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Gardasil vs. Cervarix
Nov 24, 2010

Dear Dr.,

I'm an HIV+ 44y/o male, currently on Truvada/Isentress (after switching off from Atripla). CD4>500, VL<U/D. My Dr. is willing to prescribe me "off label" HPV vaccine but I'm a bit confused between the 2 options out there. I read that Gardasil has been approved by FDA for males<26 y/o while Ceravix has only been approved in females. On the other hand my Dr. says that Ceravix covers more strains of HPV and therefore he believes it might be more beneficial to go with that option. What's the latest 'trend" in off-label HPV vaccines for HIV MSM over 26 y/o and which of the two products would you recommend?

Thanks for any advice!

Response from Dr. McGowan

Cervarix vaccine can induce protection against 2 cancer causing strains of HPV (strains 16 and 18). These 2 types are responsible for about 70% of cervical cancers in women, as well as anal cancers in men and women.

Guardasil can induce protection against 4 strains of HPV, the 2 major cancer causing strains (16 and 18) as well as 2 strains commonly associated with genital warts (strains 6 and 11- responsible for about 90% of genital warts).

Both vaccines require a series of 3 shots over 6 months.

While Guardasil has approval for young men and boys up to age 26, it is indicated for protection against genital warts and not for cancer (anal or penile cancer) prevention.

Both vaccines are equally effective and can prevent up to 100% of pre-cancerous lesions from developing from the 2 vaccine strains.

Protection can last up to 4 years, and studies on giving "booster" doses are underway.

One reason that giving these vaccines to older peope is that they are more likley to already be infected with strains of HPV and the vaccine may not be effective in preventing warts or cancer if you already have one or more of the strains. With that in mind, the vaccines may help prevent infection with at least 1 or more of the worst HPV types.

The added protection against genital warts may give an edge to Guardasil. But in my practice most of my male patients are already infected with HPV and the benefits of vaccine may be limited.

Even if you do get the vaccine you should still get regular anal Pap screening to look for pre-cancerous signs.

Thanks for bringing up this very timely topic.

Joe



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