Epidemiology and economic cost of diseases caused by the human papilloma virus (HPV)

Humani papiloma virus (HPV) je virus koji često pogađa muškarce i žene diljem svijeta, a 50-80% spolno aktivnih muškaraca i žena zaraze se HPV om u nekome trenutku svoga života. HPV je DNA virus sastavljen od proteina virusne kapside koja se sastoji se od 72 kapsomere. Svaka kapsomera sastoji se od pet pentamera. Svaki pentamer sastoji se od 5 trokutastih proteina. Najveće opterećenje bolešću povezuje se s karcinomom cerviksa. Utvrđeno je da je infekcija onkogenim tipovima HPV a nužan uzročnik ne samo karcinoma cerviksa, nego i niza drugih karcinoma. Niskorizični tipovi HPV‑a uzrokuju bradavice, a onkogeni tipovi HPV‑a uzrokuju prekancerozne lezije. Među onkogenim tipovima, HPV tipa 16, 18, 45 i 31 četiri su najčešća tipa na svijetu i uzrokuju približno 80% karcinoma cerviksa. Svake se godine diljem svijeta zabilježi približno 530 000 novih slučajeva karcinoma cerviksa. Uglavnom je bolest mlađih žena, a najveća pojavnost je u dobi između 35 i 55 godina. U populaciji žena između 25. i 44. godine, karcinom cerviksa je po pojavnosti na drugom mjestu, odmah iza karcinoma dojke. Perzistentna infekcija onkogenim tipovima HPV‑a nužan je uzrok karcinoma cerviksa. Spolna aktivnost jedan je od glavnih faktora rizika za HPV infekciju. Mogući kofaktori (poput pušenja cigareta, pariteta i dugotrajne primjene oralnih kontraceptiva) mogu pridonijeti progresiji infekcije onkogenim tipom HPV‑a do karcinoma cerviksa. Primarna prevencija (npr. cijepljenje) usmjerena je na sprječavanje infekcije onkogenim tipom HPV‑a, dok se sekundarnom prevencijom (npr. Papa testom, kolposkopijom) otkrivaju i liječe cervikalne abnormalnosti te nastoji spriječiti progresija bolesti. Karcinom cerviksa može se liječiti na različite načine, ali tri osnovne vrste liječenja su kirurško liječenje, radioterapija i kemoterapija. Papa test je najčešća metoda probira koja se koristi za otkrivanje staničnih promjena na cerviksu. U Hrvatskoj je karcinom vrata maternice je zasigurno jedan od najpreventabilinijih sijela raka te svake godine obolijeva više od 300 žena godišnje, a umre ih 100. Trenutno su odobrena 3 cjepiva protiv HPV‑a: Dvovalentno cjepivo (Cervarix, GSK Biologicals) četverovalentno cjepivo (Gardasil MSD) i deveterovalentno cjepivo (Gardasil 9 MSD). Iako je dobro cijepiti se prije početka spolne aktivnosti ili što ranije na početku spolnog života, cijepljenje se preporuča i onima koji su spolno aktivni. Ukupni godišnji troškovi liječenja, probira i dijagnostike bolesti uzrokovanih HPV-om iznose 50.513.880,98 kn.Human papilloma virus (HPV) is a virus that often affects men and women around the world, 50-80% of the sexually active men and women get it at some point in their lives. HPV is a stable, DNA-based virus composed of viral capsid proteins that are recognised by the host immune system. The HPV viral capsid is composed of 72 capsomers, each capsomer is composed of five pentamers and each pentamer consists of 5 triangular proteins. The largest burden of disease is associated with cervical cancer. In addition to cervical cancer, infection with oncogenic HPV types has been identified as a necessary cause of a variety of other cancers. Low-risk HPV types produce warts whereas the oncogenic HPV types cause precancerous lesions. Of the oncogenic types, HPV 16, 18, 45 and 31 are the 4 most common worldwide, accounting for approximately 80% of cervical cancers. Every year around the world recorded approximately 530 000 new cases of cervical cancer. It is mostly a disease of young women, and the incidence is highest between the ages of 35 and 55 years. The population of women between 25 and 44 years, cervical cancer is the incidence in second place, just behind breast cancer. Persistent infection with oncogenic HPV types is the necessary cause of cervical cancer. Sexual activity is one of the main risk factors for HPV infection. Potential cofactors (such as cigarette smoking, parity and long-term oral contraceptive use) may contribute to the progression of oncogenic HPV infection to cervical cancer. Primary prevention (e.g. vaccination) focuses on preventing oncogenic HPV infection, whereas secondary prevention (e.g. Pap smear testing, colposcopy) detects and treats cervical abnormalities and aims to prevent disease progression. Cervical cancer can be treated in different ways, but the three basic types of treatment are surgery, radiation therapy and chemotherapy. The Pap test is the most common screening method used to detect cellular changes in the cervix. In Croatia, cervical cancer is certainly one of most prevalence types of cancer and each year are affected more than 300 women a year and killed 100 of them. Current, there are three licensed HPV vaccines: Bivalent vaccine (Cervarix, GSK Biologicals), a quadrivalent vaccine (Gardasil MSD) and 9-valent vaccine (Gardasil 9 MSD). Although is better vaccinated before the start of sexual activity or as early as possible at the beginning of sexual life, vaccination is also recommended for those who are sexually active. The total annual cost of treatment, screening and diagnosis of diseases caused by HPV amounts 50,513,880.98 kn