Toward cervical cancer prevention:: strategies employed in the development of HPV vaccines

An HPV persistent infection is doubtless the main factor involved in cervical cancer development. It is clear that the majority of HPV infections are self-limited and not all high-risk HPV infections are destined to progress to a higher grade lesion. Due to viral mechanisms that evade the immune system, in some cases the immune response against HPV is not as effective, allowing the establishment of persistent infections. The promise of a vaccine that can avoid HPV infections and therefore decrease cervical cancer incidence, has been motive of great interest and enthusiasm on the search of different strategies for obtaining an effective vaccine. At present, several prophylactic vaccines have been developed based in virus like particles (VLPs) produced with L1 viral proteins. Results of these vaccines applied to women between 16 and 23 years old show high tolerability and immunogenicity with higher antibody titers than those seen in an HPV natural infection. Even these vaccines can not wholly prevent infections caused by HPV types included in the vaccine design; its efficacy has been demonstrated for their ability to eliminate HPV persistent infections and to prevent the development of cervical intraepithelial neoplasia. These vaccines are currently in phase III of clinical trials, whose results will determine its impact in the general population. Therapeutic vaccines are focused in the elimination of established cervical lesions; nevertheless their efficacy has not been proved for clinical use.