Current prophylactic HPV vaccines and gynecologic premalignancies.

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.