HUMAN PAIPLLOMA VIRUS

Dr.T.V.Rao MD

Pa il lo mavi rid eae
► Human

papilloma virus belongs to a very large family Paillomavirideae ► Divided into 16 genera ► Among many 5 are only important ► Alpha, Beta, Gamma, Mupa and

Papilloma virus
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The size is 55 microns, Icosahedral, Large Genome ( 8 kbp ) More complex natured virus, Soluble stranded DNA Molecular wt 5 Non enveloped. Contain DNA 10 % and Protein 90 %

Outstanding Characters
► ►

The virus stimulate cell DNA synthesis, Restricted Host range, limited tissue tropisims.Significant cause of Human cancers especially Cancer cervix, The viral oncoproteins interact with cellular tumor suppressor proteins.

Papi llom a vi rus r epl icat ion

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The virus are highly tropic for epithelial cells of skin and mucous membranes Viral Nuclei acid can be found in basal stem cells. But late Genome is expression is restricted to upper most layers of differentiated keratinocytes. Stages in the viral replication cycle are dependent on specific factors that are present in the sequential differentiated stage of the epithelium

Pathology and Pathogenesis
► Transmission

occurs by close contact, ► Viral particles are released from surface of paillomatous lesions ► Causes infections at cutaneous and mucosal sites.

Infections present with
► Skin

warts ► Plantar warts ► Flat warts ► Genital – condylomas ► Laryngeial paillomas

HPV – Sexual Transmission
► HPV

genital infections are sexually transmitted ► Represent the most common sexually transmitted disease in United States

Cervical – HPV infection

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Cervical cancer is second most frequent cancer in women world wide 5,00,000 cases present with cervical cancer Major leading cause of deaths related to malignancy in the Devloping world Several cases associated with HPV infections.

HPV infections predisposes to Cervical Cancer

Lesions on Female Genital Region

Genital Warts in Female

Genital warts in Male

Risk with different types of viruses
High risk types 16 and 18 Less common risk 30, 31, 33, 35, 39, 45, 51 and 53 Low risk types 6, 11, 40, 42 – 44, 54, 61,70, 72 and 81

Immunity and HPV

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Behaviour of HPV lesions is influenced by immunity factor Cell mediated immunity is important. Nearly all HPV infections are cleared and virus are undetectable within 2 – 3 years Cervical cancer devlops slowly Some times takes years to progress High risk behaviour is leading to persistent infection and progress to

Clinical Importance Manifestations
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Globally more than 660 million people are infected with Genital human paillomas infections. Most common infection of the Genital tract. 6-2 million new infections occur in USA. Most common in youth < 25 years HPV infections are accepted as the cause of anogenital cancers. Majority ( 99 % ) are linked to HPV type 16 HPV 18 type is found in Cervical carcinomas HPV 16 and 18 are identified in > 70 % of cervical carcinomas He la cells widely used in laboratories are associated with infection with HPV 18 DNA

Other Clinical manifestations
► Men

who have sex with men develop Rectal cancers ► Oropharyngeal Cancers - subset of Head and Neck are associated with sqaumous cell cancer type associated with HPV 16 ► Role of men as carriers –Most men with HPV are subclinical and donot result in HPV associated disease

Laryngeal Paillomas
► Respiratory

paiillomatosis are caused by HPV 6, and 11 ► Infection is acquired when passing through birth canal of infected mother with warts ► Needs surgical attention ► 3 % of infected children die if not manged with

Diagnosis of HPV – Cervical Cancer / Warts.
►A

doctor usually can diagnose genital warts by direct visual examination. Women with genital warts also should be examined for possible HPV infection of the cervix. The doctor may be able to identify some otherwise invisible changes in the tissue by applying vinegar (acetic acid) to areas of suspected infection. This solution causes infected areas to whiten, which makes them more visible, particularly if a procedure called colposcopy is performed

►A

Pap smear test also may indicate the possible presence of cervical HPV infection. A Pap smear is a microscopic examination of cells scraped from the uterine cervix in order to detect cervical cancer. Abnormal Pap smear results are associated with HPV infection. Women with abnormal Pap smears should be examined further to detect and treat cervical problems.

Pap Smear – Cervical Cancer

HPV Diagnosis in Cervical Infections
► An

HPV diagnosis is typically made based on the results of a Pap smear (or Pap test). Because there are usually no symptoms of the virus, if a Pap test indicates abnormal results, a specific test for the virus is then conducted. A test is also available that can test for the virus's DNA in women.

Immuno supression and HPV
► Immunosupressed

patients experience an increased incidence of warts and cancer of cervix ► All HPV associated infections occur in HIV / AIDS more frequently

Prevention and Control
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Vaccines are cost effective. Aquadrivalent vaccine approved for human use in USA in 2006 It is non infectious recombinant vaccine produced in yeast Contain HPL1 protein Contains derivites of HP 6, 11,16, 18 The vaccine prevents infections with four HPV types A recommended vaccine for Adolescents Not effective in patients with established HPV. Yet how long the Immunity protects with 3 dose of vaccine ? Is not known.

Vaccine Use in HPV
►HPV

vaccines Gardasil and Cervarix, which block initial infection with some of the most common sexually transmitted HPV types may lead to further decreases in the incidence of HPV-induced cancer.

Us e o f Vac cine in Cana da
► The

vaccine has been approved for use in Canada for females 9-26 years of age. The vaccine requires 3 doses to be given over the course of 6 months (0, 2 and 6 months). Recommendations for use, which come from the National Advisory Committee on Immunization (NACI), were released in February 2007. The primary age group recommended for vaccination according to NACI is females aged 9 to 13. HPV is a sexually transmitted infection, and ideally, the vaccine should be administered to females before they become sexually active in order to ensure maximum benefit.

Created for awareness on Human papilloma Virus Infections
Dr.T.V.Rao MD

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