Papilomavírus humano: resposta imune e vacinação
Human papillomavirus (HPV) infection often does not induce inflammation or production of immune mediators capable of inhibiting viral replication. The proinflammatory and humoral immune response is required to break HPV-induced tolerance. The systematic review aimed to compare the safety of the n...
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| Formato: | doctoralThesis |
| Idioma: | pt_BR |
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Brasil
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| Endereço do item: | https://repositorio.ufrn.br/jspui/handle/123456789/28876 |
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| Resumo: | Human papillomavirus (HPV) infection often does not induce inflammation or
production of immune mediators capable of inhibiting viral replication. The
proinflammatory and humoral immune response is required to break HPV-induced
tolerance. The systematic review aimed to compare the safety of the nonavalent
(HPV9) versus tetravalent (HPV4) vaccine and both clinical trials aimed to describe the
course of the immune response to immunoglobulin G/A (IgG/IgA) in immunized
women, with the bivalent vaccine (HPV2), one year after vaccination and the other in
women with / without HPV-induced intraepithelial lesion, non-immunized / immunized
with HPV2. An electronic search for randomized controlled trials (RCTs) evaluating
adverse effects was performed through PubMed, Embase, Scopus, Web of Science,
and SciELO. Regarding clinical trials, serum and cervical mucus samples were
collected for detection of anti-HPV IgG / IgA by enzyme linked immunosorbent assay
(ELISA). The selected RCTs analyzed 27,465 women who received one of the two
vaccines and results as pain (OR 1.72; 95% CI 1.62-1.82) and erythema (OR 1.29;
95% CI 1.21-1.36) occurred significantly more in the HPV9 group. However, adverse
effects such as headache (OR 1.07; 95% CI 0.99-1.15), dizziness (OR 1.09; 95% CI
0.93-1.27) and fatigue (OR 1, 09; 95% CI 0.91-1.30) were equally rare between the
HPV4 and HPV9 groups. In clinical trials, with vaccinated women, IgG reactivated one
month and one year after immunization (100%), while IgA was 95% one month and
79% one year later and although significant (P <0.0001), both antibodies decreased in
cervical and serum samples one year after immunization. In the second clinical trial,
there were significant results regarding the presence of IgA produced by women with
HPV-induced (unvaccinated) lesions when compared to immunized and uninjured
women (p <0.01). IgG detection was higher in immunized serum (p <0.01). Therefore,
our findings demonstrate that the HPV9 vaccine in female patients is as safe as the
HPV4 vaccine. The immune response, although significant, decreases one year after
immunization, suggestive of a booster needed to increase antibody titers. IgA in
unvaccinated women is characterized as a possible transudation of the systemic
circulation to the cervical mucosa. Memory antibody IgG proves the efficacy of the
bivalent vaccine in protecting against HPV infection. |
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