How is HPV treated?
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Treatment of Human Papillomavirus (HPV)
Surgical Excision for HPV-Associated Neoplasia
Surgical excision is a primary treatment for HPV-associated lower genital tract neoplasia. This method is highly effective but relies on secondary prevention programs for early disease identification. However, surgical procedures alone may not be sufficient for treating high-risk HPV-driven chronic, pre-neoplastic lesions, and some early cancers.
Chemoradiation Therapy for Cervical Cancer
Chemoradiation therapy is a standard treatment for cervical cancer, contributing to a 66-79% survival rate at five years. Despite this, the prognosis for patients with persistent or recurrent cervical cancer post-treatment remains poor.
Topical Agents for High-Grade Vulvar Intraepithelial Neoplasia (VIN)
Topical agents such as imiquimod, cidofovir, and photodynamic therapy have shown efficacy (~50-60%) in treating high-grade VIN. These agents work by modifying the immune response, inhibiting viral replication, and inducing apoptosis.
Provider and Patient Administered Treatments for Genital Warts
Provider-administered treatments for genital warts include cryotherapy, trichloroacetic acid, and surgical removal, which have the highest primary clearance rates. Patient-applied therapies include podophyllotoxin and imiquimod, though recurrence rates after successful treatment are 30-40%.
Immunotherapy for HPV-Related Cancers
Immunotherapy is emerging as a promising treatment for HPV-related cancers, offering fewer adverse effects and potential survival benefits. Immunotherapeutic approaches include immune checkpoint inhibitors like PD-1/PD-L1 inhibitors, which have shown improved responses in HPV-positive patients due to an inflamed immune microenvironment .
HPV Vaccination as a Therapeutic Option
HPV vaccines, traditionally used for prevention, are now being explored as therapeutic agents. Studies have shown that HPV vaccination can reduce the recurrence of cervical intraepithelial neoplasia (CIN) and other HPV-related diseases. Adjuvant HPV vaccination post-primary treatment has been associated with a reduced risk of recurrence in various HPV-related conditions .
Novel Therapeutic Approaches
Novel therapies targeting molecular pathways mediated by HPV in cancer are under development. These include small molecule inhibitors targeting HPV E1/E2 DNA binding activities and the anti-apoptotic effects of E6/E7 oncogenes. Proteasome and histone deacetylase inhibitors, which enhance apoptosis in HPV-positive tumor cells, are also being tested in early clinical trials.
Combination Therapies
Combination therapies that integrate current treatments with new drugs targeting HPV-mediated pathways are being explored. These combinations aim to improve treatment efficacy and reduce recurrence rates.
Conclusion
The treatment of HPV-related diseases involves a multifaceted approach, including surgical excision, chemoradiation, topical agents, immunotherapy, and vaccination. Emerging therapies targeting specific molecular pathways and combination treatments hold promise for improving outcomes in HPV-associated conditions. Continued research and clinical trials are essential to optimize these treatments and enhance patient prognosis.
Sources and full results
Most relevant research papers on this topic
Therapy of human papillomavirus-related disease.
Immunotherapeutic Approaches for the Treatment of HPV-Associated (Pre-)Cancer of the Cervix, Vulva and Penis
Evaluating the Efficacy of Pervistop®, a New Combination Based on EGCG, Folic Acid, Vitamin B12 and Hyaluronic Acid on Patients with Human Papilloma Virus (HPV) Persistent Infections and Cervical Lesions: A Pilot Study
The Human Papillomavirus Vaccine as a Treatment 1 for HPV-related Dysplastic and Neoplastic Conditions: A Literature Review.
Tumor Immunity and Immunotherapy for HPV-Related Cancers.
HPV-positive status associated with inflamed immune microenvironment and improved response to anti-PD-1 therapy in head and neck squamous cell carcinoma
Impact of HPV 16/18 infection on clinical outcomes in locally advanced cervical cancers treated with radical radio (chemo) therapy - A prospective observational study.
HPV Vaccination after Primary Treatment of HPV-Related Disease across Different Organ Sites: A Multidisciplinary Comprehensive Review and Meta-Analysis
EUROGIN 2011 roadmap on prevention and treatment of HPV‐related disease
Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: A systematic review and meta-analysis.
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