Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation

Abstract

Diagnosed in more than 90% of cervical cancers, the fourth deadliest cancer in women, human papillomavirus (HPV) is currently the most common pathogen responsible for female cancers. Moreover, HPV infection is associated with many other diseases, including cutaneous and anogenital warts, and genital and upper aerodigestive tract cancers. The incidence and prevalence of these pathologies vary considerably depending on factors including HPV genotype, regional conditions, the study population, and the anatomical site sampled. Recently, features of the cervicovaginal microbiota are found to be associated with the incidence of HPV-related diseases, presenting a novel approach to identify high-risk women through both blood and cervical samples. Overall, the HPV repartition data show that HPV infection and related diseases are more prevalent in developing countries. Moreover, the available (2-, 4-, and 9-valent) vaccines based on virus-like particles, despite their proven effectiveness and safety, present some limitations in terms of system development cost, transport cold chain, and oncogenic HPV variants. In addition, vaccination programs face some challenges, leading to a considerable burden of HPV infection and related diseases. Therefore, even though the new (9-valent) vaccine seems promising, next-generation vaccines as well as awareness programs associated with HPV vaccination and budget reinforcements for immunization are needed.

Human Papilloma Virus Vaccination

“…HPV infection can often be asymptomatic, and many will never know they were infected with 70% of women clearing infection in one year and 91% clearing the infection in two years [9]. Up to 50% of healthy people are infected with low-risk genotypes 1, 2, 4, 6, 7, 11, 27, 40-44, 54, 57, 61, 65, 72, 81, and others are linked to cutaneous warts, manifesting on a variety of body surfaces including hands and feet [1,2,17]. While HPV genotypes causing cutaneous warts varies geographically, HPV 27, 57, 2, and 1 are most common [18].…”

“…While incidence of these lesions is infrequent at 3.9/100,000 adults in the United States, lesions often require retreatment and cause much distress, leading to a significant healthcare burden [19]. Benign lesions, while not as clinically serious as their counterparts, can still represent a significant burden in terms of healthcare cost, and the presence of HPV detected by deoxyribonucleic acid (DNA) testing can lead to an increase in screening, and patients may present for care regarding cutaneous warty lesions [1].…”

“…HPV is the most common pathogen in all female cancers, with 57,000 cancer cases in women related to HPV each year [1,2]. In men, 60,000 cancer cases per year can be attributed to HPV, with the virus causing up to 5% of all human cancers [2,3].…”

“…In men, 60,000 cancer cases per year can be attributed to HPV, with the virus causing up to 5% of all human cancers [2,3]. Worldwide, HPV-16 is thought to be most prevalent genotype followed by HPV-18, though this prevalence varies greatly by geographic region [1,4]. HPV-16 and -18 are high risk for vulvar, penile, vaginal, anal, and oropharyngeal cancers, while genotypes 6 and 11 play a role in genital warts [1,4,5].…”

“…Worldwide, HPV-16 is thought to be most prevalent genotype followed by HPV-18, though this prevalence varies greatly by geographic region [1,4]. HPV-16 and -18 are high risk for vulvar, penile, vaginal, anal, and oropharyngeal cancers, while genotypes 6 and 11 play a role in genital warts [1,4,5]. These cancers, as detailed in Table 1, are less prevalent than cervical cancers, but many of these cancers bear high rates of morbidity and mortality when they do occur.…”