Safety and Immunogenicity of the Nonavalent Human Papillomavirus Vaccine in Women Living with HIV
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Intervention
2.3. Clinical–Epidemiological Variables
2.4. Analytical Variables
2.5. PCR Study of HPV and Anal and Cervical Cytology
2.6. High-Resolution Anoscopy
2.7. Gynecological Examination
2.8. Nonavalent HPV Vaccine
2.9. Antibodies against the 9 HPV Genotypes of the Vaccine
2.10. Statistical Analysis
2.10.1. Sample Size
2.10.2. Data Analysis
3. Results
3.1. Study Population
3.2. HPV PCR and Anal Cytology
3.3. Cytology and Cervical HPV PCR
3.4. Adverse Effects
3.5. Immunogenicity
3.6. Risk Factors of Anal Infection by HR-HPV
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Gaisa, M.; Sigel, K.; Hand, J.; Goldstone, S. High rates of anal dysplasia in HIV-infected men who have sex with men, women, and heterosexual men. AIDS 2014, 28, 215–222. [Google Scholar] [CrossRef] [PubMed]
- Stier, E.A.; Sebring, M.C.; Mendez, A.E.; Ba, F.S.; Trimble, D.D.; Chiao, E.Y. Prevalence of anal human papillomavirus infection and anal HPV-related disorders in women: A systematic review. Am. J. Obs. Gynecol. 2015, 213, 278–309. [Google Scholar] [CrossRef]
- Jemal, A.; Simard, E.P.; Dorell, C.; Noone, A.M.; Markowitz, L.E.; Kohler, B.; Eheman, C.; Saraiya, M.; Bandi, P.; Saslow, D.; et al. Annual report to the nation on the status of cancer, 1975–2009, featuring the burden and trends in human papillomavirus (HPV)-associated cancers and HPV vaccination coverage levels. J. Natl. Cancer Inst. 2013, 105, 175–201. [Google Scholar] [CrossRef] [PubMed]
- Sendargaota-Cudos, E.; Burgos-Cibirán, J.; Rodriguez-Iglesias, M. Genital infections due to the human papillomavirus. Enferm. Infecc. Microbiol. Clin. 2019, 37, 324–334. [Google Scholar]
- Patel, P.; Hanson, D.L.; Sullivan, P.S.; Novak, R.M.; Moorman, A.C.; Tong, C.T.; Holmberg, S.D.; Brooks, J.T. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann. Intern. Med. 2008, 148, 728–736. [Google Scholar] [CrossRef] [PubMed]
- Silverberg, M.J.; Lau, B.; Justice, A.C.; Engels, E.; Gill, M.J.; Goedert, J.J.; Kirk, G.D.; D’souza, G.; Bosch, R.J.; Brooks, J.T.; et al. Risk of anal cancer in HIV-infected and HIV-uninfected individuals in North America. Clin. Infect. Dis. 2012, 54, 1026–1034. [Google Scholar] [CrossRef] [PubMed]
- Wei, F.; Goodman, M.T.; Xia, N.; Zhang, J.; Giuliano, A.R.; D’Souza, G.; A Hessol, N.; van der Loeff, M.F.S.; Dai, J.; Neukam, K.; et al. Incidence and Clearance of Anal Human Papillomavirus Infection in 16 164 Individuals, According to Human Immunodeficiency Virus Status, Sex, and Male Sexuality: An International Pooled Analysis of 34 Longitudinal Studies. Clin. Infect. Dis. 2023, 76, e692–e701. [Google Scholar] [CrossRef]
- Pérez-González, A.; Cachay, E.; Ocampo, A.; Poveda, E. Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection. Microorganisms 2022, 10, 1047. [Google Scholar] [CrossRef] [PubMed]
- Hidalgo-Tenorio, C.; Calle-Gómez, I.; Moya-Megías, R.; Rodríguez-Granges, J.; Omar, M.; López Hidalgo, J.; García-Martínez, C. HPV Infection of the Oropharyngeal, Genital and Anal Mucosa and Associated Dysplasia in People Living with HI. Viruses 2023, 15, 1170. [Google Scholar] [CrossRef]
- Firnhaber, C.; Westreich, D.; Schulze, D.; Williams, S.; Siminya, M.; Michelow, P.; Levin, S.; Faesen, M.; Smith, J.S. Highly active antiretroviral therapy and cervical dysplasia in HIV-positive women in South Africa. J. Int. AIDS Soc. 2012, 15, 17382. [Google Scholar] [CrossRef]
- Piketty, C.; Selinger-Leneman, H.; Grabar, S.; Duvivier, C.; Bonmarchand, M.; Abramowitz, L.; Costagliola, D.; Mary-Krause, M. Marked increase in the incidence of invasive anal cancer among HIV-infected patients despite treatment with combination antiretroviral therapy. AIDS 2008, 22, 1203–1211. [Google Scholar] [CrossRef] [PubMed]
- D’Souza, G.; Wiley, D.J.; Li, X.; Chmiel, J.S.; Margolick, J.B.; Cranston, R.D.M.; Jacobson, L.P. Incidence and epidemiology of anal cancer in the multicenter AIDS cohort study. J. Acquir. Immune Defic. Syndr. 2008, 48, 491–499. [Google Scholar] [CrossRef] [PubMed]
- Diamond, C.; Taylor, T.H.; Aboumrad, T.; Bringman, D.; Anton-Culver, H. Increased incidence of squamous cell anal cancer among men with AIDS in the era of highly active antiretroviral therapy. Sex. Transm. Dis. 2005, 32, 314–320. [Google Scholar] [CrossRef]
- Franceschi, S.; Lise, M.; Clifford, G.M.; Rickenbach, M.; Levi, F.; Maspoli, M.; Bouchardy, C.; Dehler, S.; Jundt, G.; Ess, S.; et al. Changing patterns of cancer incidence in the early- and late-HAART periods: The Swiss HIV Cohort Study. Br. J. Cancer 2010, 103, 416–422. [Google Scholar] [CrossRef] [PubMed]
- Van Der Snoek, E.M.; Van Der Ende, M.E.; Den Hollander, J.C.; Schutten, M.; Neumann, H.A.; van Doornum, G.J. Use of highly active antiretroviral therapy is associated with lower prevalence of anal intraepithelial neoplastic lesions and lower prevalence of human papillomavirus in HIV-infected men who have sex with men. Sex. Transm. Dis. 2012, 39, 495–500. [Google Scholar] [CrossRef]
- Hidalgo-Tenorio, C.; Rivero-Rodriguez, M.; Gil-Anguita, C.; Lopez De Hierro, M.; Palma, P.; Ramírez Taboada, J.; Esquivias, J.; López-Ruz, M.A.; Javier-Martínez, R.; Pasquau-Liaño, J. Antiretroviral therapy as a factor protective against anal dysplasia in HIV-infected males who have sex with males. PLoS ONE 2014, 27, e92376. [Google Scholar] [CrossRef] [PubMed]
- Hidalgo-Tenorio, C.; de Jesus, S.E.; Esquivias, J.; Pasquau, J. High prevalence and incidence of HPV-related anal cancer precursor lesions in HIV-positive women in the late HAART era. Enferm. Infecc. Microbiol. Clin. 2018, 36, 555–562. [Google Scholar] [CrossRef]
- Panel de Expertos del Grupo de Estudio de Sida (GESIDA). Documento de Consenso Sobre Diagnóstico y Tratamiento de Las Infecciones de Transmisión Sexual en Adultos, Niños y Adolescentes (ACTUALIZACIÓN MARZO 2017). Available online: http://www.gesida-seimc.org (accessed on 1 May 2024).
- Versión 12; Guidelines; European AIDS Clinical Society: Brussels, Belgium, 2023.
- Hidalgo-Tenorio, C.; Rivero-Rodriguez, M.; Gil-Anguita, C.; Esquivias, J.; López-Castro, R.; Ramírez-Taboada, J.; de Hierro, M.L.; López-Ruiz, M.A.; Martínez, R.J.; Llaño, J.P. The role of polymerase chain reaction of high-risk human papilloma virus in the screening of high-grade squamous intraepithelial lesions in the anal mucosa of human immunodeficiency virus-positive males having sex with males. PLoS ONE 2015, 10, e0123590. [Google Scholar]
- Salit, I.E.; Lytwyn, A.; Raboud, J.; Sano, M.; Chong, S.; Diong, C.; Chapman, W.; Mahony, J.B.; Tinmouth, J. The role of cytology (Pap test) and human papillomavirus testing in anal cancer screening. AIDS 2010, 24, 1307–1313. [Google Scholar] [CrossRef] [PubMed]
- Padilla-España, L.; Repiso-Jiménez, B.; Fernández-Sánchez, F.; Frieyro-Elicegui, M.; Fernández-Morano, T.; Pereda, T.; Rivas-Ruiz, F.; Redondo, M. Usefulness of human papillomavirus testing in. anal intraepithelial neoplasia screening in a risk behaviour population. Enferm. Infecc. Microbiol. Clin. 2014, 32, 560–564. [Google Scholar] [CrossRef]
- Palefsky, J.M.; Lee, J.Y.; Jay, N.; Goldstone, S.E.; Darragh, T.M.; Dunlevy, H.A.; Rosa-Cunha, I.; Arons, A.; Pugliese, J.C.; Vena, D.; et al. Treatment of Anal High-Grade Squamous Intraepithelial Lesions to Prevent Anal Cancer. N. Engl. J. Med. 2022, 386, 2273–2282. [Google Scholar] [CrossRef] [PubMed]
- Park, I.U.; Palefsky, J.M. Evaluation and management of anal intraepithelial neoplasia in HIV-negative and HIV-positive Men who have Sex with Men. Curr. Infect. Dis. Rep. 2010, 12, 126–133. [Google Scholar] [CrossRef] [PubMed]
- Manhart, L.E.; Koutsky, L.A. Do Condoms Prevent Genital HPV Infection, External Genital Warts, or Cervical Neoplasia? A meta-analysis. Sex. Transm. Dis. 2002, 29, 725–735. [Google Scholar] [CrossRef] [PubMed]
- Kenneth, S.H.; Cranston, R.d. Anal Cytology screening in HIV-positive men who have sex with men: What’s new and what’s now? Curr. Opin. Infect. Dis. 2010, 23, 21–25. [Google Scholar]
- Giuliano, A.R.; Palefsky, J.M.; Goldstone, S.; Moreira, E.D.J.; Penny, M.E.; Aranda, C.; Vardas, E.; Moi, H.; Jessen, H.; Hillman, R.; et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N. Engl. J. Med. 2011, 364, 401–411. [Google Scholar] [CrossRef] [PubMed]
- Wilkin, T.; Lee, J.Y.; Lensing, S.Y.; Stier, E.A.; Goldstone, S.E.; Berry, J.M. Safety and immunogenicity of the quadrivalent human papillomavirus vaccine in HIV-1-infected men. J. Infect. Dis. 2010, 202, 1246–1253. [Google Scholar] [CrossRef] [PubMed]
- Hidalgo Tenorio, C.; Ramírez-Taboada, J.; Gil-Anguita, C.; Esquivias, J.; Omar-Mohamed-Balgahata, M.; SamPedro, A.; Lopez-Ruz, M.; Pasquau, J. Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine in HIV-positive Spanish men who have sex with men (MSM). AIDS Res. Ther. 2017, 14, 34. [Google Scholar] [CrossRef]
- Wilkin, T.J.; Chen, H.; Cespedes, M.S.; Leon-Cruz, J.T.; Godfrey, C.; Chiao, E.Y.; Bastow, B.; Webster-Cyriaque, J.; Feng, Q.; Dragavon, J.; et al. ACTG A5298: A Randomized, Placebo-Controlled Trial of the Quadrivalent Human Papillomavirus Vaccine in Human Immunodeficiency Virus-Infected Adults Aged 27 Years or Older: AIDS Clinical Trials Group Protocol A5298. Clin. Infect. Dis. 2018, 67, 1339–1346. [Google Scholar] [CrossRef] [PubMed]
- Muñoz, N.; Bosch, F.X.; de Sanjose, S.; Herrero, R.; Castellsagué, X.; Shah, K.V.; Snijders, P.J.F.; Meijer, C.J.L.M. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N. Engl. J. Med. 2003, 348, 518–527. [Google Scholar] [CrossRef] [PubMed]
- Solomon, D.; Davey, D.; Kurman, R.; Moriarty, A.; O’Connor, D.; Prey, M.; Raab, S.; Sherman, M.; Wilbur, D.; Wright, T.; et al. The 2001 Bethesda system: Terminology for reporting results of cervical cytology. JAMA 2002, 287, 2114–2119. [Google Scholar] [CrossRef]
- Darragh, T.M.; Colgan, T.J.; Thomas Cox, J.; Heller, D.S.; Henry, M.R.; Luff, R.D.; McCalmont, T.; Nayar, R.; Palefsky, J.M.; Stoler, M.H.; et al. The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. J. Low. Genit. Tract. Dis. 2013, 32, 76–115. [Google Scholar] [CrossRef] [PubMed]
- Perez, S.; Iñarrea, A.; Pérez-Tanoira, R.; Gil, M.; López-Díez, E.; Valenzuela, O.; Porto, M.; Alberte-Lista, L.; Peteiro-Cancelo, M.A.; Treinta, A.; et al. Fraction of high-grade cervical intraepithelial lesions attributable to genotypes targeted by a nonavalent HPV vaccine in Galicia, Spain. Virol. J. 2017, 14, 214. [Google Scholar] [CrossRef] [PubMed]
- Falcaro, M.; Castañon, A.; Ndlela, B.; Checchi, M.; Soldan, K.; Lopez-Bernal, J.; Elliss-Brookes, L.; Sasieni, P. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: A register-based observational study. Lancet 2021, 398, 2084. [Google Scholar] [CrossRef] [PubMed]
- Ghelardi, A.; Parazzini, F.; Martella, F.; Pieralli, A.; Bay, P.; Tonetti, A.; Svelato, A.; Bertacca, G.; Lombardi, S.; Joura, E.A. SPERANZA Project: HPV vaccination after treatment for CIN2+. Gynecol. Oncol. 2018, 151, 229–234. [Google Scholar] [CrossRef] [PubMed]
- Hidalgo-Tenorio, C.; Pasquau, J.; Omar-Mohamed, M.; Sampedro, A.; López-Ruz, M.A.; López Hidalgo, J.; Ramírez-Taboada, J. Effectiveness of the Quadrivalent HPV Vaccine in Preventing Anal ≥ HSILs in a Spanish Population of HIV + MSM Aged >26 Years. Viruses 2021, 13, 144. [Google Scholar] [CrossRef] [PubMed]
- Staadegaard, L.; Rönn, M.M.; Soni, N.; Bellerose, M.E.; Bloem, P.; Brisson, M. Immunogenicity, safety, and efficacy of the HPV vaccines among people living with HIV: A systematic review and meta-analysis. EClinicalMedicine 2022, 52, 101585. [Google Scholar] [CrossRef] [PubMed]
- Zizza, A.; Banchelli, F.; Guido, M.; Marotta, C.; Di Gennaro, F.; Mazzucco, W.; Pistotti, V.; D’Amico, R. Efficacy and safety of human papillomavirus vaccination in HIV-infected patients: A systematic review and meta-analysis. Sci. Rep. 2021, 11, 4954. [Google Scholar] [CrossRef]
- Zayats, R.; Murooka, T.T.; McKinnon, L.R. HPV and the Risk of HIV Acquisition in Women. Front. Cell Infect. Microbiol. 2022, 12, 814948. [Google Scholar] [CrossRef]
Variables | n = 122 |
---|---|
Age, years; mean (±SD) | 49.62 (±9.51) |
Spanish nationality, n (%) | 87 (71.3) |
University education, n (%) | 10 (8.2) |
Partners in the previous 12 months, median (IQR) | 1 (0–1) |
Life-time partners number, median (IQR) | 5 (3–12) |
Months of sexual activity, median (IQR) | 390 (288–456) |
History of sex worker, n (%) | 20 (16.4) |
Sex worker currently, n (%) | 2 (1.6) |
Condom use, n (%) | 5 (4.1) |
History of anal/genital condylomas, n (%) | 13 (10.7) |
History of gynaecologic dysplasia | 28 (22.9) |
CIN1/VIN1/VAIN1 | 9 (7.4) |
CIN2/CIN3/VIN2/3/VAIN2/3 | 15 (12.2) |
Cervical/vaginal/vulvar cancer | 2 (1.6) |
History of anal dysplasia | 33 (27) |
AIN1 | 24 (19.7) |
AIN2/3 | 7 (5.7) |
Anal cancer | 2 (1.6) |
Duration of HIV, mean years (IQR) | 19 (8–24) |
History of AIDS, n (%) | 58 (47.5) |
CD4 mean nadir, cells/µL, (±SD) | 226.9 (178.3) |
CD4 mean, cells/µL (±SD) | 809.3 (367.4) |
CD8 mean, cells/µL (±SD) | 794.3 (458.2) |
CD8/CD4 ratio, mean (±SD) | 1.2 (0.7) |
VL of HIV log10, copies/mL (±SD) | 3.38 (4.41) |
VL < 50 copies/mL, n (%) | 115 (94.3) |
Virological failure, n (%) | 3 (2.5) |
Median duration of ART, years (IQR) | 15 (8–21.2) |
Number of lines of ART, median (IQR) | 4 (3–6) |
Antibodies of HPV, n (%) | 7 (5.7) |
Syphilis treated, n (%) | 6 (4.9) |
Other STD, n (%) | 9 (7.3) |
Chronic HCV infection not treated, n (%) | 1 (0.8) |
Chronic active HCV infection (AgHBs), n (%) | 2 (1.6) |
Smoking, n (%) | 66 (55.1) |
Smoking, packets/year, median (IQR) | 10 (1.5–23) |
Ex-IVDA, n (%) | 27 (22.1) |
Variables | n = 122 |
---|---|
PCR of HPV, n (%) | |
LR-HPV, n (%) | 42 (34.4) |
HR-HPV, n (%) | 47 (38.5) |
HR and LR HPV, n (%) | 30 (24.6) |
Number of HR-HPV (IQR) | 0 (0–1) |
Number of LR-HPV (IQR) | 0 (0–1) |
HPV Genotypes, n (%) | |
Vaccine HPV genotypes | |
HPV 6 | 9 (7.4) |
HPV11 | 1 (0.8) |
HPV16 | 13 (10.7) |
HPV18 | 2 (1.6) |
HPV 31 | 1 (0.8) |
HPV 33 | 4 (3.3) |
HPV 45 | 6 (4.9) |
HPV 52 | 6 (4.9) |
HPV 58 | 6 (4.9) |
Cytology, n (%) | 122 (100) |
Normal | 80 (65.6) |
LSIL | 21 (17.2) |
HSIL | 0 (0) |
ASCUS | 19 (15.6) |
ASCUS-H | 0 |
Invalid results | 2 (1.4) |
HRA, n (%) | 96 (78.7) |
Normal | 76 (80.8) |
LSIL (AIN1) | 18 (19.1) |
Variables | n = 122 |
---|---|
PCR of HPV | |
LR-HPV, n (%) | 31 (25.4) |
HR-HPV, n (%) | 32 (26.2) |
HR and LR HPV, n (%) | 13 (10.7) |
Number of HR-HPV (IQR) | 0 (0–1) |
Number of LR-HPV (IQR) | 0 (0–1) |
HPV Genotypes, n (%) | |
Vaccine HPV genotypes | |
HPV6 | 8 (6.6) |
HPV11 | 0 (0) |
HPV16 | 9 (7.4) |
HPV18 | 0 (0) |
HPV 31 | 2 (1.6) |
HPV 33 | 2 (1.6) |
HPV 45 | 1 (0.8) |
HPV 52 | 1 (0.8) |
HPV 58 | 2 (1.6) |
Cytology, n (%) | 122 (100) |
Normal | 111 (91) |
LSIL | 4 (3.3) |
HSIL | 1 (0.8) |
ASC/ASC-H | 0 (0) |
Invalid result | 1 (0.8) |
Colposcopy, n (%) | 64 (52.5) |
Normal | 60 (93.8) |
CIN1 | 2 (3.1) |
CIN2 | 2 (3.1) |
CIN3 | 0 (0) |
Cervical cancer | 0 (0) |
Adverse Events | V1 n = 122 | V2 n = 122 | p* (V1–V2) | V3 n = 120 | p* (V1–V3) |
---|---|---|---|---|---|
Total AE, n (%) | 81 (66.4) | 64 (52.4) | 0.07 | 58 (48.3) | 0.05 |
Injection-site pain VAS (0–10), median (IQR) | 66 (54.1) 1 (0–4.5) | 54 (44.3) 0 (0–3) | 0.109 | 47 (38.5) 0 (0–3) | 0.008 |
Local itching | 6 (4.9) | 4 (3.3) | 0.066 | 3 (2.5) | 0.102 |
Injection-site nodule | 7 (5.7) | 5 (4.1) | 0.56 | 5 (4.1) | 0.782 |
Dizziness | 2 (1.6) | 1 (0.8) | 0.32 | 3 (2.5) | 0.157 |
AE leading to treatment discontinuation, n (%) | 0 (0) | 0 (0) | 0 (0) | ||
Deaths, n (%) | 0 (0) | 0 (0) | 0 (0) | ||
Serious AE, n (%) | 0 (0) | 0 (0) | 0 (0) | ||
Grade 3 or 4 abnormalities related to nHPV vaccine, n (%) | 0 (0) | 0 (0) | 0 (0) |
Variables | Baseline (B) | 2 m | 6 m | 7 m | p* B-7 m |
---|---|---|---|---|---|
CD4, cells/ul, mean (±SD) | 809.34 (367.36) | 834.63 (366.78) | 812.08 (368.5) | 792.35 (349.95) | 0.357 |
CD8, cells/ul, mean (±SD) | 790.59 (460.44) | 817.05 (527.74) | 815.78 (663.69) | 809.61 (521.71) | 0.534 |
CD4/CD8 ratio, mean (±SD) | 1.2 (0.7) | 1.25 (0.7) | 1.28 (0.73) | 1.2 (0.7) | 0.826 |
VL, log10, mean (±SD) | 3.38 (4.41) | 0.97(1.39) | 1.13(1.77) | 1.62(2.55) | 0.125 |
SGOT, mean (±SD) | 21.24 (7.82) | 22.28 (8.51) | 22.39 (9.98) | 23.63 (16.85) | 0.051 |
SGPT, mean (±SD) | 20.76 (10.41) | 20.84 (8.69) | 22.31 (11.20) | 23.84 (21.23) | 0.012 |
GGT, mean (±SD) | 39.56 (120.12) | 37.34 (110.53) | 48.13 (218.51) | 49.62 (189.40) | 0.060 |
AP, mean (±SD) | 77.85 (47.03) | 79.06 (58.88) | 79.15 (52.32) | 83.45 (56.18) | 0.191 |
Bilirubin, mean (±SD) | 0.71 (1.01) | 0.61 (0.62) | 0.56 (0.27) | 0.57 (0.25) | 0.036 |
Creatinine, mean (±SD) | 0.81 (0.19) | 0.84 (0.48) | 0.84 (0.51) | 1.49 (±6.81) | 0.64 |
Anti-HPV Ab, nm, median (IQR) | 0 (0–0.14) | 2.44 (1.12–4) | 3.8 (2.2–6.62) | 6.91 (3.3–19.7) | 0.0001 |
Anti-HPV Ab positive, n (%) | 10 (8.2) | 72 (59) | 109 (89.3) | 118 (96.7) | 0.0001 |
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Hidalgo-Tenorio, C.; Moya, R.; Omar, M.; Muñoz, L.; SamPedro, A.; López-Hidalgo, J.; Garcia-Vallecillos, C.; Gómez-Ronquillo, P. Safety and Immunogenicity of the Nonavalent Human Papillomavirus Vaccine in Women Living with HIV. Vaccines 2024, 12, 838. https://doi.org/10.3390/vaccines12080838
Hidalgo-Tenorio C, Moya R, Omar M, Muñoz L, SamPedro A, López-Hidalgo J, Garcia-Vallecillos C, Gómez-Ronquillo P. Safety and Immunogenicity of the Nonavalent Human Papillomavirus Vaccine in Women Living with HIV. Vaccines. 2024; 12(8):838. https://doi.org/10.3390/vaccines12080838
Chicago/Turabian StyleHidalgo-Tenorio, Carmen, Raquel Moya, Mohamed Omar, Leopoldo Muñoz, Antonio SamPedro, Javier López-Hidalgo, Coral Garcia-Vallecillos, and Patricia Gómez-Ronquillo. 2024. "Safety and Immunogenicity of the Nonavalent Human Papillomavirus Vaccine in Women Living with HIV" Vaccines 12, no. 8: 838. https://doi.org/10.3390/vaccines12080838