First generation prophylactic HPV vaccines: the state of the art

A chronic infection with "high risk" human papillomavirus (HPV) is as an obligated step in the development of cervical dysplasia and cancer and, less frequently, other types of cancers. It has been suggested to be responsible for an estimated 100% of cases of cervical cancer, 90% of anal cancers, 40% of vulvar, vaginal and penile cancers and very likely about 18% of oropharyngeal cancers. Furthermore, infection with "low risk" HPV types is responsible for some benign conditions such as genital warts and recurrent respiratory papillomatosis. Even if it is only very rarely a causative factor leading to cancer, these benign diseases have a high socio-economic impact. HPV vaccination has been shown to be viable method in the prevention of HPV-related pathologies. Currently, there are two vaccine formulas belonging to the very low particles (VLPs) first generation vaccines. The first is the bivalent vaccine Cervarix®, which is active against high risk HPV 16 and 18. The second is the quadrivalent vaccine Gardasil®, which is active against high risk HPV 16 and 18, as well as against the low risk HPV types 6, 11. In this paper, we will discuss typical HPV-related pathologies, the effectiveness of these two first generation vaccines, existing advices, potential side effects and limits as well as new directions for HPV-vaccines implementation.