Imunologia no câncer

Human Papillomavirus
• More than 100 types
– More than 60 cutaneous types
 Can lead to skin warts
– 40 mucosal types
 High risk types (particularly 16 and 18)
– cervical cell abnormalities
– certain anogenital cancers
 Low risk types (particularly 6 and 11)
– cervical cell abnormalities- usually resolve spontaneously and do not lead to cancer
– genital warts
– respiratory papillomatosis

Natural History of HPV Infection
Up to Decades
Within 1 Year

1-5 Years

Persistent
Infection
Initial
HPV
Infection
CIN 1

Cleared HPV Infection

CIN
2/3

Cervical
Cancer

HPV para Cancer
•
•
•
•
•

HPV de Alto risco – 16,18,31,33 e 45
E6 – P53
E7- pRB
30.000 pacientes com HPV
3600 – apresentarão NIC (Baixo
Grau)
• 360 – NIC Alto Grau
• 30 – Câncer de colo uterino
• neoplasias intra-epiteliais cervicais

P53 polimorfismo e o risco para neoplasia • Franco EL, Villa LL, Sobrinho JP, et al.
Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer. J Infect Dis 1999; 180:1415–23.

neoplasias intra-epiteliais cervicai

Vacinas anti-HPV
• Vacinas estão aprovadas no Brasil: a vacina quadrivalente (HPV 6, 11, 16,
18) da Merck Sharp & Dohme (MSD) e as vacinas bivalentes (HPV 16, 18) da
Glaxo Smith Kline (GSK).
• Resposta Humoral anti-HPV

Vacina HPV
• This prophylactic vaccine works by preventing four HPV types: HPV 16 and 18, which cause 70% of cervical cancers, and HPV 6 and 11, which cause 90% of genital warts. The vaccine has no therapeutic effect on
HPV-related disease, so it will not treat existing diseases or conditions caused by HPV.
• The vaccine is made from noninfectious HPV-like particles (VLP). It does not contain thimerosal or

Cancer Attributable to HPV - 2002
Estimated Attributable
Cancer
Fraction
Cases
Cervical
100%
12,000
Anal
90%
3,700
Vulvar/vaginal 4,480
40%
Penile
40%
1,000