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Current prophylactic HPV vaccines and gynecologic premalignancies

Harper, Diane M

Current Opinion in Obstetrics & Gynecology: December 2009 - Volume 21 - Issue 6 - p 457–464
doi: 10.1097/GCO.0b013e328332c910
Women's health: Edited by Joseph Aquilina

Purpose of review: Studies of the human papillomavirus (HPV) vaccines, Cervarix and Gardasil provide strong evidence for the recommendation that HPV vaccines may minimize the incidence of cervical cancer over time.

Recent findings: Both Cervarix and Gardasil provided more than 90% efficacy in preventing cervical intraepithelial neoplasia grade 2+ (CIN 2+) disease caused by HPV 16 and 18 in women 16–26 years who were seronegative and PCR-negative for HPV 16 and 18 at baseline. Cervarix provides more than 75% efficacy in independent cross-protection against persistent HPV 31 and 45, and 47% efficacy against HPV 33; whereas Gardasil offers 50% efficacy only against persistent HPV 31. A reduction in excisional therapies for CIN 2+ is nearly 70% for Cervarix, and 40% for Gardasil. Cervarix efficacy is documented to 6.4 years; Gardasil's to 5 years. Immunologically, Cervarix induces three to nine-fold higher peak-neutralizing antibody titers to HPV 16/18 than Gardasil, has significantly higher cervicovaginal mucus-neutralizing antibody presence than Gardasil, and significantly higher B memory cell response than Gardasil. Safety reports indicate injection site reactions for both Cervarix and Gardasil. Rare serious adverse events have been reported.

Summary: The benefits and risks of vaccination must be weighed with the benefits and risks of screening to reduce cervical cancer in a cost-effective manner.

Departments of Community and Family Medicine, Obstetrics and Gynecology, Informatics and Personalized Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood, Kansas City, Missouri, USA

Correspondence to Diane M. Harper, MD, MPH, MS, Professor, Vice-Chair, Research, Departments of Community and Family Medicine, Obstetrics and Gynecology, Informatics and Personalized Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood, 7900 Lee's Summit Road, Kansas City, MO 64139, USA Tel: +1 816 404 7107; fax: +1 816 404 7142; e-mail: diane.m.harper@gmail.com

© 2009 Lippincott Williams & Wilkins, Inc.