Sexual & Reproductive Health
Human papillomavirus (HPV) is the most common sexually transmitted infection, affecting more than one in ten women and one in five men worldwide. In sub-Saharan Africa, almost a quarter of women and more than three-quarters of men are infected.
While most infections are asymptomatic and resolve spontaneously, infection with key HPV strains can result in pre-cancer and cancer. HPV infection is the causal agent in almost all cases of cervical cancer, which is the fourth most frequent cancer worldwide and a leading cause of cancer death in women. There were 570,000 new cases and 311,000 deaths from cervical cancer in 2018, with more than 85% of deaths occurring in LMICs. In the presence of HIV, HPV infection is also more likely to lead to earlier development of cervical cancer, taking as little as 5 years for invasive cervical cancer to develop.
Given the absence of HPV-specific drug treatments and availability of highly effective preventive vaccines, current global approaches focus on prevention. This remains a challenge in LMICs, however, due to inequity of access to existing vaccines and challenging dosing regimens. While three vaccines have received WHO prequalification, these follow a two- or three-dose schedule, do not protect against all high-risk HPV strains and are unable to eliminate pre-existing infection. Following a number of dose-reduction studies of existing
HPV vaccines, the WHO formally recommended a single-dose schedule in Dec 2022, but its guidance has yet to be fully implemented. Screening is also instrumental in the timely implementation of adequate surveillance and treatment. Current screening technologies, including DNA tests, are resource intensive, reaching only 5% of women in LMICs. The most widely used screening method, visual inspection with acetic acid, offers poor specificity and high observer variability. Several technologies in development aim to provide simpler, more reliable, and safe point-of-care use in LMICs.
India’s Drugs Controller General granted market authorisation to the Serum Institute of India for India’s first Quadrivalent Human Papillomavirus vaccine, CERVAVAC, against HPV-related cervical cancer. The therapeutic vaccine candidate, TG4001, a modified vaccinia virus Ankara (MVA)-based vaccine is due to complete Phase Ib/II testing for HPV-16 positive metastatic cervical cancer by late 2024.