Human papillomavirus vaccination in immunocompromised adults: Rationale, evidence, and clinical guidance

Although human papillomavirus (HPV) vaccination is widely recommended for adolescents, its immunogenicity and effectiveness in immunocompromised adults are less well established. Given the elevated risk of HPV-related morbidity in these populations, understanding vaccine performance is essential. This review summarizes current evidence on the immunogenicity and safety of HPV vaccination in immunocompromised adults, excluding individuals with human immunodeficiency virus (HIV), based on a targeted literature review. The focus is on populations for which prospective vaccine studies are available, including recipients of solid organ transplantation (SOT), hematopoietic stem cell transplantation (HSCT), and patients with autoimmune or inflammatory diseases such as inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE). Current vaccination guidelines from major expert organizations are also reviewed. HPV vaccination primarily protects against viral types not previously encountered. In immunocompetent individuals with high-grade cervical lesions, vaccination has been associated with reduced recurrence rates, although the underlying mechanisms remain unclear. Prospective studies demonstrate that HPV vaccines are safe and immunogenic in immunocompromised adults, though antibody responses may be attenuated, particularly following SOT. A three-dose schedule (0,1–2 and 6 months) is recommended for immunocompromised individuals. While the 9-valent vaccine offers the broadest protection, any available HPV vaccine formulation should be used when access to the 9-valent is limited. Optimal timing of vaccination initiation should be individualized according to immunosuppressive status and underlying condition. • Higher risk of persistent HPV and cancers in immunocompromised patients. • HPV vaccines are preventive; some data suggest possible therapeutic effects. • Data are limited for vaccine use in men and people over 45 years. • Best responses seen with low immunosuppression, but delay may reduce benefit. • Three doses of HPV vaccine (preferably 9-valent) are advised for immunocompromised people.