Eighth International Congress on Drug Therapy in HIV Infection Glasgow, UK - 12-16 November 2006

Int Cong Drug Therapy HIV 2006 Nov 12-16;8:Abstract No. PL7.1

Matti Lehtinen
National Public Health Institute and University of Tampere, Finland

BACKGROUND: High risk (hr) human papillomaviruses (HPV), most notably HPV16/18 are the major causes of human cancer, with cervical cancer and other HPV-associated cancers estimated to comprise >5% of all cancers. On the other hand, Chlamydia trachomatis infection is associated with at least half of infertility cases. Increasing incidences of HPV-associated anogenital cancers and infertility in many EU countries are due to decreasing age at sexual debut, increasing risk taking sexual behaviour resulting in increasing occurrence of hrHPV and C.trachomatis infections. HPV vaccination and C. trachomatis screening are getting started in the EU. This plenary lecture considers. How to implement these intervention programmes, and how to assess their impact?

OBJECTIVES: Population based adolescent cohorts are enrolled for longitudinal community randomized intervention studies on hrHPV and C. trachomatis infections, with particular reference to using biobanks to match the communities for evaluating the implementation and long-term effectiveness of the interventions and to generate basis for health-promotion strategies.

WORK CONTENT: A community randomized trial is being planned for Finland. Vaccination of population-based cohorts of early adolescents (ages 13-15 years) with 70% coverage using HPV or hepatitis B virus (HBV) vaccines in a community randomized setting with three arms: A) HPV girls/HBV boys, B) HPV girls/HPV boys, C) HBV girls & boys in 10, 10 and 5 communities/arm, respectively (up to 3,000 early adolescents/community), yields 90% power for the demonstration of 80% difference of HPV16/18 prevalence between arms A and C, assuming sexual contacts in the same community with vaccine efficacy of 80%, expected HPV16/18 prevalence of 20% in unvaccinated 18 year-olds and 10% variability between the communities. The cohorts will be followed up to the age of 18 to 25 years by HPV and C. trachomatis self-sampling, cross-over vaccination and pertinent host genotyping will take place. Need for rescreening and boostering is also determined in this context. Molecular epidemiology of breakthrough infections/type-replacement of the HPV types, and genetic epidemiology of identified hrHPV and C. trachomatis infections will be studied. Combinations of screening for C. trachomatis, screening for hrHPV infections and screening for cervical cancer, as well as prospects for sexual health education will be evaluated. The community randomized setting is also exploited to gain knowledge on possible relevance of the interventions for developing countries.

IMPACT: The most effective way of controlling common sexually transmitted diseases (STD) is inclusion of efficacious preventive measures into national vaccination/screening programmes directed to the young in a coordinated and evaluable, i.e., randomized manner. Our trial is a proof of principle on how population-based cohorts and biobanks can provide new knowledge on implementation and evaluation of these programmes. Improved understanding from molecular epidemiology of the common STDs to cost-effectiveness of the interventions against the common STDs is gained, and propects for eradication of both the infectious causes and the diseases are evaluated.

References Lehtinen M, et al. “Chapter 28: Studies to assess the long-term efficacy and effectiveness of HPV vaccination in developed and developing countries” Vaccine. 2006 Aug 21;24 Suppl 3:S233-41.

Plenary Session: HIV-related Infections, Co-infections and Malignancies II

2006-11-12
PL7.1

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