Human papillomavirus vaccination beyond prophylaxis: A narrative review to assess its benefits when combined with treatment for different types of lesions

Abstract

Human papillomavirus (HPV) vaccination has established itself as one of the main strategies for the primary prevention of HPV-associated infections and neoplasms. However, in recent years, there has been growing interest in the potential benefit of the prophylactic vaccine in post-exposure settings, particularly as an adjunctive strategy following treatment of HPV-related lesions. The objective of this study was to review the available evidence on the role of HPV vaccination beyond prophylaxis, with an emphasis on its potential adjuvant benefit in reducing recurrence and in the clinical management of HPV-associated diseases at different anatomical sites. This is a narrative review, with searches conducted in the PubMed, Scopus, and LILACS databases, including publications in Portuguese, English, and Spanish published over the past 15 years. We included studies that evaluated the use of the vaccine in individuals previously exposed to HPV or who had undergone treatment for HPV-related lesions, encompassing clinical trials, observational studies, case series, and relevant reviews. The evidence was organized according to the affected anatomical site. Greater consistency in adjuvant benefit was observed in the cervical tract, especially following treatment for cervical intraepithelial neoplasia, and promising results were noted in recurrent respiratory papillomatosis, with a reduction in the number of procedures and an increase in the interval between recurrences. In the vulva, vagina, and anal region, observational studies suggest a possible reduction in recurrence in specific contexts, although the findings are heterogeneous and not always confirmed by randomized clinical trials. For penile cancer and head and neck neoplasms, the evidence is predominantly indirect or still insufficient to support robust conclusions. It is concluded that the prophylactic HPV vaccine should not be interpreted as a direct treatment for active disease, but may play an adjunctive role in certain clinical scenarios, particularly in reducing recurrence after local treatment. The magnitude of this benefit varies depending on the anatomical site and the methodological quality of the available studies and remains undefined, indicating the need for prospective clinical trials and specific guidelines for its incorporation into clinical practice.