuvo alto riesgo de sesgo y otro no fue incluido en el metanálisis. La vacuna cuadrivalente reduce el riesgo de VAG en 62% (RR: 0,38; IC95%:0,32-0,45; I2:0%) en el análisis ITT y en 95% (RR: 0,05; IC95%:0,01-0,25; I2:66%) en el análisis PP. Los análisis de subgrupos (mujeres y estudios con bajo riesgo de sesgo) proporcionaron resultados similares. Conclusión. La vacuna cuadrivalente es eficaz en la prevención de VAG en hombres y mujeres.

Costo-efectividad de la vacuna tetravalente contra VPH en Argentina, a partir de un modelo dinámico de transmisión / Cost-effectiveness of quadrivalent vaccine against human papilloma virus in Argentina based on a dynamic transmission model

Objetivo. Evaluar la costo-efectividad (CE) de la vacuna tetravalente contra el virus de papiloma humano (VPH) en Argentina, desde la perspectiva del sistema de salud. Material y métodos. Se utilizó un modelo dinámico de transmisión para estimar el impacto en la incidencia de cáncer de cuello uterino (Cacu), verrugas y otras lesiones, en los años de vida ajustados por calidad (AVAC) y en costos sanitarios. Resultados. La vacuna podría reducir en 60% el riesgo de muerte por Cacu y en 67% el de padecer verrugas genitales. Comparada con no vacunar, la estrategia de vacunación mostró un beneficio incremental promedio de 0.00234 AVAC por persona a un costo incremental de 2.36 dólares, con una CE de 1007.55 dólares por AVAC ganado. Los resultados demostraron ser robustos en el análisis de sensibilidad. Conclusiones. La inmunización resultaría costo-efectiva, con una CE inferior a un producto interno bruto per cápita (15 009 dólares) por AVAC ganado.

Objective. To assess the cost-effectiveness of the quadrivalent vaccine against human papillomavirus (HPV) in Argentina from the health system perspective. Materials and methods. A dynamic transmission model was used to estimate the impact of the vaccine on the incidence of cervical cancer, warts, and other HPV related diseases; in quality adjusted life years (QALYs); and in healthcare costs. Results. Vaccination could reduce the risk of cervical cancer by 60% and by 67% the risk of genital warts. Compared to a non-vaccine scenario, the immunization strategy showed an incremental benefit of 0.00234 QALY per person at an incremental cost of US$2.36, resulting in an incremental cost-effectiveness ratio of US$1007.55 per QALY gained. Sensitivity analysis proved the robustness of these results. Conclusions. Immunization with the quadrivalent vaccine was a cost-effective intervention in Argentina, and it was far below the threshold of one gross domestic product per capita (US$15 009) per QALY gained.

A vacinação contra o HPV, a intersetorialidade como processo do alcance da vacinação das adolescentes no Distrito Federal / Vaccination against HPV, the intersectionality as a process

A vacinação contra HPV em meninas entrou no rol das ações de prevenção primária visando a médio e longo prazo reduzir a incidência do câncer do colo do útero no DF.

Intervención educativa sobre el condiloma acuminado en mujeres en edad fértil / Educational intervention on condyloma acuminata in childbearing-age women

Introducción: el condiloma acuminado producido por el virus del papiloma humano (VPH) es una infección de transmisión sexual frecuente en las mujeres en edad fértil. Objetivo: incrementar el nivel de conocimiento de la infección por VPH. Métodos: se realizó un estudio de intervención educativa en mujeres en edad fértil atendidas en la consulta de ginecología del Hospital Centenario de la provincia de Camagüey...

Introduction: condyloma acuminatum caused by human papilloma virus (HPV) is a common sexually transmitted infection in women of childbearing age. Objective: to increase the level of knowledge of HPV infection. Methods: An educational intervention study was conducted in women of childbearing age assisted at the Gynecology Hospital Centenario in Camaguey province. The universe consisted of 32 patients treated in this consultation from 1. January 1st 2009 to January 31st, 2010. An initial questionnaire was given to those patients who expressed their consent in relation to knowledge about ways of infection, clinical manifestations and complications...

Infeccao pelo HPV durante o ciclo gravidico-puerperal / Infection caused by HPV during the gravidic puerperal cycle

A infeccao pelo Papiloma Virus Humano (HPV) e patologia que atinge mulheres principalmente durante o periodo reprodutivo. Desse modo, sua associacao com a gestacao e usual e pode implicar em complicacoes tanto para a mae como para o feto. A principal complicacao que atinge o recem-nato e a Papilomatose Recorrente Infantil (PRI). Apesar dos neonatos estarem sob menor risco de exposicao ao HPV com a cesarea, a taxa de infeccao pelo HPV por esta via de parto e especialmente alta, e o parto cesareo pode nao ser eficaz na protecao das...

Prevençäo da infecçäo pelo papilomavírus humano / Prevention of the human papillomavírus infection

Trata-se de uma revisäo atualizada da literatura sobre métodos de prevençäo da infecçäo por HPV. Apresenta também controvérsias e perspectivas na conduçäo do rastreio da infecçäo pelo HPV