HPV Vaccination and Anal Problems

[edfu]

https://www.poz.com/article/HPV-Vaccination-For-All-Positive-Gay-Men-12736-8777

I think this news article is one of the most important yet for all of us who have previously posted about various anal problems (HPV, warts, cancer, etc.).  Be sure to click on to the Aidsmap source article.  The results reported are shocking.  I am afraid, though, that it will take some time before Gardasil is easily available to gay men, to say nothing of the inevitable conflict to get insurance companies to pay for it.   

[Basquo]

Does Gardisil help if you already have HPV?

[Lisa]

Same thing I was wondering Creighton.
But given that they are doing specific studies for gay men, I think it is encouraging that it would be available to anyone.
(unfortunately, it will likely be politicized at the whim of our "leadership")

[rocket]

From what I understand Gardidilwill not work if you are already infected,thats why they want to give it to young people before they have sex.If you dont already have the 16 or 18 ones(the worst strains)but have some others,Im not sure if it would protect or not.   I would pay for this with my own money if it worked and was available,I dont care if I had to barrow the money.I hope they aprove it for men soon,if ever.

[Miss Philicia]

If it doesn't help (which I also thought it did not) then why are they recommending that ALL HIV-positive gay men get the vaccination?  They must think there is a therapeutic benefit, or am I reading something wrong?

[edfu]

There are many variants of HPV, not all of which cause cancer.  In the U.S. Department of Veterans Affairs study, involving HIV-positive men, 31% were positive for the cancer-causing HPV-16, 3% were positive for HPV-18, which is also associated with a high risk of cancer, and 7% were dually infected with both HPV-18 and HPV-16.  Gardasil would not help these 41%.  However, 59% of those with anal HPV infection had infection with a strain of HPV other than HPV-16 or HPV-18.  Gardasil would help that majority.  

The 41% prevalence of HPV genotypes 16 and 18 is what is so shocking (even in this small study of 70 individuals), which is why there is a strong rationale for vaccinating all gay men, whether HIV-positive or HIV-negative, until there is HPV DNA testing available outside of research settings. This argument is furthered by the Australian study, which looked at the prevalence of pre-cancerous cell changes in surgically removed anal warts:  78% of HIV-positive men had pre-cancerous cell changes in the anus, as did 20% of HIV-negative men, and 8% of women.  The Australian researchers suggest that this indicates an increase in the incidence of anal cancer in the future.  

[gerry]

(unfortunately, it will likely be politicized at the whim of our "leadership")

This is already highly politicized even with the age group and gender in which it is currently approved (i.e., pre-adolescent girls).  In my opinion, as soon as evidence emerges that vaccinating men reduces the prevalence of cancer-inducing HPV, it should be offered to all boys and girls prior to the onset of sexual activity irrespective of sexual orientation.

[Iggy]

I am having trouble with the broad HPV vaccination label since it isn't all strains of HPV that is covered.

I just hope that with the vaccination campaign is an equally loud and clear message that people are still at risk and that they need to still get examined for any polyps or precancerous growth regularly.

[gerry]

I am having trouble with the broad HPV vaccination label since it isn't all strains of HPV that is covered.

I just hope that with the vaccination campaign is an equally loud and clear message that people are still at risk and that they need to still get examined for any polyps or precancerous growth regularly.

Even if there is a vaccine that covers all cancer-inducing serotypes, which is unlikely, it is still not going to be 100% effective anyway as there will be nonresponders.  Vaccinating does not eliminate the need for cancer screening (for example, it will not change the regular pap smear recommendations for women).

Hep B, for instance, contains only 1 type of antigen and is very effective but still not quite 100%.  It is recommended to all kids in the US as part of routine immunization.  It initially started as being recommended only to at-risk groups.  The strategy was not effective in reducing hep B infections significantly.  Thus it was subsequently broadened to get all kids vaccinated and that has made an impact in reducing hep b infections on a population basis.  However, because it is not 100% effective, those individuals who remain at-risk for acquiring the infection in adulthood who have gone through the vaccination are advised to make sure they have proof that the vaccine induced adequate antibody response and is protecting them.

[edfu]

Further clarification:  Gardasil protects against four types of HPV--16 and 18 (the two that cause cancer) and 6 and 11, which cause 90% of genital warts. 

HPV is easily transmissible, and protection in the vaccinated host also means transmission is prevented.

The cost of the three-shot regimen is $360, and insurance companies have already protested that the cost is too high.