Determining the HPV vaccine schedule for a HIV-infected population in sub Saharan Africa, a commentary

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Background:
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.
Conclusion:
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 mm3, 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.
Keywords:
HIV; Sub Saharan Africa; Vaccine schedule

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Authors & affiliation: 
Menon S1,2, Rossi R3, Kariisa M4, Callens S5,6. Author information 1 International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium. soniasimonemenon@gmail.com. 2 International Committee of Red Cross, Geneva, Switzerland. soniasimonemenon@gmail.com. 3 International Committee of Red Cross, Geneva, Switzerland. 4 March of Dimes Foundation, White Plains, New York, USA. 5 International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium. 6 Department of Internal Medicine & Infectious diseases, University Hospital, Ghent, Belgium.
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Published In: 
Virol J. 2018 Aug 16;15(1):129. doi: 10.1186/s12985-018-1039-y.
Publication date: 
Thursday, August 16, 2018