EACS strengthens HPV vaccination advice

The European AIDS Clinical Society has recommended HPV vaccination for everyone living with HIV aged under 26 and all men who have sex with men up to the age of 40, Aidsmap reports.

HPV (human papillomavirus) is a sexually transmitted virus that causes genital warts, and in some forms, leads to the development of cervical, anal and oropharyngeal cancers. Anal cancer, rare in the general population, is becoming more common in people living with HIV, especially men who have sex with men.

HPV vaccination

Deborah Konopnicki of St Pierre University Hospital, Brussels presented a review of the evidence supporting vaccination against HPV in people living with HIV at last month’s 16th European AIDS Conference in Milan.

Greater use of preventive vaccines has the potential to reduce HPV-associated morbidity. Vaccination of girls and young women has resulted in significant reductions in HPV-associated morbidity in Australia, Denmark and Scotland, within ten years of the first vaccination programmes.

Only one study, the ACTG 5298 study, has looked at the effect of vaccination on protection against HPV infection in HIV-positive adults. That study found that in a predominantly male population with a median age of 47 years vaccination did not reduce persistent infection with HPV.

This finding led EACS to recommend that HPV vaccination should be offered to people with HIV aged 26 and under. EACS has also followed the British HIV Association in recommending vaccination for all men who have sex with men with HIV under the age of 40. Previous guidance issued in 2015 recommended that doctors should follow national guidance on HPV vaccination.

Although EACS states that the efficacy of the vaccine is questionable in people who have already been exposed to HPV, Deborah Konopnicki said it is still plausible that vaccination could improve protection against HPV-associated disease.

The ACTG A5240 study showed that in women already seropositive for any of the HPV types included in the quadrivalent vaccine, vaccination resulted in a substantial increase in HPV antibody levels.

There is also some evidence from studies in HIV-negative women and men who have sex with men that vaccination after the treatment of HPV-associated cervical or anal lesions is associated with reductions in recurrence of lesions. Two ongoing studies are likely to provide further information on vaccination’s role in the prevention of recurrence in people living with HIV.

Vaccination results in greater antibody responses in women living with HIV who already have undetectable HIV viral load at the time of the first vaccination, probably because viral suppression permits immune restoration.

EACS recommends the 9-valent HPV vaccine if available (active against nine common types of HPV).

Anal cancer

Research from Austria presented at the 16th European AIDS Conference by Robert Zangerle of the Medical University, Innsbruck, showed that by 2015, anal cancer had already affected at least one in forty men who have sex with men receiving care in clinics affiliated to the Austrian HIV Cohort Study. Dr Zangerle said that the rate was already “alarmingly high”.

The cohort covers around three-quarters of patients receiving HIV care in Austria (7511 patients). Between 2003 and 2015, 46 cases of anal cancer were diagnosed, 63% in men who have sex with men.