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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

► 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
► 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

► 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

► 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
► 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
Pap Smear – Cervical
Cancer
►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.
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
► 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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