HUMAN PAPILLOMAVIRUS VACCINE CONCERNS

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I currently test for human papillomavirus (HPV) DNA as a marker for HPV infection. With the advent of the HPV vaccine, how will clinicians be able to distinguish between an active HPV infection and immunity? Will HPV tests for antibodies and antigens be available similar to those for hepatitis B?
—Karin Greer, MS, MPH, PA-C, East Windsor, N.J.

You are correct that the current vaccine will not protect women against all the HPV types that cause cervical cancer. Therefore, it will be important for women to continue Pap smear testing even after receiving the vaccine. The HPV test checks for the genetic material (DNA) of the human papillomavirus. Guidelines recommend that women younger than 30 years of age who have an abnormal Pap smear undergo subsequent HPV DNA testing and women 30 years and older be offered simultaneous testing for HPV DNA along with the Pap smear as screening for cervical cancer. The vaccine does not contain any nucleic acid and will not interfere with the HPV DNA test. Subunit viruslike particles (VLPs) composed of viral protein and contained in the vaccine induce high levels of neutralizing antibodies. It remains to be seen how long these antibodies will persist and how much cross-reactivity against HPV types not included in the vaccine will occur.
—Jo Ann Deasy, PA-C, MPH (99-3)

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