Papilomatosis respiratoria recurrente y el rol de la vacunación antiVPH

Abstract

RESUMENLa papilomatosis respiratoria recurrente es una enfermedad infrecuente de la vía aereodigestiva, que afecta a niños y adultos, causada por el virus papiloma humano subtipos 6 y 11. La enfermedad tiene un curso impredecible y ha sido reportada la extensión pulmonar y la transformación maligna.Actualmente todos los tratamientos disponibles, tanto médicos como quirúrgicos, son sólo paliativos, enfocados a mantener una vía aérea adecuada y una calidad de voz aceptable. Se han desarrollado dos vacunas contra el virus papiloma humano con el fin de prevenir el cáncer cervicouterino causado por éste. Una de estas vacunas también incluye los subtipos asociados a la papilomatosis, por lo que la vacunación masiva podría disminuir drásticamente la incidencia de la enfermedad.Palabras clave: Papilomatosis, virus papiloma humano, vacunación. ABSTRACTRecurrent respiratory papillomatosis is a rare disease of the aerodigestive tract that affects children and adults, caused by the human papiloma virus subtypes 6 and 11. The disease has a unpredictable course and pulmonary spread and malignant transformation have been reported.All the medical and surgical treatments available are only palliative and are focused on keeping a adequate airway and an acceptable voice quality. Two vaccines have been developed against the human papilloma virus for the prevention of cervical cancer. One of these vaccines also includes the subtypes associated with papillomatosis so widespread vaccination could drastically diminish the incidence of the disease.

Human papillomavirus infections in low‐grade squamous intraepithelial lesion in Peruvian pregnant woman: A cross‐sectional cytology‐based study

“…[43][44][45] Although it is a benign disease that normally involves only the larynx, the RRP has an unpredictable clinical course, tends to recur, extends to the rest of the aerodigestive tract, and can undergo a malignant transformation from 3% to 7% of cases. 13,46 Transmission of HPV 6 or HPV 11 in juvenile-onset RRP is most likely to occur in mother-to-child transmission while the fetus is passing through an infected birth canal. 47 RRP is a rare pediatric pathology but difficult to manage and may compromise the patient's life.…”

“…Given the associations between age at diagnosis and aggressive clinical behavior reported in the US National Registry of RRP, Danish, and Colombian studies, the assessment of HPV in pregnant women is most important for RRP 43–45 . Although it is a benign disease that normally involves only the larynx, the RRP has an unpredictable clinical course, tends to recur, extends to the rest of the aerodigestive tract, and can undergo a malignant transformation from 3% to 7% of cases 13,46 …”

“…11,12 The degree of immunosuppression naturally caused by pregnancy increases the prevalence and persistence of HPV infection. 13 Thus, the surveillance of this group of patients is relevant and the Papanicolaou test (Pap test) offers a window of opportunity for the screening and identification of SIL and HPV during pregnancy, principally in its early stages. Several studies showed that the LSIL with koilocytic atypia could change between 1.5% and 6.8% with different ratios of regression and progression of SIL, pointing to the need for detection and follow-up of SIL in all pregnant women and related complications such as RPP and vulgar wart and oral papilloma in newborns.…”

“…The degree of immunosuppression naturally caused by pregnancy increases the prevalence and persistence of HPV infection 13 . Thus, the surveillance of this group of patients is relevant and the Papanicolaou test (Pap test) offers a window of opportunity for the screening and identification of SIL and HPV during pregnancy, principally in its early stages.…”