HUMAN PAPILLOMA VIRUS (HPV)

HUMAN PAPILLOMA VIRUS (HPV)      *HPV infection is a sexually transmitted viral disease effecting primarily the cervix, but also the male genitalia, oral cavity, and esophagus D’Souza G, 2007).  Viral changes in cervical cells can often be detected on routine Pap tests.  The virus is more commonly seen in anemic younger women (>30 years old), contraceptive hormone users, smokers, alcohol users,  the poor, during late pregnancy, and in periods of low immunity (Moreno V, 2002, Santos C, 2001, Broker TR, 2001, Thomson SW, 2000)
     *HPV has been found in association with low folic acid and antioxidant micronutrient status (Hernandez BY, 2003, Kwasniewska A, 2002 & 1997, Harper JM, 1994).  Folic acid has been shown to have a protective effect against the development of HPV, and improving folate status in people at risk of getting infected or who are already infected may have a beneficial impact in the prevention of cervical cancer (Piyathilake CJ, 2004).
     *Many cases of HPV resolve on their own but certain strains, such as HPV-16, 18, 30, 33, and 45, are considered more aggressive and may lead to cervical cancer.  HPV-DNA testing has shown that virtually all cervical cancers test positive for HPV with over 90% of them testing positive for HPV-16, 18, and 45 (Munoz N, 2003, Ngelangel C, 1998).  Women who are HIV positive are particularly vulnerable to HPV and often have unrelenting reoccurrences that quickly progress to invasive cervical cancer (Lee YC, 2000).  HPV is so common in HIV positive women, it is now listed as an AID’s defining illness.  HPV is at epidemic proportions, although early detection through Pap tests is helping to reduce its occurrence and deaths from cervical cancer worldwide (Lambert EC, 2001).  Cervical cancer kills approximately 300,000 women worldwide.  Recent studies have also strongly linked certain strains of HPV, especially HPV-16,  with the pathogenesis of squamous cell carcinoma of the throat in both men and women (D’Souza G, 2007).
      *A major breakthrough in the prevention of cervical cancer has recently been made as there are now two approved vaccines, Gardasil and Cervarix, that will provide substantial protection against the most common high risk types of HPV (HPV16 and 18, which cause about 70% of cervical cancers, and HPV 6 and 11, which cause approximately 90% of genital warts) in girls and young women (9-26 years of age) who have not yet been exposed to the virus. While the vaccines provide almost 100% protection against the above four HPV strains, they may increase the risk of developing lesions that lead to cervical cancer in women already exposed to the virus.  Therefore, the vaccines are not recommended for women who test positive for HPV-DNA.  Furthermore, the vaccines do not protect against less common strains of HPV that may lead to cervical cancer such as HPV-30 and HPV-33 so regular Pap tests will still be required  to detect precancerous changes in the cervix to allow treatment.  The effectiveness of the vaccines are thought to be only for about 3 1/2 years so a booster may be required after that time.  It has been estimated that the full effect of these vaccines against HPV in the general population will probably take about three decades to accomplish.  Makers of the vaccines are also working on a version for boys and young men (WP Report , FDA Report) who harbor the virus and test positive for HPV-DNA at about equal rates to that of women and who can spread the virus as well.  Vaccinating not only girls, but also boys, will help boost protect against not only cervical cancer but also oral cancer. Currently, some countries, such as Scotland, are offering the HPV vaccine to school girls as part of their government immunization program (Lyndsay M, 2007)The vaccine has been shown to be almost 100% effective in providing immunity to the most common forms of the virus that can lead to cervical cancer. A more recent development is a blood test for cancer causing strains of HPV.  It is now patented and waiting additional approval for use (see Grant Life Sciences, 2007).
     *Hallmark cellular changes in epithelial cells of the cervix are mild to moderate dysplasia with koilocytotic atypia (a peculiar wide clearing of the cytoplasm around the nucleus). Koilocytotic atypia is pathognomonic of HPV.  Identification of HPV on Pap tests is always given an abnormal interpretation.  Frequent repeat smears and other follow-up tests are often recommended for several years after an HPV lesion is initially diagnosed.  A new study published in the British Journal of Medicine in October, 2007 found the risk of cervical cancer after initial detection of a high grade HPV lesion still remains high 25 years after treatment.  In this study the risk of cervical cancer was shown to have increased since the 1960s and to be pronounced in women over age 50 (Strander B, 2007).  It should be noted that starting in the 1960’s significant use of and exposure to synthetic steroid hormones (estrogen and progesterone) began in women of developed countries starting with DES in-utero exposure, then birth control pills, and finally hormone replacement therapy. Various estrogen or estrogen and progesterone combinations were also given liberally to many of these women to stop lactation after child birth (estrogen) and for ovarian and menstrual disorders (The Pill). 

http://cancerres.aacrjournals.org/cgi/content/abstract/64/23/8788

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