UBC Theses and Dissertations
Human papillomavirus vaccination in girls and women living with HIV McClymont, Elisabeth
Background: Human papillomavirus (HPV) is the causal agent of virtually all cervical cancer and genital warts. Women living with HIV (WLWH) experience higher rates of HPV-associated infection and disease than women without HIV. HPV vaccination has proven safe and efficacious in young women without HIV, however, little was known about the vaccine in WLWH. The work represented in this thesis was designed to answer key questions around HPV infection and the impact of HPV vaccination in WLWH. Methods: WLWH across Canada were invited to participate in a CIHR-funded, multi-centre study of quadrivalent HPV vaccination starting in 2009. Participants were administered three doses of vaccine at 0/2/6 months. Demographic and clinical data, serology (cLIA), liquid-based cervical cytology, and HPV DNA genotyping (Linear array assay) were collected at baseline and post-vaccine series every 6-12 months up to 8 years. Participants were referred for clinical colposcopies as per the standard at their institutions. Results: Pre-vaccination rates of prevalent and persistent oncogenic HPV infection among participants were high. Extending the spacing of the three vaccine doses out to two years did not significantly impact the peak anti-HPV antibody titer achieved in this cohort. Two years post-vaccination, efficacy of the vaccine was good, demonstrating lower rates of clinical endpoints than in unvaccinated Canadian WLWH, but higher rates than those seen in vaccinated women without HIV. Post-vaccination rates of persistent non-vaccine oncogenic HPV types were relatively high with a higher proportion of non-vaccine HPV types than of HPV types contained in the nonavalent vaccine. Conclusions: These findings support the value of HPV vaccination and the need for ongoing cervical cancer screening post-vaccination in WLWH. They also do not indicate concern with extending the spacing interval between the first and third doses up to two years. Collectively, these findings have provided great value to the clinical care of WLWH by informing best vaccination and screening practices for this particularly vulnerable population.
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