Prevention and Control of Neoplasms Associated With HPV in High-risk Groups in Mexico City: The Condesa Study

Men who have sex with men (MSM), people with HIV, homeless people (many of whom participate in survival sex), female sex workers, transgender women and rape victims are at high risk for human papillomavirus (HPV) infection and consequently developing cancers associated with chronic HPV infection including cervical, vaginal , vulvar , and anal cancers in women, cancer of the penis , anal cancer, in men, and cancer of the oropharynx , tongue, and tonsils in both men and women, In part, this is related to increased life expectancy among people with HIV (given greater anti-retroviral treatment coverage).

Some countries have implemented HPV vaccination policies that include men. This is based on promotion of protection against an increased risk of HPV infection, universal increase in coverage and a gender equity perspective . Since population-level introduction of HPV vaccines, there has been a dramatic impact in areas with over 60% vaccination coverage. Decreases of approximately 90% have been reported for HPV-6/11/16/18 infections, over 90% for new cases of genital warts, 45% for low-grade cytological abnormalities, and 85% for anogenital high-grade histological lesions .

The HPV FASTER concept combines HPV vaccination with HPV screening. It is based on the HPV vaccine's high efficacy and the high sensitivity of high-risk HPV testing for primary detection of anogenital cancer precursor lesions (as documented by our research group in more than 200,000 Mexican women). This strategy is effective because HPV vaccination among women and men over a wide age range offers protection to those not currently infected and protects against subsequent re-infections16. Thus, a combined HPV vaccination and screening strategy will potentially: 1) mitigate the demand for timely screening tests by expanding screening intervals; 2) improve the cost-benefit balance of secondary prevention programs; and 3) provide greater protection and quality of life to more people by reducing the burden of diseases attributable to HPV. This intervention can save many lives over the next 30 years and be more cost-effective than traditional approaches.

Recently, the US vaccination advisory group recommended HPV vaccination among sexually abused children, recognizing their increased risk of HPV infection , . The US Centers for Disease Control recommends administering the HPV vaccine to subjects with immunosuppressive conditions, HIV infection, and men who have sex with men . HPV vaccination in HIV-positive people is safe and reduces the incidence of HPV-associated cancers, including anal cancer, which is increasing in these populations , . Moreover, some research has shown that vaccination against HPV in populations with HIV is cost-effective.

HPV serotypes 16 and 18, found in the HPV bivalent and tetravalent vaccines, have an estimated relative contribution to invasive cervical cancer of at least 70% in Latin America. These vaccines are highly effective, provide high levels of immunogenicity , have acceptable security profiles and have been incorporated into public vaccination policies with 3-dose schedules over a 6-month period based on pharmaceutical industry recommendations.