HPV Vaccination an Opportune Time for HIV Testing

The recent review article by Rupp et al did an excellent job of highlighting new adolescent vaccination visits as opportune times to provide preventative counseling and care. Specifically routine vaccination against the sexually transmitted human papilloma virus (HPV) will require three separate visits. The authors propose a clear schedule for delivering the separate required doses across three early adolescent health visits for 11-12-year-olds and suggest that anticipatory guidance also be provided at these visits. Additionally the authors point out that catch-up vaccinations for older adolescents provide similar opportunities for risk behavior counseling. Among older adolescents HPV vaccination visits may also serve as opportune times for routine human immunodeficiency virus (HIV) testing. The Centers for Disease Control and Prevention recently issued recommendations for universal HIV screening among those aged 13-64 years who are seen in a clinical setting. Adoption of these guidelines by adolescent providers may serve to identify treat and prevent HIV disease among our youth. Universal HIV screening like universal HPV vaccination can serve to decrease stigma that may otherwise be associated with these two important diagnostic and preventative interventions. It is anticipated that in several years we will have an HIV vaccine. HIV vaccine candidates are in phase II B clinical trials and a HIV vaccine may be available within the next 10 years. As with an HPV vaccine adolescents may represent the ideal population to target with an HIV vaccine once it is available. Effective three-dose HPV vaccine delivery programs for adolescents may serve as models for the future delivery of a multi-dose HIV vaccine. Among sexually active adolescents HIV vaccine delivery programs will need to include routine HIV testing. It is important to establish effective HPV vaccine delivery programs among early adolescents before the onset of sexual activity. Equally critical is the successful implementation of HPV vaccine delivery catch-up programs among older adolescents. Combining routine HIV testing with HPV vaccination for older adolescents will serve to facilitate the adoption of the new universal testing guidelines for HIV and will also set the stage for the HIV testing that will be routinely indicated before HIV vaccination once we have an HIV vaccine. (full text)