Human PapillomaVirus (HPV)

Ans. is a and b i.e. Type 16; and Type 18

On the basis of strength of association to Ca cervix – HPV has been classified into

Low risk type

• Cause genital warts and subclinical HPV infection
• Cause high grade CIN which progress to invasive cancer
• Type 16, 18, 31. 33, 45, 58
• Subtype of HPV 6.

6 & 11 REF: Robbins 7^th edition page 324

See APPENDIX-31 for “HUMAN PAPILLOMA VIRUS”

HPV infection REF: Shaw’s Gynecology 13th ed p- 78, The pap test by Richard M. DeMay page 49-50

“Koilocytes, dyskeratocytes, macrocytes, etc. are some of the cytologic findings that are characteristic of condylomas (HPV). Koilocytes with perinuclear halo is pathognomonic of HPV infection”

Ans. is ‘a’ i.e., Papova virus 

• Human papilloma virus belongs to papovaviridae family.

Ans. is. ‘d’ i.e., Both bivalent and quadrivalent 

Human papillomavirus (HPV) vaccine

• HPV is one of the most important risk factor for cervical cancer, widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two thirds, if all women were to take the vaccine and if protection turns out to be long term.

.   In addition, the vaccine can reduce the need for medical care, biopsies and invasive procedures associated with the follow up from abnormal pap tests. Thus, helping to reduce the health care costs and anxieties related to abnormal pap tests and follow up procedures.

.   HPV vaccines are ‑

1)    Preventive vaccines

– The role of HPV vaccine is to prevent infection with certain species of Human papillomavirus associated with the development of cervical cancer, genital warts and some less common type of cancers.

– These vaccines are based on virus like particles (VLPs) assembled from recombinant HPV coat proteins (major capsid protein L1).

– Currently, one quadrivalent product containing HPV types 6,11,16 and 18 has been licenced in US and

recommended by the centres for disease control and prevention for administration to girls and young women

9-26 years of age —> type 16 and 18 are most important as they cause 70% of cervical cancer world wide. – Another product contains HPV types 16 and 18 ( bivalent) and is likely to be available in the near future.

2)    Therapeutic vaccines (under trial)

– In addition to above two preventive vaccines, laboratory research and several human clinical trials are focused on the development of therapetic HPV vaccines. In general these vaccines focus on the main HPV oncogenes, E6 and E7. Since expression of E6 and E7 is required for promoting the growth of cervical cancer cells and cells within warts, it is hoped that immune responses against two oncogenes might eradicate established tumors.

Ans. is ‘c’ i.e., Efficacy >70% for cervical cancer

. There are two types of HPV vaccines :-

i)         Quadrivalent :- containing HPV types 6,11,16,18

ii)       Bivalent :- containing HPV types 16,18

.  Efficacy of vaccine has varied according to the immunologic and virological characteristics of study populations at baseline and according to the endpoints evaluated. Most of the time, rates of vaccine efficacy exceed 90%.

.  Vaccine is recommended for girls and young women 9-26 years of age.

.  The quadrivalent vaccine is administered intramuscularly as three separate doses, with second dose given at 2months after the first dose and the third dose 6 months after the first dose.

Ans. is ‘c’ i.e., 6,11

.    High risk HPV: HPV-16, 18, 31, 33 & 45 —> associated with cervical cancer.

.    Low risk HPV: HPV- 6 & 11 –> associated with precursor lesions CM and condyloma accuminatum

.    HPV-5 & 8    associated with squamous cell cancer in patients with epidermodysplasia verruciformis

Ans. is ‘b’ i.e., Multiple papillomatosis

o Multiple warts are common.

Ans. is ‘c’ i.e., Type 16,18

Human papillomavirus (HPV) vaccine

• HPV is one of the most important risk factor for cervical cancer, widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two thirds, if all women were to take the vaccine and if protection turns out to be long term.
• In addition, the vaccine can reduce the need for medical care, biopsies and invasive procedures associated with the follow up from abnormal pap tests. Thus, helping to reduce the health care costs and anxieties related to abnormal pap tests and follow up procedures.
• HPV vaccines are ‑

1) Preventive vaccines

• The role of HPV vaccine is to prevent infection with certain species of Human papillomavirus associated with the development of cervical cancer, genital warts and some less common type of cancers.
• These vaccines are based on virus like particles (VLPs) assembled from recombinant HPV coat proteins (major capsid protein L1).
• Currently, one quadrivalent product containing HPV types 6,11,16 and 18 has been licenced in US and recommended by the centres for disease control and prevention for administration to girls and young women 9-26 years of age — type 16 and 18 are most important as they cause 70% of cervical cancer world wide.
• Another product contains HPV types 16 and 18 ( bivalent) and is likely to be available in the near future.

2) Therapeutic vaccines (under trial)

• In addition to above two preventive vaccines, laboratory research and several human clinical trials are focused on the development of therapetic HPV vaccines. In general these vaccines focus on the main HPV oncogenes, E6 and E7. Since expression of E6 and E7 is required for promoting the growth of cervical cancer cells and cells within warts, it is hoped that immune responses against two oncogenes might eradicate established tumors.

This condition is Genital Warts (condyloma accuminata)

Ans A

• Burkitt’s lymphoma (Epstein-Barr virus)
• Hepatocellular carcinoma (hepatitis viruses)
• Cervical cancer [human papillomavirus (HPV)]
• T cell leukemia (retroviruses)

Ans. is ‘b’ i.e., Condyloma acuminata

Ans. is ‘b’ i.e., 6, 11

Ans. is `c’ i.e., 16, 18

• HPV DNA of oncogenic types (High risk) in HPV-16, 18, 31, 33 and 45 → associated with cervical cancer 
• HPV-6 and 11 (Low risk HPV) → associated with precursor lesions of cervical cancer (CIN) and Condyloma Acuminatum.
• In patients with epidermodysplasia verruciformis, Squamous cell cancer develop frequently at sites infected with specific HPV types, including 5 and 8.
• E6 and E7genes of HPV are responsible for carcinogenicity.