{"id":40624,"date":"2021-06-01T07:36:19","date_gmt":"2021-06-01T07:36:19","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=40624"},"modified":"2021-06-01T08:45:46","modified_gmt":"2021-06-01T08:45:46","slug":"hpv-vaccine-fails-to-prevent-recurrence-of-high-grade-lesions-in-hiv-positive-gay-men","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/40624","title":{"rendered":"HPV vaccine does not prevent short-term recurrence of high grade lesions in HIV positive gay men"},"content":{"rendered":"
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Simon Collins, HIV i-Base<\/strong><\/p>\n<\/div>\n

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The hope that the HPV vaccine might protect against recurrence of high-grade anal intraepithelial neoplasia (HGAIN) in HIV positive gay men was unfortunately not seen in a randomised clinical study from the Netherlands, published ahead of print in the journal AIDS.<\/strong><\/p>\n<\/div>\n

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HGAIN are precursors to anal cancer and rates of recurrence after treatment in this population are high, often >50% within 12 months.<\/p>\n<\/div>\n

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This double-blind placebo controlled study randomised 126 HIV positive gay men with CD4 counts >350 cells\/mm3 and recent successful treatment of HGAIN to quadrivalent HPV (qHPV) vaccine or placebo at 0, 2 and 6 months. Participants were enrolled between March 2014 and June 2017. Median age was 49 (+\/\u20139) years old.<\/p>\n

The primary endpoint was return of biopsy-proven lesions by high resolution anoscopy (HRA) at 18 months.<\/p>\n<\/div>\n

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The study reported no differences in cumulative recurrence between the groups: \u00a068% (44\/64) vs 61% (38\/62) in the active vs placebo groups respectively, p = 0.38. This was despite adequate serological responses to the vaccine.<\/p>\n<\/div>\n

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Of the 78 participants with a recurrent HGAIN, 47%, 24% and 28% recurred at 6, 12 and 18 months respectively. There were no progressions to anal cancer.<\/p>\n<\/div>\n

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In both groups, approximately 40% vs 60% of recurrent HGAIN were with HPV types covered by the vaccine vs other HPV strains.<\/p>\n<\/div>\n

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In multivariate analysis, higher baseline CD4 count was associated with recurrence (aOR=1.30 per 100 cell increase (95%CI: 1.05 to 1.61), p=0.02.<\/p>\n<\/div>\n

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Earlier preliminary results from this study had been presented at specialist medical meetings in 2019 and 2020.<\/p>\n<\/div>\n

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comment<\/h3>\n<\/div>\n
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Although this vaccine is highly effective in preventing anal HPV infections and related complications in young men it is\u00a0disappointing that this study did not find a short-term treatment effect.<\/strong><\/p>\n<\/div>\n

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The lack of effect was seen in all analyses and in all sub groups.<\/strong><\/p>\n

This doesn’t mean that the vaccine might not have other benefits, including in reducing the risk of anal cancer linked to HPV strains covered by the vaccines.<\/strong><\/p>\n

Some advocates also think that there might be a longer-term benefit that was not shown in this study and that if available to individuals the vaccine is unlikely to cause harm.<\/strong><\/p>\n<\/div>\n

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Reference<\/p>\n<\/div>\n

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Karien G et al. HPV vaccination to prevent recurrence of Anal Intraepithelial Neoplasia in HIV+ MSM: a randomised placebo-controlled multicentre trial. AIDS, doi: 10.1097\/QAD.0000000000002928OPENSDCPAP. (5 May 2021).
\nhttps:\/\/journals.lww.com\/aidsonline\/Abstract\/9000\/HPV_vaccination_to_prevent_recurrence_of_Anal.96413.aspx<\/a><\/p>\n<\/div>\n

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This reports was first published on 10 May 2021.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Simon Collins, HIV i-Base The hope that the HPV vaccine might protect against recurrence of high-grade anal intraepithelial neoplasia (HGAIN) in HIV positive gay men was unfortunately not seen in a randomised clinical study from the Netherlands, published ahead of …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[31,18],"tags":[],"class_list":["post-40624","post","type-post","status-publish","format-standard","hentry","category-opportunistic-infections-coinfections-and-complications","category-cancer-and-hiv"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40624","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=40624"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40624\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=40624"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=40624"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=40624"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}