Band 106, Heft s1

Human papillomavirus (HPV) is a ubiquitous human pathogen that causes cervical and other anogenital cancers as well as genital warts and recurrent respiratory papillomatosis. Human papillomavirus infection is most common among young, sexually active individuals, and it is so prevalent that approximately 75% to 80% of sexually active individuals will become infected in their lifetime. Currently, options are limited for both prevention of infection of patients with HPV-associated disease: infection can only be prevented with complete abstinence from all forms of sexual activity because condoms do not offer complete protection from HPV and HPV can be transmitted by nonintromissive sexual activities. Treatment of patients with HPV-associated disease such as cervical intraepithelial neoplasia and genital warts consists of counseling, treatment if indicated, and monitoring for recurrence. Soon, however, prevention of these HPV-related diseases may be available in the form of a prophylactic HPV vaccine. Phase 3 studies of a quadrivalent vaccine that protects against both high- and low-risk types of HPV demonstrated the vaccine to be 100% effective in preventing HPV type 16– and type 18–associated cervical disease, suggesting that these vaccines, if made widely available, will dramatically reduce the burden of HPV-related disease.

Human papillomavirus (HPV) is a common sexually transmitted pathogen. Although most anogenital HPV infections resolve within several years, persistent infection may lead to neoplasia of the cervix, vagina, vulva, anus, and penis, and also genital warts. High-risk HPV types 16 and 18 are known to cause approximately 70% of all cervical cancers, and low-risk HPV types 6 and 11 are the main causes of genital warts. Prophylactic HPV vaccines have the potential to block the acquisition of HPV and hence subsequent development of anogenital neoplasia. Results from several clinical trials have demonstrated that the HPV L1 virus-like–particle vaccines are safe and highly immunogenic. These trials have documented a 100% vaccine efficacy in prevention of persistent HPV infection and, more important, of HPV-associated anogenital neoplasia in per-protocol analyses. Widespread vaccination of sexually naïve preadolescent children could substantially reduce the morbidity and mortality associated with anogenital malignancies. Furthermore, such a primary prevention program would also reduce healthcare costs.

Multivalent prophylactic human papillomavirus (HPV) vaccines currently in the late stages of clinical testing are safe, immunogenic, and efficacious; and phase 3 tests of a quadrivalent vaccine show that it is 100% effective at preventing HPV types 16 and 18–associated cervical intraepithelial neoplasia grades 2 and 3, adenocarcinoma in situ, and cervical cancer through 2 years of postvaccination follow-up. These vaccines promise to reduce the burden of HPV-related disease. Realizing the full benefit of these vaccines will require a vaccination program that addresses the needs and concerns of healthcare providers, parents, and young adolescent patients who will be involved in the vaccine decision-making process. Osteopathic physicians, by virtue of their dedication to holistic care, are in an optimal position to play a key role in facilitating acceptance of these vaccines among potential vaccinees and their parents and guardians.