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Title	HIV Viral Suppression Results in Higher Antibody Responses in HIV-Positive Women Vaccinated with the Quadrivalent Human Papillomavirus Vaccine
Creator	Money, Deborah M. Moses, Erin Blitz, Sandra Vandriel, Shannon M. Lipsky, Nancy Walmsley, Sharon L. Loutfy, Mona R. Trottier, Sylvie Smaill, Fiona Yudin, Mark H. Klein, Marina Harris, Marianne Cohen, Jeffrey Wobeser, Wendy Bitnun, Ari Lapointe, Normand Samson, Lindy Brophy, Jason Karatzios, Christos Ogilvie, Gina Coutlée, François Raboud, Janet HPV in HIV Study Group
Date Issued	2016-09
Description	Objective: To evaluate the immunogenicity and safety of the quadrivalent HPV (qHPV) vaccine in HIV-positive women over 24 months. Design: Between November 2008 and December 2012, 372 women aged 15 and older were enrolled from 14 Canadian HIV outpatient clinics in an open label cohort study. The qHPV vaccine (0.5 mL) was administered intramuscularly at months 0, 2 and 6. The primary study endpoint was seroconversion to any of the HPV types targeted by the qHPV vaccine. Antibody levels were measured at 0, 2, 7, 18, and 24 months. Adverse events were recorded throughout. Results: Of 372 participants enrolled, 310 (83%) received at least one dose of the qHPV vaccine and 277 (74%) received all three doses. Ninety-five percent (293/308) were seronegative for at least one vaccine type at baseline. The median age was 38 years (IQR 32-45, range 15-66), 36% were white, 44% black and 13% were of Indigenous origin. Seventy-two percent of participants had suppressed HIV viral load (VL<40c/ml) at baseline, with a median CD4 count of 510 cells/mm³ (376-695). Month 7 HPV type-specific seroconversion rates were 99.0%, 98.7%, 98.1% and 93.6% for HPV types 6, 11, 16 and 18 respectively in the per-protocol population. Participants with suppressed HIV VL at first vaccine had a 1.74-3.05 fold higher peak antibody response compared to those without (p from 0.006-<0.0001). Conclusions: This study is the first to examine the qHPV vaccine in HIV-positive women out to 24 months and the first to include HIV-positive women through to age 66. The qHPV vaccine was well tolerated, and highly immunogenic. As women with suppressed viral load had higher antibody responses, planning HPV vaccination to occur when persons are virologically suppressed would be optimal for maximizing immune response. Findings provide strong evidence that older HIV-positive women can still benefit from HPV vaccination.
Subject	HIV-positive Human Papillomavirus Vaccines Immunogenicity Safety HPV Antibody Response
Genre	Article Postprint
Type	Text
Language	eng
Date Available	2017-08-17
Provider	Vancouver : University of British Columbia Library
Rights	Attribution-NonCommercial-NoDerivatives 4.0 International
DOI	10.14288/1.0354417
URI	http://hdl.handle.net/2429/62678
Affiliation	Medicine, Faculty of Non UBC Family Practice, Department of Infectious Diseases, Division of Obstetrics and Gynaecology, Department of Pathology and Laboratory Medicine, Department of Pediatrics, Department of Population and Public Health (SPPH), School of Medicine, Department of
Citation	Money D, Moses E, Blitz S, Vandriel SM, Lipsky N, Walmsley SL, Loutfy M, Trottier S, Smaill F, Yudin M, Klein M, Harris M, Cohen J, Wobeser W, Bitnun A, Lapointe N, Samson L, Brophy J, Karatzios C, Ogilvie G, Coutlée F, Raboud J, & the HPV in HIV Study Group. HIV viral suppression results in higher antibody responses in HIV-positive women vaccinated with the quadrivalent human papillomavirus vaccine. Vaccine. 2016 Sep,34(4). 4799-4806. PMID: 27544584
Peer Review Status	Reviewed
Scholarly Level	Faculty Unknown
Rights URI	http://creativecommons.org/licenses/by-nc-nd/4.0/
AggregatedSourceRepository	DSpace

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Table 4: Antibody response in per-protocol efficacy HIV-positive women compared to HIV-417 negative women ages 15-26 & 24-45 418 419 HIV-negative women HIV-positive women Age Group Month HPV Type N GMT (95%CI) N GMT (95%CI) p value 15-26 years† 7 6 2635 543 (526, 560) 16 708 (422,1190) 0.29 11 2659 762 (735, 789) 21 595 (397,892) 0.22 16 2573 2294 (2185, 2408) 18 3473 (2168,5566) 0.08 18 2800 462 (444, 480) 19 334 (189,591) 0.25 24 6 2438 113 (109,118) 10 118 (52,267) 0.91 11 2469 145 (139, 150) 13 81  (38,172) 0.12 16 2381 460 (441, 481) 12 319 (167,610) 0.24 18 2603 52 (49, 55) 14 16  (9,27) <0.001 24-45 years‡ 7 6 1249 416 61 426 (324,561) 0.86 11 1249 551 98 540 (436,668) 0.85 16 1269 2226 66 1495 (1046,2137) 0.03 18 1430 357 94 295.0 (223,391) 0.18 24 6 1207 70 53 129 (93,179) <0.001 11 1207 78 78 125 (97,160) <0.001 16 1225 279 54 459 (341,618) <0.01 18 1378 28 72 54  (39,74) <0.0001 † Joura Vaccine 2008 420 ‡ Castellsague Br J Cancer 2011 421 GMT = geometric mean titre; CI = confidence interval 422 

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