International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium.
International Committee of Red Cross, Geneva, Switzerland.
Virol J. 2018 Aug 16;15(1):129. doi: 10.1186/s12985-018-1039-y.
Epidemiological studies have established human papillomavirus (HPV) infection as the central cause of invasive cervical cancer (ICC) and its precursor lesions. HIV is associated with a higher prevalence and persistence of a broader range of high-risk HPV genotypes, which in turn results in a higher risk of cervical disease. Recent WHO HPV vaccination schedule recommendations, along with the roll out of HAART at an earlier CD4 count within the female HIV-infected population, may have programmatic implications for sub Saharan Africa. This communication identifies research areas, which will need to be addressed for determining a HPV vaccine schedule for this population in sub Saharan Africa. A review of WHO latest recommendations and the evidence concerning one-dose HPV vaccine schedules was undertaken.
For females ≥15 years at the time of first dose and immunocompromised and/or HIV-infected, a 3-dose schedule (0, 1-2, 6 months) is recommended for all three vaccines. There is some evidence that there is similar protection against HPV 16 and 18 infection from a single vaccination than from two or three doses, however there is no cross protection conferred to other genotypes. There is a need for periodic prevalence studies to determine the vaccination coverage of bivalent, quadrivalent and nonavalent vaccine targeted oncogenic HPV genotypes in women with CIN 3 or ICC at national level. In light of the increasing number of sub Saharan HIV-infected girls initiating HAART at a CD4 count above 350 mm there are a number of clinical, virological and public health research gaps to address before a tailored vaccine schedule can be established for this population.
流行病学研究已经确定人乳头瘤病毒（HPV）感染是浸润性宫颈癌（ICC）及其前体病变的主要原因。HIV 与更广泛的高危 HPV 基因型的更高流行率和持续存在相关，这反过来又增加了患宫颈癌的风险。最近世界卫生组织（WHO）的 HPV 疫苗接种时间表建议，以及在女性 HIV 感染者中更早地在 CD4 计数达到 350 时推出高效抗逆转录病毒治疗（HAART），可能对撒哈拉以南非洲的项目规划产生影响。本通讯确定了需要解决的研究领域，以确定撒哈拉以南非洲这一人群的 HPV 疫苗接种时间表。我们对世界卫生组织的最新建议以及关于一剂 HPV 疫苗接种时间表的证据进行了审查。
对于首次接种时年龄≥15 岁的女性，以及免疫功能低下者和/或 HIV 感染者，推荐所有三种疫苗均采用 3 剂接种方案（0、1-2、6 个月）。有一些证据表明，单次接种对 HPV 16 和 18 感染的保护作用与接种两剂或三剂相似，但对其他基因型没有交叉保护作用。需要定期进行流行率研究，以确定在国家层面上，接受 CIN 3 或 ICC 治疗的女性中，二价、四价和九价疫苗针对的致癌性 HPV 基因型的疫苗接种覆盖率。鉴于撒哈拉以南非洲越来越多的 HIV 感染女孩在 CD4 计数超过 350 时开始接受 HAART，在为这一人群制定个性化疫苗接种时间表之前，有许多临床、病毒学和公共卫生研究空白需要填补。
