Hope in the Form of Historic Progress 

The truth is, we’re coronavirus fatigued. Quarantine fatigued. Precautions fatigued. But—we’ve got some distance yet to go, before we arrive an even an uneasy truce with COVID-19. So, maybe it’s time for a success story or two to remind us that we’ve been this way before with a virus or two, and have—at least to some extent—prevailed. 

Human Immunodeficiency Virus (HIV)

For one example: there’s HIV, a monumental scourge that took way too long to manage. “Manage” because there still is no cure. But antiretroviral drug therapy (ART) keeps a person’s viral load low, slowing progression of the disease. Aside from the significant benefit the patient derives, there’s another major upside with ART: someone with a low viral load is less likely to transmit the virus to others.  

Even better news on the HIV front: there’s a way to prevent it. Pre-exposure prophylaxis (PrEP)—Truvada® or Descovy®—used consistently, does a great job of preventing HIV. Per the Centers for Disease Control and Prevention (CDC), PrEP can benefit you if you are HIV negative AND fall into any of the following groups: 

 You are a gay or bisexual man who:

-Has an HIV-positive partner or

-Has multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown—and you also:

-Have anal sex without a condom, or

-Recently had a sexually transmitted infection (STI).

You are a heterosexual (man or woman) who:

-Has an HIV-positive partner; or

-Has multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown—and you also:

-Don’t always use a condom for sex with people who inject drugs or

-Don’t always use a condom for sex with bisexual men.

You inject drugs AND you:

-Share needles or equipment to inject drugs;

-Recently went to a drug treatment program; or

-Are at risk for getting HIV from sex. 

Human Papilloma Virus (HPV)

Then there’s HPV, which is responsible for about 35,000 cancers diagnosed each year in the US. Routine screening is available for only one of these: cervical cancer, which is diagnosed in about 11,000 women in this country each year. That means the other HPV-related cancers (oropharyngeal (throat) cancer, vaginal/vulvar cancer, anal cancer, and penile cancer) can go undetected for some time. 

The good news? Since the early 2000s, there has been a vaccine against HPV. Over the years, it has gone from targeting two genotypes of HPV, to targeting nine. 

In mid-June, there was big news for the existing vaccine, Gardasil 9®: the FDA expanded its approved indications to include “prevention of HPV-related oropharyngeal (throat) and other head and neck cancers,” based on its demonstrated success in preventing cervical, anal, vulvar, and vaginal cancers. Gardasil 9® prevents over 90 percent of these cancers caused by human papilloma virus. 

Expanding the indication to include throat cancer is a big deal: about 70 percent of the 19,000 throat cancers diagnosed in the US each year are HPV-related. That’s 13,500 cancer diagnoses that could be avoided altogether! The biggest beneficiaries of this: men, who are five times more likely than women to be diagnosed with HPV-related throat cancer. 

The only disappointing news about the HPV vaccine: despite its proven efficacy, uptake remains far from universal. By 2018, only a little over half (51.1 percent) of US teens were fully vaccinated against HPV. Why the relatively low rate of vaccination? 

Well, one reason may be that ideally, the HPV vaccination needs to begin between the ages of nine and 12*. Some parents are uncomfortable vaccinating children against a virus that is transmitted via sexual activity. 

Further, the vaccine’s initial indication was prevention of cervical cancer. Parents—already squeamish about vaccinating their young daughters against a sexually transmitted virus—might have felt there was a “fail-safe” built in: screening for cervical cancer was long-established. Even if their daughters developed cervical cancer, they could be successfully treated. Of course, that’s not a great fallback; not everyone pursues routine screening, and about 4,000 women in the US die of cervical cancer each year.

Clearly, there’s still work to be done to improve vaccination rates for the HPV vaccine. But there is a vaccine. It’s safe and effective. HPV is a virus we’ve found a way to avoid. The novel coronavirus (SARS-CoV-2, which causes COVID-19) will one day be another.

*Vaccination of older adolescents and young adults (up to age 26) requires a series of three (v. two) injections but can also be effective. Even if you’re between the ages of 27 and 45, talk to your health care provider: if you weren’t adequately vaccinated when you were younger, there may still be benefit to vaccination.

Marj Shannon is an epidemiologist and wordsmith who has devoted her life to minutiae. She reports that yes, the devils are in the details.