HPV and All the Hype

Who knew HPV would get so popular? It is like its parents left town and it had the party of the semester. One day it is this little-talked about virus. The next day it’s Lady GaGa. It has been all over the news this week and for good reason. There are two new major findings, one the result of a study, one the result of a panel.

As background, HPV, human papilloma virus, is the most common sexually transmitted disease, thought to affect anywhere from 45-75% of sexually active people at some time in their life. When you are young, the body’s immune system usually clears the virus, leaving you no dangerous sequelae. As you get older, there is more of a chance that your old immune system (is nothing immune from the aging process?) will not clear the virus. In women, the virus can cause cervical cancer. In both men and women, the virus can cause anogenital warts, and anogenital, oral and throat cancer. There are many different strains of HPV, only some of which are dangerous.

What’s the news, what’s the controversy?

1. The HPV vaccine was approved by the FDA in 2006 and it was recommended for females between the ages of 9-26. Only about a third of the potential recipients in the U.S. have gotten the three-shot series. Why? In the first place, because of the media attention to the later-disproven link between MMR and autism, people are scared of vaccines, especially new ones. Most parents do not want to consider the future sexual activity of their pre-teens. (Hepatitis B is a sexually transmitted disease. Your child probably received this three shot series in the first 6 months of his or her life.) The biggest obstacle to having adult women, ages 18-26, vaccinated is getting them to commit to return for the shots and convincing them it would be beneficial.

2. While the vaccine has always been approved for boys, it wasn’t recommended. Two days ago the CDC put forth the recommendations that boys ages 11 and 12 should receive the vaccine routinely, and boys 13-19 should be vaccinated if they haven’t already been. A CDC recommendation will encourage insurance companies to pay for the vaccine, which is fairly expensive. In my opinion, the recommendation is great because vaccinating more kids will put us on the road to essentially eradicating the dangerous strains of HPV – less cancer to worry about. The controversy is this. One, people think it encourages sexual promiscuity. Two, for the most part, only homosexual sex puts men at risk for the anogenital and throat cancer. Like many parents don’t want to think of their baby girl having sex, they don’t want to think of their little boy’s future sexual preference. O.K. I get that, but ….

3. A new study released three days ago found a link between HPV infection and cardiovascular disease (CVD). This is really cool. It was a small study but definitely will prompt further investigation. It is known that the protein p53 is diminished by HPV. This is partly why it causes cancer. p53 is critical in the body for the regulation of atherosclerosis. Less p53 -> more atherosclerosis -> greater chance of heart attack and stroke. About 20% of people who present to their doctor or emergency room with a heart attack or stroke have none of the traditional risk factors for CVD. This study sheds some light on what else can put a person at risk for heart disease.

4. What now for kids? Perhaps the link between CVD and HPV will further incentivize parents to choose to have their children vaccinated – male or female. I hope so. I will be having all five of my kids, three girls and two boys, vaccinated. I don’t want to think about their sex life, nor will I . I find it easy to look past the mode of transmission of this virus to the benefit of decreasing their risk for some cancers and of possibly decreasing their risk for heart disease. I look forward to more research into the HPV/CVD link.

5. What now for adults? Going forward, it may be even more important to know someone’s HPV status. It might encourage both men and women to get their check ups. For adults who are HPV negative and sexually active, it may someday be recommended they too are vaccinated for the potential cardiovascular benefit. Who knows? Stay posted. Even if you aren’t a science person, this is pretty intriguing stuff.

What about side effects of the vaccine? Like any vaccine, there are side effects and you should do your homework. But, please remember that vaccines in general have been nothing short of miraculous in the prevention of diseases, some of which were killers and maimers of children. I must confess my bias, I am always up for a shot.

 

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