Suchergebnisse

Objetivo: Conocer las estrategias para asumir la vacunación contra el virus del papiloma humano en América Latina a partir de una revisión temática internacional, para encontrar experiencias que contribuyan a mantener resultados satisfactorios en Colombia. Materiales y métodos: Se realizó una revisión de literatura internacional en español, inglés y portugués sobre el estado de implementación y éxito del programa de vacunación en América Latina en bases de datos: Medline, Embase y Cochrane, portales de Organización Mundial y Panamericana de la Salud, páginas web de entes rectores y sitios electrónicos especializados en control del cáncer. Resultados: Se revisaron 97 referencias. En la región, diez países incorporaron dosis de la vacuna en sus esquemas para niñas entre 9 y 13 años; realizan diversas estrategias a corto plazo para mantener sus tasas de cobertura; siendo la articulación de los sectores salud-educación, el reconocimiento del contexto y la obligatoriedad las más exitosas. Conclusión: La situación en otros países en la implementación de la vacunación contra el VPH, muestra que la alianza entre salud, educación y comunicación es clave para mantener resultados satisfactorios. Educar y sensibilizar puede mantener la articulación con la comunidad. La aceptación o rechazo de la vacunación, depende del grado de información de la población; por tanto, es útil la consulta con profesionales de la salud y la aplicación de consentimiento informado para reducir la incertidumbre. ; Objective: To know the strategies to take responsibility for vaccination against human papillomavirus infection in Latin America through an international thematic review to find experiences that contribute to maintain satisfactory results in Colombia. Materials and methods: A review of international literature in Spanish, English and Portuguese about the state of implementation and achievement of the vaccination programs used in Latin America was carried out using the Medline, Embase and Cochrane Library electronic databases, portals of the World Health Organization and Pan American Health Organization, governmental websites, and websites specialized in cancer control. Results: Ninety-seven references were reviewed. Ten countries in the region incorporated the vaccine doses in their program among 9 and 13 years old girls. They perform several short-term strategies to maintain their coverage rates, being the articulation between the health-education sectors, the context recognition, and their obligatory nature the most successful. Conclusion: The situation in other countries regarding the implementation of an HPV-vaccination program shows that the alliance between healthcare, education and communication is the key to the sustainability of satisfactory results. Educating and raising awareness can maintain the articulation with the community. The acceptance or rejection of the vaccine depends on the degree of information of the population. Therefore, consultation with health-professionals and the application of informed consent are useful to reduce uncertainty.

BACKGROUND: Anogenital warts are the second most common sexually transmitted infection diagnosed in sexual health services in England. About 90% of genital warts are caused by human papillomavirus (HPV) types 6 or 11, and half of episodes diagnosed are recurrences. The best and most cost-effective treatment for patients with anogenital warts is unknown. The commonly used treatments are self-administered topical agents, podophyllotoxin (0.15% cream) or imiquimod (5% cream), or cryotherapy with liquid nitrogen. Quadrivalent HPV (qHPV) vaccination is effective in preventing infection, and disease, but whether it has any therapeutic effect is not known. METHODS AND DESIGN: To investigate the efficacy of clearance and prevention of recurrence of external anogenital warts by topical treatments, podophyllotoxin 0.15% cream or imiquimod 5% cream, in combination with a three-dose regimen of qHPV or control vaccination. 500 adult patients presenting with external anogenital warts with either a first or subsequent episode of anogenital warts will be entered into this randomised, controlled partially blinded 2 × 2 factorial trial. DISCUSSION: The trial is expected to provide the first high-quality evidence of the comparative efficacy and cost-effectiveness of the two topical treatments in current use, as well as investigate the potential benefit of HPV vaccination, in the management of anogenital warts. TRIAL REGISTRATION: The trial was registered prior to starting recruitment under the following reference numbers: International Standard Randomized Controlled Trial Number (ISRCTN) Registry - ISRCTN32729817 (registered 25 July 2014); European Union Clinical Trials Register (EudraCT) - 2013-002951-14 (registered 26 June 2013).

Infections by the human papillomavirus (HPV) have currently increased, becoming a common infection with a significant rise in the population, with pregnant women being the most affected group, posing risks to both the mother and the newborn. HPV during pregnancy can lead to a variety of complications, ranging from mild to severe, representing a risk for both the mother and the fetus. These complications in the mother are attributed to the numerous physiological changes experienced during pregnancy, which can favor the development of pathological alterations. The present research aimed to analyze and synthesize the available scientific evidence to understand how HPV infection can affect pregnancy. The methodology involved a systematic review, where scientific articles from reliable databases were selected. The results revealed that during pregnancy, especially in the first two trimesters, there is a decrease in immunity or immunosuppression, which can increase susceptibility to HPV infection or viral replication. There is a possibility of vertical transmission of HPV from mother to newborn during childbirth, resulting in the appearance of anogenital and laryngeal lesions in the newborn. In conclusion, the accurate diagnosis of HPV infection during pregnancy is essential to manage complications adequately and apply safe treatments, considering the limitation of certain therapeutic approaches during gestation.

Despite impressive progress in prevention and therapy of premalignant and malignant dysplasia the worldwide burden of cancer is relatively unchanged. Supplementation of the therapeutic arsenal by immunotherapeutic methods would have the potential to make a significant impact. Dysplastic lesions and cancer of the cervix show strong association with human papillomaviruses (HPV), as do tumours of other mucosal epithelia like squamous cell carcinoma of the head and neck. Such tumours are distinct from most other malignancies in that they harbour foreign antigens derived from the virus. The expression of viral oncogenes is necessary to maintain the cancerous phenotype. Therefore, these antigens are unique to the tumour and very attractive targets for 'proof of concept' studies in the development of therapeutic vaccinesshowing the general applicability of tumour vaccination and prove the correlation of immune response and clinical response. To date numerous clinical trials have been performed with candidate vaccines predominantly for cervical cancer and its precursors. Although a naturally induced anti-HPV T cell response in patients can be shown, the success of therapeutic vaccines has so far been limited. This can probably be attributed to immunosuppression, immunoselection and immunoediting of the tumour cells and other, mostly unknown, factors of the individual contributing to the failure of autonomous clearance of the infection. Overriding this failure, reversing immunosuppression and application in early stages of the disease are the key tasks for future development of therapeutic vaccines. This review will summarize the basis and recent developments of therapeutic vaccines and discuss obstacles that hinder their success.

Persistent infection by specific oncogenic human papillomaviruses (HPVs) is established as the necessary cause of cervix cancer. DNA sequence differences between HPV genomes determine whether an HPV has the potential to cause cancer. Of the more than 100 HPV genotypes characterized at the genetic level, at least 15 are associated, to varying degrees, with cervical cancer. Classification based on nucleotide similarity places nearly all HPVs that infect the cervicovaginal area within the α-PV genus. Within this genus, phylogenetic trees inferred from the entire viral genome cluster all cancer-causing types together, suggesting the existence of a common ancestor for the oncogenic HPVs. However, in separate trees built from the early open reading frames (ORFs; i.e. E1, E2, E6, E7) or the late ORFs (i.e. L1, L2), the carcinogenic potential sorts with the early region of the genome, but not the late region. Thus, genetic differences within the early region specify the pathogenic potential of α-HPV infections. Since the HPV genomes are monophyletic and sites are highly correlated across the genome, diagnosis of oncogenic types and non-oncogenic types can be accomplished using any region across the genome. Here we review our current understanding of the evolutionary history of the oncogenic HPVs, in particular, we focus on the importance of viral genome heterogeneity and discuss the genetic basis for the oncogenic phenotype in some but not all α-PVs.

Approximately 20% of all cancers are associated with infectious agents. Among them, human papillomaviruses (HPVs) are very common and are now recognized as the etiological agent of cervical cancer, the second most common cancer in women worldwide, and they are increasingly linked with other forms of dysplasia. Carcinogenesis is a complex and multistep process requiring the acquisition of several genetic and/or epigenetic alterations. HPV-induced neoplasia, however, is in part mediated by the intrinsic functions of the viral proteins. In order to replicate its genome, HPV modulates the cell cycle, while deploying mechanisms to escape the host immune response, cellular senescence and apoptosis. As such, HPV infection leads directly and indirectly to genomic instability, further favouring transforming genetic events and progression to malignancy. This review aims to summarize our current understanding of the molecular mechanisms exploited by HPV to induce neoplasia, with an emphasis on the role of the 2 viral oncoproteins E6 and E7. Greater understanding of the role of HPV proteins in these processes will ultimately aid in the development of antiviral therapies, as well as unravel general mechanisms of oncogenesis.

CONTEXT: Sexually transmitted infections (STIs) have a well-established synergistic relationship with human immunodeficiency virus (HIV) infection. Coinfection with HIV and STI can increase the probability of HIV transmission to an uninfected partner by increasing HIV concentrations in genital lesions, genital secretions, or both. Concurrent HIV infection alters the natural history of the classic STIs. AIMS: The aim was to study the current scenario of STIs with HIV co-infection, and to recognize different manifestations of STIs than the classical presentation in people living with HIV/AIDS (PLHIV). SETTINGS AND DESIGN: It was an open, cross-sectional, descriptive study carried out in the setting of state government hospital with attached antiretroviral therapy referral center. SUBJECTS AND METHODS: The sample size of the study was duration based (30 months). INCLUSION CRITERIA: All PLHIV presenting to the department of dermatology with STIs were included in the study. EXCLUSION CRITERIA: Non-STI causes of genital ulceration were excluded in the study. RESULTS: The study includes total (n = 484) patients living with HIV/AIDS, prevalence of different STIs was in the following order, herpes simplex virus infections 24.17%, human papillomavirus infections 8.88%, molluscum contagiosum 7.43%, secondary syphilis 4.33%, gonorrhea 1.85%, chancroid 1.44%, and granuloma inguinale 0.41%. Of all the patients with herpes simplex virus infections, 45.6% (n = 57) had multiple recurrences (>6/year). The incidence of mixed STI was 17.29% in the present study. CONCLUSIONS: The study represents decreasing trends in bacterial STIs and the rise of viral STIs. Atypical presentations of classic STIs were more frequent than non-HIV-infected individuals.

Screening with Pap cytology has substantially reduced cervical cancer morbidity and mortality during the last 50 years in high-income countries. Unfortunately, in resource-poor countries, Pap screening has either not been effectively implemented or has failed to reduce cervical cancer rates. Cervical cancer in these countries thus remains a major public health problem. Infection with certain human papillomavirus (HPV) types is now recognized as a necessary cause of this disease and has led to new preventive strategies for cervical cancer. Testing for HPV DNA of oncogenic types is gaining increasing interest and application in cervical cancer screening. It has much greater sensitivity and only slightly lower specificity than Pap cytology. Molecular-based screening will be of particular clinical value in the post-vaccine era in which cervical disease will be a rare event and may escape cytology-based detection. As a primary screening test followed by Pap triage of HPV-positive cases, HPV testing has the potential to improve the overall quality of screening programmes, thus allowing for increased testing intervals, which would lower program costs with acceptable safety. Prophylactic vaccines against the 2 leading oncogenic HPV types (16 and 18) have been recently licensed. In large clinical trials, they have shown excellent safety and nearly 100% efficacy in preventing persistent infections and the cervical pre-cancers due to vaccine HPV types 16 and 18. Combining modern screening techniques and universal prophylactic HPV vaccination is likely to produce the most advanced and cost-effective preventive strategy to fight cervical cancer worldwide.

Cervical cancer remains an important public health problem in developing countries where over 80% of the global burden occurs annually but screening has been ineffective. In a polygamous country like Ghana with a high incidence of cervical cancer but no national screening program, the Human Papilloma Virus (HPV) vaccine presents a unique opportunity to reduce the burden of HPV infection and cervical cancer in Ghanaian women. The evidence so far indicates that the vaccines are safe and efficacious. Although routine HPV vaccination of girls raises several religious, political, socioeconomic and ethical challenges, the emphasis of this paper will be on addressing the ethical challenges using the principles of autonomy, beneficence, non-maleficence and justice as a framework. Parental autonomy can be preserved with judicious exemptions for those who decline the vaccine on religious and philosophical grounds. This promotes public health without trampling parental authority. Routine HPV vaccination confers several benefits to individuals and society by preventing HPV infection. Instead of causing harm; it reduces harm by preventing the development of about 70% of cervical cancers and removing the negative physical and psychological impact of a cervical cancer diagnosis. It also has the potential to reduce the disparities in cervical cancer rates and its cost effectiveness will ensure considerable cost savings in terms of the money spent on diagnosis and treatment. Consequently, the HPV vaccine is an important public health landmark and achievement in women's health that must be heralded, especially in developing countries where the bulk of the disease and death occur.

Human papillomaviruses (HPV) are the etiologic agents of cancer of the uterine cervix and several other neoplasias. Detection of HPV infection will improve the sensitivity of primary and secondary screening of cervical cancer. The clinical indications for the use of HPV tests will have to consider the natural history of HPV infection and diseases, and the multiplicity of types involved. Signal amplification HPV DNA tests detect several high-risk HPV types, are standardized, commercially available and approved for clinical use. Nucleic acid amplification techniques are ideal methods for epidemiologic purposes since they minimize misclassification of HPV infection status and allow detection of infection with low viral burden. They are currently under evaluation for clinical use. PCR is the most widespread method for HPV typing, especially with the use of consensus primers and typing with reverse hybridization techniques. Novel promising HPV detection strategies are now proposed, such as HPV mRNA detection, and suspension or solid phase arrays. These novel techniques will have to be evaluated as stringently as actual assays in clinical studies. Although assays have been developed for the evaluation of viral load, viral integration and HPV polymorphism in molecular epidemiological studies, their role in clinical practice is not currently defined.

<i>Background:</i> With promising efficacy results from randomized control trials of human papillomavirus (HPV) vaccines and the availability of new screening paradigms, policymakers are being asked to make recommendations and decisions regarding the optimal strategies to reduce HPV infection and disease. Such decisions are increasingly being made with significant input from mathematical and economic models. The demand for modeling has resulted in the publication of numerous mathematical models looking at the cost-effectiveness of HPV vaccination. <i>Objective:</i> To review published models that have been used to evaluate the cost-effectiveness of HPV vaccination in developed countries and highlight points of consensus and disagreement in methods and findings. <i>Methods:</i> This review consists of cost-effectiveness studies published in the peer-reviewed literature before August 2008. <i>Results:</i> Despite variations in methods, modeling studies are producing consistent conclusions: (1) vaccinating young girls against HPV is likely to be cost- effective; (2) vaccinating boys will most likely not be cost- effective in countries that can reach high coverage rates in girls, and (3) results are most sensitive to the duration of vaccine protection. However, results from analyses examining the effectiveness and cost-effectiveness of vaccinating boys when coverage rates are low (≤80%) and catch-up strategies have reached conflicting conclusions.