The role of human papillomavirus vaccines in cervical neoplasia

Cervical cancer is the second most common cause of cancer-related death in women, in some developing countries accounting for the highest cancer morta lity. The evidence for the association of high-risk human papillomavirus ty pes with the aetiology of cervical neoplasia is firmly established, human p apillomavirus being detected in virtually all cervical cancers. The risk of progression of precursor cervical intra-epithelial neoplasia lesions is as sociated with persistence of human papillomavirus infection. One strategy f or the management of cervical neoplasia worldwide could be the development of prophylactic and/or therapeutic human papillomavirus vaccines. This chap ter will discuss the natural history of human papillomavirus infection, vir al immunity and the clinical course of resultant disease as the background to the effective design and use of human papillomavirus vaccines for protec tion or therapy. The progress of ongoing phase I and II clinical trials for several different vaccine preparations and the challenges for establishing their future use will be discussed.