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Vol. 26. Núm. S1.
Vacunas: presente y futuro
Páginas 65-77 (Enero 2008)
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Vol. 26. Núm. S1.
Vacunas: presente y futuro
Páginas 65-77 (Enero 2008)
Vacunas: presente y futuro
DOI: 10.1016/S0213-005X(08)76226-8
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Vacunas frente al virus del papiloma humano
Vaccines against the human papilloma virus
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Xavier Castellsagué Piqué??
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xcastellsague@iconcologia.net

Correspondencia: Dr. X. Castellsagué. Servicio de Epidemiología y Registro del Cáncer. IDIBELL. Institut Català d’Oncologia. Avda. Gran Via, s/n km 2,7. 08907 L’Hospitalet de Llobregat. Barcelona. España.
, F. Xavier Bosch José
Servicio de Epidemiología y Registro del Cáncer. IDIBELL. Institut Català d’Oncologia. L’Hospitalet de Llobregat. Barcelona. España
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La infección anogenital por el virus del papiloma humano (VPH) constituye una enfermedad de transmisión sexual muy común en la población sexualmente activa. Aunque la mayoría de las infecciones siguen un curso benigno y se resuelven espontáneamente, la infección persistente por ciertos genotipos del VPH está asociada causalmente con el desarrollo del cáncer de cuello uterino y de una fracción de otros cánceres anogenitales, de la cavidad oral y de la orofaringe.

Los datos procedentes de los ensayos clínicos de las 2 vacunas VPH disponibles hasta la fecha —una bivalente frente a los tipos del VPH 16/18 y otra tetravalente frente a los tipos virales 6/11/16/18— demuestran que estas vacunas son seguras, inmunogénicas y altamente eficaces en la prevención no sólo de la infección persistente por los tipos virales incluidos en las vacunas, sino también en la prevención de las lesiones precursoras inmediatas al carcinoma invasivo de cuello de útero. Asimismo, los resultados de los ensayos de la vacuna tetravalente indican que esta vacuna es también altamente eficaz en la prevención de las verrugas genitales o condilomas, así como de las neoplasias avanzadas de la vulva y la vagina. Ambas vacunas presentan evidencias de protección cruzada contra la infección por tipos virales no incluidos en la vacuna, pero ninguna de las dos tiene efectos terapéuticos. La población diana de vacunación para alcanzar el máximo potencial preventivo son las niñas preadolescentes a partir de los 9 años de edad.

La comunidad científica es optimista y se estima que en los próximos 25-30 años se observará una reducción de las tasas de incidencia del cáncer de cuello uterino y otras lesiones asociadas al VPH, siempre que los programas de vacunación frente al VPH alcancen una buena cobertura. Con anterioridad a esta reducción, podrá observarse un impacto importante en las tasas de lesiones citológicas cervicales con la consecuente reducción del número de colposcopias, biopsias y tratamientos quirúrgicos, así como una disminución de la carga de ansiedad que ocasiona en la mujer el diagnóstico de enfermedades asociadas al VPH.

Palabras clave:
Virus del papiloma humano
VPH
Vacuna
Epidemiología
Cáncer de cuello de útero
Prevención

Anogenital infection due to human papilloma virus (HPV) is a highly common sexually transmitted disease in the sexually active population. Although most infections have a benign course and resolve spontaneously, persistent infection by certain HPV genotypes is causally associated with the development of cervical cancer and of a fraction of some other cancers of the anogenital area, oral cavity, and oropharynx. The data available from clinical trials of two HPV vaccines – a bivalent vaccine against HPV 16/18 and a tetravalent vaccine against HPV 6/11/16/18 – show that these vaccines are safe, immunogenic, and highly effective in preventing not only of persistent infection by the viral types included in these vaccines but also in preventing immediate precursor lesions of invasive cervical carcinoma. Likewise, the results of trials of the tetravalent vaccine indicate that this vaccine is also highly effective in preventing against genital warts or condylomas, as well as advanced neoploasias, as well advanced neoplasias, as well as advanced tumours of the vulva and vagina. There is evidence that both vaccines confer cross protection against infection by viral types not included in the vaccines, but neither of the two vaccines has therapeutical effects. The vaccination target population to achieve the maximum preventive potential consists of preadolescent girls aged 9 years old or above. The scientific community is optimistic and it is estimated that in the next 25 to 30 years there will be a reduction in the incidence rates of cervical cancer and other lesions associated with HPV, as long as vaccination programs against this virus achieve good coverage. Before this reduction occurs, there may be a substantial impact on the rates of cytological cervical lesions with a consequent reduction in the number of colposcopies, biopsies and surgical treatments, as well as a decrease in anxiety in women caused by the diagnosis of HPV-related diseases.

Key words:
Human papillomavirus
HPV
Vaccine
Epidemiology
Cervical cancer
Prevention
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Copyright © 2008. Elsevier España S.L.. Todos los derechos reservados
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