Gardasil 9 After Cervarix — SCE Infectious Diseases MCQ

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ModerateTravel Medicine & VaccinationGardasil 9 After CervarixSCE Infectious Diseases

A 28-year-old man with HIV (CD4 450, VL <50 on ART) develops anal condylomata acuminata (genital warts). He has previously received the bivalent HPV vaccine (Cervarix). His clinician considers offering Gardasil 9 now. What is the rationale?

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Correct answer: D — Gardasil 9 covers HPV 6 and 11 (genital warts) plus additional high-risk oncogenic types not covered by Cervarix — vaccination may prevent future infections with types not yet acquired

Cervarix (bivalent) covers HPV 16 and 18 only. Gardasil 9 (nonavalent) covers HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58. Even in a previously exposed/infected individual, vaccination with Gardasil 9 can protect against types not yet acquired. The UK switched to Gardasil 9 in 2023. BHIVA recommends HPV vaccination for PLWH who have not received Gardasil 9, as it provides broader protection against both oncogenic types and genital wart-causing types. Three doses are recommended for immunocompromised individuals.

Reference: BHIVA 2024 – Vaccination in HIV; UKHSA 2024 – Green Book Ch 18a: HPV