Findings Support Nonavalent HPV Vaccine Use in Women With HIV

Gardasil HPV vaccine
The HR-HPV types covered by the nonavalent HPV vaccine had similar clearance rates to HR-HPV types not included, and women infected with multiple anogenital HR-HPV types had lower rates of clearance than women infected with only 1 type.

A high-risk (HR) human papillomavirus (HPV) nonavalent vaccine (Gardasil® 9; Merck & Co, Inc, Kenilworth, New Jersey) may be effective in decreasing HR-HPV infection burden in women with HIV, according to a study published in the Journal of Infectious Diseases.

Due to effective combination antiretroviral therapy (ART), the HIV-infected population is living longer but diagnosis of non-AIDS-defining conditions has increased and the prevalence of anogenital HPV infections remains high. Of the estimated 14 million new cancers occurring worldwide, approximately 5% were attributable to HPV infection. HR-HPV persistent infection causes cervical, anal, vulvar, vaginal, penile, and oropharyngeal cancers.

Previous studies have shown a greater prevalence of anal HPV infection than cervical HPV infection in women with HIV. With a focus on preventive strategy development, there are currently 3 licensed vaccines targeting HR-HPV types in the United States, but only the nonavalent vaccine (9v) is available (Gardasil 9). The prevalence, incidence and clearance of 7 HR-HPV types covered by 9v (HPV 16, 18, 31, 33, 45, 52, 58) and 7 HR-HPV types not covered (HPV 35, 39, 51, 56, 59, 66, 68) were examined in women with HIV in the SUN Study (Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy).

A total of 126 generally healthy women with HIV (median age 38) receiving routine outpatient care were included. Participants were either antiretroviral-naïve or had antiretroviral experience consisting of only effective combination ART. Anal and cervical specimens were collected annually for cytology and identification of 37 HPV types.

Prevalence of anal HR-HPV infection was higher than cervical HR-HPV infection. Baseline HPV infection was more prevalent at the anus (90%) than the cervix (83%) (P =.088), which included infection with HR-HPV (anus: 79%; cervix 61%; P <.001). The prevalence of HR-HPV types was also higher in the anus than the cervix in both 9v covered HR-HPV types (anus: 67%; cervix: 51%; P =.002) and non-9v HR-HPV types (anus: 54%; cervix: 29%; P <.001).

The HR-HPV types covered by the 9v had similar clearance rates to HR-HPV types not included. Clearance for both 9v and non-9v types were generally lower in the anus compared with the cervix. The overall clearance of any anal HR-HPV was 71% and of any cervical HR-HPV was 89%. The clearance of anal HR-HPV was 42% in 9v types and 46% in non-9v types; the clearance of cervical HR-HPV was 61% in 9v types and 59% in non-9v types. Women with ≥2 types were less likely to clear HPV compared with women having only 1 type in both the anus and cervix.

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Overall, although prevalence of non-9v HR-HPV was substantial, 9v HR-HPV types were generally more prevalent. When compared with a national representative sample of women (14.1%), 9v-HR-HPV types in the cervix were much higher in this HIV-infected cohort (51%). The majority of HR-HPV types detected in abnormal anogenital cytologies were types included in the vaccine. Therefore, the study investigators concluded that “because its use might impact the clearance rates of HR-HPV by decreasing the overall burden of anogenital HPV infection in HIV-infected women, these findings further support use of the nonavalent vaccine.”

Disclosures: Teresa M. Darragh, MD, has received research support from Hologic, and consulting fees from Roche, BD, The Vax, and Antiva. W. Keith Henry, MD, has listed the following disclosures: Janssen, Merck, GSK/ViiV, and Gilead.


Kojic EM, Conley L, Bush T, et al. Prevalence and incidence of anal and cervical high-risk human papillomavirus (HPV) types covered by current HPV vaccines among HIV-infected women in the study to understand the natural history of HIV/AIDS in the era of effective therapy (The SUN Study) [published online February 14, 2018]. J Infect Dis. doi:10.1093/infdis/jiy087