Papilomavírus humano: resposta imune e vacinação

Abstract

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.