Failure Rates for HPV Vaccine Higher in HIV-Positive Women, Girls

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HIV-positive status was found to be associated with increased risk for failure of the HPV vaccine.
HIV-positive status was found to be associated with increased risk for failure of the HPV vaccine.

HIV-positive status was found to be associated with increased risk for failure of the human papillomavirus (HPV) vaccine, according to a study published in Clinical Infectious Diseases.

A team of Canadian investigators conducted a national observational study in which women and girls living with HIV underwent HPV vaccination. The investigators compared their results with published data on vaccinated and unvaccinated women living with and without HIV.

Volunteers were administered 3 doses of qHPV vaccine at baseline, 2 months, and 6 months.

Of the 420 women and girls (aged 9 to 65 years; median age, 39 years) enrolled in the analysis, 279 were eligible to participate. The majority of participants were of mixed ethnicity but mainly black (41.9%) and white (36.2%), with regions of origin predominantly Canada (50.5%) and Africa (33.3%).

More than 95% (n=266) of participants received 3 doses of the quadrivalent HPV vaccine, which has been found to be safe and effective for women with HIV. HPV16, HPV52, and HPV45 were the most commonly reported HPV types identified at the start of the analysis (10.3%, 9.1%, and 7.1%, respectively.

After a median follow-up of 2 years, the incidence rate was 2.3 per 100 person-years (/100PY) for both genital warts and continued HPV infection in the intention-to-treat group. The per-protocol efficacy group incidence rate for both genital warts and continued HPV infection was 1.0/100PY.

Incidence rates of HPV-linked infection and disease in treated women without HIV, untreated women without HIV, and treated women with HIV were 0.1, 1.5, and 1.2/100PY, respectively; for women with HIV, vaccination reduced HPV persistence rates (2.3/100PY, vaccinated; 6.0/100PY, unvaccinated).

“[T]he HPV vaccine should continue to be offered to a wide range of [women living with HIV],” the authors wrote. “It is, however, important to recognize that [women living with HIV] appear to be at higher risk than women without HIV for acquiring persistent [HPV]-related infection and disease despite vaccination against HPV. As a result, regular cervical screening remains important in vaccinated [women living with HIV].”

Reference

McClymont E, Lee M, Raboud J, et al; for the CTN 236 HPV in HIV Study Team. The efficacy of the quadrivalent human papillomavirus vaccine in girls and women living with HIV [published online July 7, 2018]. Clin Infect Dis. doi.org/10.1093/cid/ciy575

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