By Katherine Lewis

Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States, with nearly 80 million Americans currently infected. According to the Centers for Disease Control (CDC), “HPV infections are so common that nearly all men and women will get at least one type of HPV at some point in their lives”. However, most people infected with this virus never develop symptoms and, therefore, are unaware of its presence.

Currently, there is no cure for the HPV virus once infection occurs. However, on February 3rd, Dr. Eva Ramón Gallegos announced that she and her team of researchers had successfully eradicated the HPV virus in 29 women. A researcher at Instituto Politécnico Nacional, one of Mexico´s largest public universities, Ramón had been studying the virus for decades leading up to this breakthrough.

The study used a novel technique known as photodynamic therapy that involves the application of a drug called delta aminolevulinic acid, which, after four hours, is transformed into protoporphyrin IX. This chemical accumulates in damaged cells and allows them to be destroyed with energy from a laser light without damaging non-cancerous cells.

This image is the logo of Instituto Politécnico Nacional where the research described took place. The logo is maroon on a white background and includes a building, a gear, a scale, and the letters IPN.
Image by the Instituto Politécnico Nacional. This is the logo of IPN, one of the largest public universities in Mexico, where Eva Ramón Gallegos´s study was performed.

In all, the study examined 420 women in Oaxaca and Veracruz for the first phase, along with 29 women in Mexico City for the second stage. Following promising results of the first phase, researchers doubled the concentration of the treatment, which led to 100% elimination of the virus in participants who were infected but had not yet developed pre-cancerous lesions. The same treatment successfully eliminated the virus in 64.3% of those who had the virus along with pre-cancerous lesions, and in 57.2% of those who had pre-cancerous lesions, but not the virus.

While this study could pave the way forth the future of HPV treatment, the results have not yet been published in a peer-reviewed journal, so it is difficult to evaluate their validity and robustness. The results must be verified and more research is needed to fully understand the effectiveness of photodynamic therapy in treating HPV. Because of this, the study has not been covered by major news sources, although Ramón was featured in a three minute interview by CNN Mexico in which she discusses her findings.

There are a several different types of HPV viruses, which cause a wide variety of symptoms in carriers. While some HPV’s do not cause any noticeable symptoms, others can lead to genital warts and various types of cancers, including cervical cancer, years or decades after the initial infection. According to the National Cancer Institute, HPV types 6 and 11 cause 90% of genital wart cases, while types 16 and 18 are responsible for 70% of cervical cancer cases. Other HPV types can cause different types of cancer such as anal, oropharyngeal, penile, vulvar, and vaginal. The link between HPV and cancer was discovered by Dr. Xavier Bosch, who is currently the editor-in-chief of the Elsevier journal, Papillomavirus Research.

This is an infographic of HPV-related cases of oral cancer. 30,000 new cases of oral cancer are diagnosed every year, 60% of which are linked to HPV.
Image by Brown Taylor

Current HPV treatment is centered around prevention, due to the lack of effective treatment options. For those infected, resulting health complications must be treated separately. For example, treatment for HPV-caused cervical cancer may include surgery, chemotherapy, or radiation, but the virus itself cannot be eliminated.

In order to prevent HPV, the CDC recommends the use of latex condoms as well as the Gardasil 9 vaccine, which is the only HPV vaccine approved for use in the US. According to the CDC, “clinical trials showed HPV vaccines provide close to 100% protection against cervical precancers and genital warts. Since the first HPV vaccine was recommended in 2006, there has been a 64% reduction in vaccine-type HPV infections among teen girls in the United States.” The CDC vaccination guidelines recommend that all children receive the Gardasil 9 vaccine, which is administered in a series of 2-3 doses, at age 11 or 12. For those who were not vaccinated at this age, the CDC recommends catch-up vaccines for males through age 21 and for females through age 26.

Increasing awareness about both the virus and the effectiveness of prevention methods will be crucial in the creation of an HPV-free future. Journals such as Elsevier’s open access Papillomavirus Research, allow this information and new scientific discoveries to be shared with the public. Today’s HPV research is largely focused on the effectiveness of the vaccine, screening methods for the virus, and the mechanism by which HPV induces cancer. In one Elsevier article, Dr. Bosch commented, “We are now in a position to show the world that by vaccinating entire cohorts, there is a very immediate effect in the reduction of the infection and the reduction of the disease”.

According to an investigation into the barriers to HPV vaccination in South Carolina, there are challenges at the personal, provider, and policy levels. These include “concerns about vaccinating adolescents for an STD”, infrequency of doctor visits for those at the recommended age to receive the vaccine, and the fact that HPV vaccination is not a requirement for school entry. The same investigation identified strategies to increase vaccination coverage, which include “advocating for policy changes around HPV vaccine coverage, vaccine education, and pharmacy-based vaccination” as well as increasing awareness of the importance of the vaccine and improving the coordination of efforts between all involved parties.[1] Similarly, a recent report by the Human Papillomavirus Prevention and Control Board, identified anti-vaccination campaigns as a threat to increasing HPV vaccination coverage, while also highlighting the importance of well-coordinated communication campaigns, which incorporate social media to raise awareness.[2]

Continued research into the treatment and prevention of HPV will be crucial in further lowering the rates of both the virus and associated cancers in the future. Campaigns such as the International HPV Awareness Day on March 4th, 2018, incorporate the use of social media and global partnerships in order to raise awareness of both the problem and existing prevention strategies, such as the HPV vaccine.

References

  1. Cartmell, Young-Pierce, Mcgue, Alberg, Luque, Zubizarreta, & Brandt. (2018). Barriers, facilitators, and potential strategies for increasing HPV vaccination: A statewide assessment to inform action. Papillomavirus Research,5, 21-31.
  2. Vorsters, Arbyn, Baay, Bosch, De Sanjosé, Hanley, . . . Van Damme. (2017). Overcoming barriers in HPV vaccination and screening programs. Papillomavirus Research,4, 45-53.

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