HPV Vaccine Does Not Prevent HSIL Recurrence in Women With HIV

The human papillomavirus (HPV) vaccine does not prevent high-grade squamous intraepithelial lesion (HSIL) recurrence when used as adjuvant therapy after loop electroexcision procedure (LEEP) among women with HIV, according to new study results presented at the Conference on Retroviruses and Opportunistic Infections 2019.

Women with HIV, particularly those residing in sub-Saharan Africa, are at increased risk for cervical HSIL. Effective treatments for HSIL lesions among women with HIV are still needed.

Previous studies have suggested the HPV vaccine can improve the response to HSIL when used as adjuvant therapy with LEEP in women without HIV.

Dr Cindy Firnhaber from the University of Colorado and colleagues evaluated the effectiveness of the HPV quadrivalent vaccine for the prevention of recurrent HSIL after LEEP among 180 women residing in Johannesburg, South Africa.

The researchers randomly assigned women (1:1) to quadrivalent HPV or placebo vaccine at baseline, week 4, and week 26. LEEP was performed at week 4. Colposcopy and directed biopsies and cervical cytology were performed at weeks 26 and 52.

Cervical HSIL by histology or cytology at 26 or 52 weeks served as the study’s primary endpoint and was compared with arms via Chi-square analysis.

Overall, analyses did not indicate HPV vaccination could be used as a supportive adjuvant therapy for preventing recurrent HSIL after LEEP. Recurrent HSIL was high despite reduced viral load from antiretroviral therapy.

“More effective treatment strategies are needed to reduce the burden of recurrent cervical HSIL in this high-risk population,” the researchers concluded.

—Melinda Stevens

Reference:

Firnhaber C, Swarts A, Mulongo M, et al. HPV vaccine with LEEP did not prevent recurrent cervical HSIL in HIV-infected women. Paper presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle, WA. http://www.croiconference.org/sessions/hpv-vaccine-leep-did-not-prevent-recurrent-cervical-hsil-hiv-infected-women. Accessed March 7, 2019.