Most vaccines aim to increase the T-cell immune response using viral vectors, recombinant DNA or other. Nine unsuccessful studies are summarized by Stern et al. [68]. Limited success was recently shown using synthetic or recombinant HPV16E6 related peptides. Clinicaltrial.gov lists 3 active, on-going trials on therapeutic HPV vaccines. Safety issues and issues of administration of the vaccine limit the potential use of 4 non-clinicaltrial.gov-listed compounds currently FK228 manufacturer in phase I or II (personal communication, Genticel, France). Recently a phase

I trial using recombinant HPV16E7 and HPV18E7 concluded that the product was safe to use and a phase II trial has been planned (personal communication, Genticel, France). The currently available vaccines, Cervarix™

and Gardasil™, are recommended for prophylactic use. They will not clear an existing infection or disease. BTK activity inhibition To obtain optimal benefit of the vaccine, it must be given before exposure to HPV, which is before sexual debut [22] and [69]. The vaccines can be administered to persons 9 years old and above. Although specific target age groups may differ among countries, many countries start the vaccination for girls at age 11–12 years [70]. In the United Kingdom, catch-up vaccination is considered cost-effective for females aged 13–18 years [71]. Currently, vaccination for males is not recommended [22], though some countries, like Australia and USA, do vaccinate males as well [37] and [41]. Adding males in a HPV vaccination programme might have direct benefits in protecting

against HPV-related cancers in men and anogenital warts [72]. However, mathematical models revealed that increasing vaccine uptake among adolescent girls is more effective in reducing HPV infection rather than including boys in existing vaccination programmes [72] and [73]. Vaccinating the sex with the highest prevalence will reduce the population prevalence most effectively [73]. The cost-effectiveness of including males depend on the predicted herd immunity in heterosexual males derived from vaccinating females, and the proportion of all male HPV-related disease in homosexual men [72]. However, the HPV-related burden of disease is lower in males than in females Bay 11-7085 [72], and the incremental benefits of adding boys are dependent on the coverage in girls [74]. If coverage in girls is higher than 50%, including boys in the vaccination programme is likely not cost-effective [72]. The introduction of HPV vaccine in industrialised countries (e.g. United Kingdom, Australia, Belgium) is achieving good coverage through school-based vaccination programmes. These countries aim to vaccinate all girls around the age of 12 years, and also include catch-up vaccination of slightly older adolescents during the first years of introduction. Vaccination coverage of above 70% has been observed in both Australia and the United Kingdom [75] and [76]. In Belgium, 83.