Human papillomavirus infection and neoplasia. Speculations for the future

Human papillomavirus infections of the skin and anogenital tract are common. The association of these viruses with neoplasia, particularly of the anogenital tract, has stimulated efforts to devise practical methods of detection and typing of HPV. Although experimental diagnostic tests are available, they are, for the most part, complex and time consuming and are limited to medical centers researching HPV. New methods for preparing probes with higher sensitivities for hybridization tests will allow use of in situ methods on formalin-fixed tissues and will probably be the method of choice. Antigen detection systems are not available, except for antisera directed against the common structural antigens. The most useful immunologic test will be directed toward detection of nonstructural antigens in fixed tissues; such a system could also be useful for virus typing. Therapies based on use of these antigens to stimulate the immune system may be applicable as an alternative to current therapies. Most intriguing are the prospects for a vaccine based on either structural or nonstructural viral antigens. It has been estimated that as many as 20% of cancer deaths in women worldwide are associated with HPV. Thus, use of an effective vaccine would relieve considerable human suffering. Until the host immune response to HPV infection is better defined, however, much of the effort dedicated to developing a vaccine may be futile.