{"id":1294,"date":"2017-07-04T15:55:24","date_gmt":"2017-07-04T14:55:24","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1294"},"modified":"2017-11-01T15:24:03","modified_gmt":"2017-11-01T15:24:03","slug":"does-it-ever-make-sense-to-target-hpv-screening-at-hiv-infected-individuals","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/07\/04\/does-it-ever-make-sense-to-target-hpv-screening-at-hiv-infected-individuals\/","title":{"rendered":"Does it ever make sense to target HPV screening at HIV-infected individuals?"},"content":{"rendered":"

A number of recent studies have considered the case for HPV-related cancer prevention interventions that are targeted at specific populations. In the developed world, interventions of cervical screening and teenage vaccination aim to cover the female, or male and female, population (at a certain age) in order to prevent cervical cancer.\u00a0 The question of more targeted<\/em> interventions generally arises in relation to MSM \u2013 and especially HIV+ MSM \u2013 on account of their heightened risk of HPV-induced anal cancers.\u00a0 There has been a marked rise in these cancers since the 1980s.\u00a0 Unlike cervical cancers in heterosexual women (which decline with age), anal cancers are prevalent in MSM of all ages (Poynton & Grulich<\/a> (STI)) \u2013 possibly reflecting higher rates of exposure through new partners.\u00a0 Particularly high rates of anal cancer in older MSM living with HIV may be attributable to long-term immunologic defects in this population (van der Laar & Richel<\/a> (STI)). \u00a0Elevated HPV rates have also been shown in sexual minority women (Reiter & McRee<\/a> (STI)).\u00a0 Of course, the problem of anal cancers in MSM could be resolved through vaccination of adolescent boys.\u00a0 However, a recent UK study has investigated the feasibility of delivering a targeted HPV vaccination programme to adult MSM through STI clinics (Bayley & Soldan<\/a> (STI)).<\/p>\n

In developing countries, there could also be a case for targeting HPV screening \u2013 but for the prevention of cervical cancer in heterosexual women, rather anal cancer amongst MSM.\u00a0 In most parts of sub-Saharan African, and other limited resource settings, neither cervical screening nor widespread adolescent vaccination have proved feasible, and rates of cervical cancer are relatively high (WJCO: Cervical Screening in Limited Resource Settings<\/a>).\u00a0 Here, Whitham & Kulasingam<\/a> (W&K) have argued in a recent analysis of the evidence from six longitudinal studies undertaken in Senegal from 1994-2010, that some targeting of the available resources towards women who are HIV+ is justified given their considerably elevated levels of risk.\u00a0 Like the HIV+ MSM in the studies mentioned above, HIV+ heterosexual women, according to W&K, have much higher rates of progression from HPV to high-grade squamous intraepithelial lesions (HSIL) (HR 2.55<\/strong> times), as well as higher levels of progression from normal to HPV, and from normal to HSIL (respectively, HR 1.53<\/strong> and 1.58<\/strong>). These rates corroborate the results of earlier studies (e.g. Mayaud & Lacey<\/a> (STI)) that suggest high-risk HPV types and a tendency to HSIL in HIV+ in the older female population.<\/p>\n

These findings prompt W&K to recommend, in the sub-Saharan setting, the policy of targeting of HPV vaccination to the HIV+ population recently proposed in the developed world for HIV+ MSM. \u00a0Unfortunately, various problems make such an intervention considerably less feasible in the case of sub-Saharan HIV+ women.\u00a0 First, the sheer prevalence of HPV amongst the target population make HPV testing inefficient as a stand-alone screening strategy and tends to reduce its positive predictive value.\u00a0 Second, the tests current in the West (cytology and Hybrid Capture 2) require laboratory equipment and technician expertise not likely to be available in Africa.\u00a0 On the latter point, however, W&K note that the recently developed careHPV test may offer a more effective alternative to Visual Inspection with Acetic acid (VIA).<\/p>\n","protected":false},"excerpt":{"rendered":"

A number of recent studies have considered the case for HPV-related cancer prevention interventions that are targeted at specific populations. In the developed world, interventions of cervical screening and teenage vaccination aim to cover the female, or male and female, population (at a certain age) in order to prevent cervical cancer.\u00a0 The question of more […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16498,2012,16508,4362],"tags":[],"class_list":["post-1294","post","type-post","status-publish","format-standard","hentry","category-cervical-screening-and-hpv","category-hiv-infection","category-hivhpv-co-infection","category-hpv-and-cancer"],"yoast_head":"\nDoes it ever make sense to target HPV screening at HIV-infected individuals? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/07\/04\/does-it-ever-make-sense-to-target-hpv-screening-at-hiv-infected-individuals\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Does it ever make sense to target HPV screening at HIV-infected individuals? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"A number of recent studies have considered the case for HPV-related cancer prevention interventions that are targeted at specific populations. 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