A 25-year-old woman comes to the office due to a recent diagnosis of HIV after unprotected intercourse with an HIV-positive partner. The patient is tolerating antiretroviral therapy with no side effects. She recently underwent cervical conization due to high-grade dysplasia diagnosed on routine Pap testing and confirmed on cervical biopsies. The patient received a dose of the human papillomavirus (HPV) vaccine at age 15 but did not complete the series. She recently had a progestin-containing intrauterine device placed for contraception.
Vital signs are normal. BMI is 22 kg/m². The remainder of the physical examination is unremarkable. Urine pregnancy test is negative.
Which of the following is a contraindication to administration of HPV vaccination in this patient?

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Quizplus · Accepted Answer

11ec193a_97e8_b364_853d_6319a1af24f7_MD0002_00 Human papillomavirus (HPV) vaccination is indicated for male and female patients to reduce the risk of anogenital disease (eg, cervical cancer, penile cancer) and oropharyngeal cancer associated with high-risk HPV types (ie, 16, 18). HPV vaccines are preventive (prophylactic) and are most effective if administered prior to the onset of sexual activity (ie, exposure to HPV). Routine HPV vaccination is given between age 11 and 26 but can be given from age 9-45 (Choice A). Currently, the main contraindication to vaccination is if the patient has had a previous allergic reaction or hypersensitivity to the vaccine. HPV vaccination is not recommended during pregnancy due to lack of an established safety profile, although available data from inadvertent HPV vaccine exposure indicate no adverse outcomes (ie, miscarriage, fetal anomalies). Women who are breastfeeding can receive the HPV vaccine because infant safety is unaffected by vaccine exposure. (Choice B) HPV vaccination is safe and recommended for immunocompromised (eg, HIV-positive) patients due to their significantly higher risk of HPV-related disease. (Choice D) The HPV vaccine is administered as a scheduled series. Previous incomplete vaccination (ie, missed doses) is not a contraindication to HPV vaccination; the vaccine schedule can be resumed without restarting the series. (Choice E) An abnormal Pap test (ie, cervical dysplasia) does not preclude initiation of the HPV vaccine series, as completion of the vaccination series offers protection against HPV strains that the patient may acquire during future sexual encounters. Educational objective: The human papillomavirus vaccination series is indicated for male and female patients to reduce the risk of HPV-associated disease regardless of HIV status, prior incomplete vaccination, or prior abnormal Pap tests. HPV vaccination is routinely administered between age 11 and 26 but can be given from ages 9-45. __________ References: Committee opinion no. 704 summary: human papillomavirus vaccination. (http://www.ncbi.nlm.nih.gov/pubmed/28538494) Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. (http://www.ncbi.nlm.nih.gov/pubmed/31415491) HPV vaccination and the effects on rates of HPV-related cancers. (http://www.ncbi.nlm.nih.gov/pubmed/30041818) The efficacy of the quadrivalent human papillomavirus vaccine in girls and women living with human immunodeficiency virus. (http://www.ncbi.nlm.nih.gov/pubmed/29985988)

A 25-Year-Old Woman Comes to the Office Due to a Recent