Executive Summary
The 27th International Papillomavirus (IPV) Conference & Clinical Workshop took place on September 17-22, in Berlin. The Foundation attended this year’s IPV Conference to learn about the latest developments in scientific and clinical research along with public health related studies. Several studies piqued our interest; especially regarding the prevalence of HPV infection in the anus of adolescent and young women. Discussions focused on the issue of HPV vaccination and prevention in males, with highlighted studies on HPV infection in cervical and non-cervical sites in both sexes and methods used for screening, prevention, and treatment of HPV disease. Bonnie Diraimondo of the HPV Support Network spoke about her experience as a patient with HPV infection and the trials and tribulations associated with diagnosis and treatment along with follow-up care. The Foundation received a positive response from the community of health care workers, scientists, and public health researchers. We are inspired by the positive movements taken to eradicate HPV and HPV-related cancers but realize there is still much work to do. Thank you to all who contributed their time and shared their opinions and research throughout the conference. Please read our detailed summary below:
IPV 2011
The HPV and Anal Cancer Foundation has just returned from this year’s International Papillomavirus Conference in Berlin, Germany. Last year, the Foundation attended IPV 2010 in Montreal for the first time, and it was inspiring to hear the ongoing discussions surrounding HPV research, epidemiology/public health and clinical progress at this year’s conference. The conference was a truly dynamic event attended by over two thousand participants featuring presentations by researchers, clinicians, health practitioners and individuals representing private and public organizations. Two members of the Foundation’s scientific advisory board - Dr. Karl Munger and Dr. Joel Palefsky, chaired sessions in the basic science and applied/clinical science workshops respectively. A third member of the scientific advisory board, Dr. Lambert, authored several studies presented by his colleagues at the conference. Below is a summary highlighting issues and discussions covered at this year’s event.
Thrivers in the spotlight
For the first time in the history of the IPV conference, the experience of a patient impacted by HPV was highlighted. Bonnie Diraimondo of the HPV Support Network spoke about her ongoing experience with HPV complications and the difficulty she had dealing with health practitioners regarding the detection of HPV-related precancerous lesions such as cervical intraepithelial neoplasia (CIN) and anal intraepithelial neoplasia (AIN). The struggles she faced with treatment alongside prevention methods to avert the progression of the disease has been a continuous physical, emotional, and mental battle that has been exacerbated by the lack of resources regarding appropriate protocols for screening and follow-up care. Ms. Diraimondo reminded us that it is crucial to do your own research as a patient and find a doctor who is knowledgeable about HPV related complications and cautious about follow-up care; especially for patients with a history of cervical or anal lesions.
HPV is not a single sex issue
The debate surrounding the issue of HPV vaccination for males was resurrected this year, with a number of researchers arguing it is in the best interest of the population at-large to encourage an uptake in male vaccination. The issue of whether vaccinating males is “cost-effective” in terms of economic feasibility for nations such as the United States to widely implement and encourage government funding for a male vaccination campaign seemed to be the biggest hindrance. Although research has shown the efficacy and safety of HPV vaccines for males, it is believed that by vaccinating women, the herd immunity effect will take place in males who have sexual encounters with vaccinated women and therefore receive protection from the virus without having to be vaccinated themselves. The herd immunity effect has already been demonstrated in Australia where new incidences of genital warts significantly declined in female populations due to the large amount of females vaccinated by the quadrivalent vaccine. Though heterosexual males showed a decline in genital warts most likely attributable to herd immunity, the MSM population did not benefit from herd immunity because there was no decline in genital warts within this group. Herd immunity appears to be taking place in Australia where a large percentage of the young female population is vaccinated, though the problem with relying on herd immunity for HPV protection is evident in the case of the United States where a significant number of women and girls remain unvaccinated. In this case, males are less likely to be protected from high risk HPV types when they have sexual relations with females.
Also, the MSM population does not benefit from herd immunity when women alone are vaccinated. Several researchers suggested women should not have to bear the full burden of vaccination alone, and that men should do their part as well to help eradicate HPV-related cancers. The issue was viewed as an ethical quandary; by limiting the HPV vaccine to women, we fail to address the reality of this virus. HPV is prevalent in men who can be both transmitters of the virus and infected individuals as well. Although HPV is best known for its link with cervical cancer in females, men may contract anal, penile, oral and oropharyngeal cancers from HPV as well as sexually transmitted infections such as genital warts. Therefore, it is through standards of equity that both males and females should consider HPV vaccination.
Transplant patients at risk for anal and other HPV-related cancers
Another study showed the susceptibility of solid organ transplant recipients in HPV-related cancer diagnosis. The compromised immune systems of such recipients places them at risk for developing anogenital and oropharyngeal cancers. The greater the number of transplants a patient receives, the more likely the patient will be diagnosed with HPV-related cancers such as anal and/or vulvar cancers. Those with kidney transplants were most at risk for developing invasive anal cancer as compared to other HPV-related cancers. This data demonstrates that solid organ transplantation is a risk factor which increases the susceptibility of developing oncogenic HPV infection and consequently cancer among transplant recipients.
Oropharyngeal cancers on the rise
One of the most startling presentations at this year’s conference was a study which showed the increase of HPV-related oropharyngeal cancer incidence in the United States. According to the study, if trends continue at the current rate of infection, by 2020 there will be more persons affected by oropharyngeal cancers than cervical cancers. Although more women have been shown to harbor HPV infections in the oropharynx than men, males are more likely to be diagnosed with oropharyngeal cancers as a result of HPV infection.
Adolescent females with growing incidence of anal HPV infections
Several studies showed the prevalence of HPV infection in adolescent females. One study focused on sexually active inner-city adolescents. Anal HPV infection was detected in 41% of 14-20 year old female study participants. Cervical HPV was evident in 54% of participants and oral HPV infection in 21% of participants. This study showed that HPV-types 16 and 18 diminished in the cervix as the number of HPV vaccinations increased, however this trend was not noticed in the anal canal or oral cavity. This can suggest that the vaccine may be best administered prior to on-set of sexual activity within a high-risk population for maximum prevention so that it can be more effective against carcinogenic HPV-types such as 16 and 18 in the anal and oral areas than once sexual activity and thus HPV exposure has commenced. Another study analyzed anal HPV infection in healthy young women between 22-29 years of age. A lifestyle questionnaire based on sex practices and anal specimens were collected for HPV testing. The results showed anal HPV infection in 32% of the participants, with 22% demonstrating oncogenic HPV-types. Anal HPV infection was prevalent in young women without regard to their sexual lifestyle, however higher HPV infections in the anal region were detected in young women who disclosed involvement in anal sex. This shows that anal HPV infection may be linked to both anal sex practice and via nonsexual passage from the cervix.
RRP Developments
One of the most promising studies at the conference demonstrated the possibility to culture cells from patient samples. Recurrent Respiratory Papillomatosis (RRP) is a rare disease caused by HPV-6 and HPV-11 that results in tumors in the throat. In the case of a patient with Recurrent Respiratory Papillomatosis (RRP), pulmonary tumors harboring HPV-11 were replicated in an in vitro setting by duplicating the HPV genome to screen against therapies targeting tumors. One treatment, Vorinostat, proved to be the most effective in vitro and after placing the patient on this therapy, some tumors ceased to grow whereas other areas showed a regression in tumor size.
Another study showed a hopeful therapeutic treatment for patients with RRP by inhibiting the Cox-2 enzyme in a demonstrated signaling pathway expressed in RRP patients participating in the study. Phase II trials demonstrated an over 50% reduction of disease with several patients portraying remission of disease when administered with celecoxib; a Cox-2 inhibitor used in the trial.
Moving forward
In November 2011, the GAVI Alliance (a public/private alliance) will vote whether to include HPV in their immunization program to provide the vaccine for the world’s poorest populations in 70 developing countries. According to GAVI, 88% of the 275,000 women who die from cervical cancer every year live in developing countries. By offering the HPV vaccine to the global population who is most burdened by cervical cancer deaths, GAVI can significantly improve the health standards of HPV-affected patients in the developing world. Governments of countries such as Mexico where HPV is responsible for the second greatest deaths in women, have already acknowledged the importance of an HPV vaccination campaign and will begin universal coverage for its citizens in January 2012.
Other studies aimed to discover whether the vaccine can have therapeutic properties and if it can be administered in two doses. In September 2010, the Canadian government of British Columbia granted a two dose immunization policy with an optional third dose after studies showed prolonged protection of high risk HPV types when administered in two doses. Other research presented the possibility of therapeutic protection in preventing the progression of advanced anal precancer, high grade intraepithelial neoplasia (HGAIN) in male populations.
There has been an outpour of positive movements in the laboratory setting including the development of biobanks to benefit the scientific research community such as the Scottish HPV Archive. The Archive was established by the Chief Scientist Office in Scotland two years ago to aid in cervical cancer and HPV-related disease research by hosting HPV tissue resources which harbor DNA tests from liquid cytology samples obtained through routine screenings such as colposcopy and pathology. Though it was a timely and expensive process to establish the HPV Archive, samples from the Archive can be used to further HPV-related cancer research.
We look forward to reading follow-up studies and hearing about positive developments in the HPV research community in the near future. Please email email us or visit our Facebook page for updates on HPV research and to join in the discussion.
