Vaccination Against Human Papillomavirus

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Persistent infection with high-risk type HPV is a necessary cause of cervical cancer and therefore elimination of HPV infection will prevent this cancer (33,34). Furthermore, the majority of infections are cleared by the host's immune system suggesting the vaccination against this agent is feasible. Historically, vaccines have come to represent a highly cost-effective means to reduce the morbidity and mortality of infectious diseases. These facts have driven the rational development of preventative and therapeutic vaccination strategies based on the detailed understanding of the molecular biology of the HPV life cycle. Vaccination could be implemented to prevent infection (prophylactic) or eliminate infection (therapeutic), or optimally by combining both strategies in a preventive and therapeutic vaccine. The preventive vaccines typically elicit neutralizing antibody to interfere with HPV infection. The therapeutic vaccines would be likely to induce a virus-specific cellular immune response to trigger the regression of pre-existing lesions. It is also possible that therapeutic vaccines could be used "prophylacti-cally," not to prevent the initial infection, but to clear the virus before clinically apparent lesions are established. The remainder of this chapter will discuss the recent developments in the clinical applications of HPV vaccines.

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