Journal Article

The Efficacy of the Quadrivalent Human Papillomavirus Vaccine in Girls and Women Living With Human Immunodeficiency Virus

Walmsley, Sharon, Klein, Marina B., Harris, Marianne, Wobeser, Wendy, McClymont, Elisabeth, Lee, Marette, Coutlée, François, Raboud, Janet, Trottier, Sylvie, Lipsky, Nancy, Smaill, Fiona, Money, Deborah, Yudin, Mark H., Loutfy, Mona, Cohen, Jeffrey

2019

Overview

Abstract Background Human papillomavirus (HPV) vaccination is safe and efficacious in women without human immunodeficiency virus (HIV). Although good immunogenicity has been observed in women living with HIV (WLWH), efficacy data in this population are needed. Methods We enrolled 420 females aged ≥9 years (range, 9–65) living with HIV. Participants were to receive 3 doses of qHPV vaccine (0/2/6 months). The main endpoint was vaccine failure (ie, incident persistent qHPV infection, cervical intraepithelial neoplasia of grade 2 or higher [CIN2+], or genital warts). We compared these rates to published rates in vaccinated and unvaccinated women without HIV as well as unvaccinated WLWH. Results Among 279 eligible women, median follow-up was 2 years. In the intention-to-treat population, the incidence rate (IR) of persistent qHPV (HPV6/11/16/18) was 2.3 per 100 person-years (/100PY) (95% confidence interval [CI], 1.1–4.1), and IR of genital warts was 2.3/100PY (95% CI, 1.2–4.1). In the per-protocol efficacy population, IR of persistent qHPV was 1.0/100PY (95% CI, 0.3–2.6) and of genital warts was 1.0/100PY (95% CI, 0.3–2.5). No cases of CIN2+ occurred. Reported rates of qHPV-related infection and disease within vaccinated women without HIV, unvaccinated women without HIV, and vaccinated WLWH: 0.1 (95% CI, 0.02–0.03), 1.5 (95% CI, 1.1–2.0), and 1.2 (95% CI, 0.2–3.4) /100PY, respectively. The rate of persistent qHPV among vaccinated WLWH was lower than among unvaccinated WLWH (2.3 vs 6.0/100PY). Conclusions Vaccinated WLWH may be at higher risk for vaccine failure than vaccinated women without HIV. However, overall rates of vaccine failure were low, and rates of persistent qHPV were lower than in unvaccinated WLWH. Vaccinated women living with Human Immunodeficiency Virus (HIV) may be at higher risk for vaccine failure than vaccinated women without HIV. However, overall vaccine failure rates were low and rates of persistent vaccine-type HPV were lower than in unvaccinated women living with HIV.

• Publisher: Oxford University Press
• Subject: Adolescent / Adult / Aged / Antibodies, Viral / ARTICLES AND COMMENTARIES / CD4 Lymphocyte Count / Female / HIV Infections - complications / Humans / Middle Aged / Papillomavirus Infections - prevention & control / Papillomavirus Vaccines - immunology / Vaccination / Viral Load / Young Adult