Dion Gregory R, Teng Stephanie, Boyd Leslie R, Northam Antonia, Mason-Apps Charlotte, Vieira Dorice, Amin Milan R, Branski Ryan C
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York.
Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York.
JAMA Otolaryngol Head Neck Surg. 2017 Jun 1;143(6):614-622. doi: 10.1001/jamaoto.2016.4736.
Human papillomavirus (HPV) vaccination is recommended for children and younger adults but not older adults or those with prior HPV exposure, leaving a large portion of the population at risk for HPV-mediated disease. Emerging data suggest a possible role for vaccination as an adjuvant treatment for individuals with HPV-related clinical disease.
To systematically review the literature regarding HPV vaccination for secondary disease prevention after treatment of active clinical disease across disease sites to serve as a platform for the management of HPV-related disease of the head and neck.
A systematic search from August 3 to 21, 2015, of the PubMed, MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science, Biosis Citation Index, Current Contents Connect, Scientific Library Online, and Global Health databases used PRISMA guidelines to identify 326 relevant articles related to adjuvant use of HPV vaccination. Primary search terms were (HPV vaccine OR human papillomavirus vaccine OR papillomarvirus vaccines OR alphapapillomavirus vaccine) AND (HPV OR human papillomavirus OR alphapapillomavirus OR papillomaviridae OR virus warts OR wart virus) AND (recurrence OR relapse OR reoccurrence OR recurrences OR relapses OR relapsing). Forty-five full texts in English were reviewed, with 19 articles included in the final review. In some studies, subpopulations of individuals with HPV DNA positivity and/or seropositivity were extracted for inclusion. Included studies were assessed for bias and separated based on the presence of active clinical disease or HPV DNA positivity or seropositivity.
Nineteen studies with 22 474 unique patients were included in the review. When HPV vaccination was used as an adjuvant treatment for active clinical disease, 9 of 12 studies reported decreased disease recurrence, decreased disease burden, or increased intersurgical interval. In contrast, none of the 7 studies of vaccination in individuals with HPV DNA positivity and/or seropositivity without clinical disease reported improved outcomes.
Differences between adjuvant vaccination in HPV-mediated clinical disease and vaccination in HPV DNA-positive and/or HPV-seropositive populations posit underlying differences in disease and immune processes. These data suggest that additional evaluation of adjuvant HPV vaccination in individuals with active clinical disease is warranted.
人乳头瘤病毒（HPV）疫苗接种推荐用于儿童和较年轻的成年人，但不包括较年长的成年人或既往有HPV暴露史的人群，这使得很大一部分人口面临HPV介导疾病的风险。新出现的数据表明，疫苗接种可能作为HPV相关临床疾病患者的辅助治疗手段发挥作用。
系统回顾关于在治疗活动性临床疾病后进行HPV疫苗接种以预防继发性疾病的文献，为头颈部HPV相关疾病的管理提供一个平台。
2015年8月3日至21日，按照PRISMA指南对PubMed、MEDLINE、EMBASE、CINAHL、Cochrane图书馆、科学网、生物学文摘索引、现刊目次连接、科学图书馆在线和全球健康数据库进行系统检索，以识别326篇与HPV疫苗接种辅助使用相关的文章。主要检索词为（HPV疫苗或人乳头瘤病毒疫苗或乳头瘤病毒疫苗或α乳头瘤病毒疫苗）与（HPV或人乳头瘤病毒或α乳头瘤病毒或乳头瘤病毒科或病毒疣或疣病毒）与（复发或再发或反复出现或复发情况或再发情况或复发的）。对45篇英文全文进行了审查，最终审查纳入了19篇文章。在一些研究中，提取了HPV DNA阳性和/或血清学阳性个体的亚组进行纳入。对纳入的研究进行偏倚评估，并根据是否存在活动性临床疾病或HPV DNA阳性或血清学阳性进行分类。
本综述纳入了19项研究，共22474例独特患者。当HPV疫苗接种用作活动性临床疾病的辅助治疗时，12项研究中的9项报告疾病复发减少、疾病负担减轻或手术间期延长。相比之下，7项针对无临床疾病的HPV DNA阳性和/或血清学阳性个体进行疫苗接种的研究均未报告结局改善。
HPV介导的临床疾病中的辅助疫苗接种与HPV DNA阳性和/或HPV血清学阳性人群中的疫苗接种之间的差异表明疾病和免疫过程存在潜在差异。这些数据表明，有必要对活动性临床疾病患者的辅助HPV疫苗接种进行进一步评估。
