Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, USA; MSD Sharp & Dohme GmbH, Levelingstraße 4a, 81673 Munich, Germany.
Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, United Kingdom.
Vaccine. 2023 Oct 6;41(42):6194-6205. doi: 10.1016/j.vaccine.2023.08.047. Epub 2023 Sep 12.
Individuals with human papillomavirus (HPV)-related disease remain at risk for subsequent HPV infection and related disease after treatment of specific lesions. Prophylactic HPV vaccines have shown benefits in preventing subsequent HPV-related disease when administered before or soon after treatment. Based on our understanding of the HPV life cycle and vaccine mechanism of action, prophylactic HPV vaccination is not expected to clear active persistent HPV infection or unresected HPV-associated dysplastic tissue remaining after surgery. However, vaccination may reasonably be expected to prevent new HPV infections caused by a different HPV type as well as re-infection with the same HPV type, whether from a new exposure to an infected partner or through autoinoculation from an adjacent or distant productively infected site. In this review, we describe the evidence for using prophylactic HPV vaccines in patients with HPV-associated disease before, during, or after treatment and discuss potential mechanisms by which individuals with HPV-associated disease may or may not benefit from prophylactic vaccines. We also consider how precise terminology relating to the use of prophylactic vaccines in this population is critical to avoid the incorrect implication that prophylactic vaccines have direct therapeutic potential, which would be counter to the vaccine's mechanism of action, as well as considered off-label. In other words, the observed effects occur through the known mechanism of action of prophylactic HPV vaccines, namely by preventing virus of the same or a different HPV type from infecting the patient after the procedure.
个体在 HPV 相关疾病得到治疗后，仍有再次感染 HPV 并发生相关疾病的风险。HPV 预防性疫苗在治疗前或治疗后不久接种，已被证明可预防随后发生的 HPV 相关疾病。根据我们对 HPV 生命周期和疫苗作用机制的了解，HPV 预防性疫苗预计不会清除治疗后仍存在的活跃持续性 HPV 感染或未切除的 HPV 相关异型组织。然而，接种疫苗可能合理地预防因不同 HPV 型引起的新的 HPV 感染，以及同种 HPV 型的再感染，无论是通过与感染伴侣的新接触还是通过来自邻近或远处有活性感染部位的自身接种。在本综述中，我们描述了在 HPV 相关疾病患者治疗前、治疗期间或治疗后使用预防性 HPV 疫苗的证据，并讨论了 HPV 相关疾病患者可能受益或不能受益于预防性疫苗的潜在机制。我们还考虑了在该人群中使用预防性疫苗的确切术语如何至关重要，以避免错误暗示预防性疫苗具有直接治疗潜力，这与疫苗的作用机制相悖，也被认为是超适应证使用。换句话说，观察到的效果是通过预防性 HPV 疫苗的已知作用机制产生的，即防止与治疗后相同或不同 HPV 型的病毒感染患者。
