title: An overview of early investigational drugs for the treatment of human papilloma virus infection and associated dysplasia.
abstract: BACKGROUND
  High-risk HPV (HR-HPV) related invasive cervical cancer (ICC) causes >270,000 deaths per annum world-wide with over 85% of these occurring in low-resource countries. Ablative and excisional treatment modalities are restricted for use with high-grade pre-cancerous cervical disease with HPV infection and low-grade dysplasia mostly managed by a watch-and-wait policy.
  
  
  METHODS
  Various pharmacological approaches have been investigated as non-destructive alternatives for the treatment of HR-HPV infection and associated dysplasia. These are discussed dealing with efficacy, ease-of-use (physician or self-applied), systemic or locally applied, side-effects, cost and risks. The main focus is the perceived impact on current clinical practice of a self-applied, effective and safe pharmacological anti-HPV treatment.
  
  
  CONCLUSIONS
  Current prophylactic HPV vaccines are expensive, HPV type restricted and have little effect in already infected women. Therapeutic vaccines are under development but are also HPV type-restricted. At present, the developed nations use national cytology screening and surgical procedures to treat only women identified with HPV-related high-grade dysplastic disease. However, since HPV testing is rapidly replacing cytology as the test-of-choice, a suitable topically-applied and low-cost antiviral treatment could be an ideal solution for treatment of HPV infection per se with test-of-cure carried out by repeat HPV testing. Cytology would only then be necessary for women who remained HPV positive. Although of significant benefit in the developed countries, combining such a treatment with self-sampled HPV testing could revolutionise the management of this disease in the developing world which lack both the infrastructure and resources to establish national cytology screening programs.
authors.affiliation: a Viral Oncology Laboratories, Research Floor, St Mary's Hospital , University of Manchester , Manchester M13 9WL , UK.
authors.forename: Lynne
authors.initials: L
authors.lastname: Hampson
authors.affiliation: b Department of Obstetrics and Gynaecology , Royal Preston Hospital , Preston PR2 9HT , UK.
authors.forename: Pierre
authors.initials: P
authors.lastname: Martin-Hirsch
authors.affiliation: a Viral Oncology Laboratories, Research Floor, St Mary's Hospital , University of Manchester , Manchester M13 9WL , UK.
authors.forename: Ian N
authors.initials: IN
authors.lastname: Hampson
mesh_terms: D000818:Animals; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D015195:Drug Design; D015507:Drugs, Investigational / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000188:drug therapy*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000188:drug therapy* / Q000821:virology
chemical_list: D000998:Antiviral Agents; D015507:Drugs, Investigational; D053918:Papillomavirus Vaccines
keywords: CIN; HIV PI lopinavir; HPV; HSIL; PDT; cidofovir; dysplasia; imiquimod; pharmacotherapy; therapeutic vaccines