Inosine Pranobex in the Treatment of Cervical HPV Infections

Introduction

Persistent or recurrent infections of the cervix caused by human papillomavirus (HPV) are the main cause of cervical cancer. The body's defense against HPV infection largely depends on the state of the immune system, which, when functioning properly, can prevent HPV progression and deal with the infection without clinical complications. The virus interacts with the immune system in various ways, but the exact mechanism has not yet been fully clarified. Immunotherapy with inosine pranobex significantly helps eliminate the virus, which the authors from the Military Medical Academy in Sofia focused on.

HPV and Cervical Cancer

The oncogenesis of cervical cancer is a multi-step process that begins with an HPV infection affecting the cervical epithelium. Cervical cancer development occurs following persistent or recurrent HPV infections, for which the immune system's condition is responsible based on available findings. Both cellular and humoral immunity are crucial for eliminating HPV infections. Antiviral drugs capable of effectively eradicating HPV infection of the cervix are not yet available, leaving the body reliant on its immune system to combat this infection.

Nevertheless, compounds like inosine pranobex, which modulates both cellular and humoral immunity, show positive effects. Despite its effectiveness being known since the 1970s, it is rarely used to treat HPV infection of the cervix. It is an antiviral compound consisting of inosine and dimepranol acedoben in a ratio of 1:3, and it is applicable in treating diseases caused by herpes simplex virus (HSV), varicella zoster virus (VZV), Epstein-Barr virus (EBV), or cytomegalovirus (CMV).

Analyzed Studies

The review article analyzes prospective controlled studies with observational or retrospective designs and meta-analyses from 1971 to 2021 that explored immunotherapy in patients with HPV cervical infections. A total of 41 works were included in the review. The primary parameter observed was the persistence of HPV on the cervix, specifically its elimination in women undergoing immunotherapy with inosine pranobex and the occurrence of cervical intraepithelial neoplasias or low- or high-grade squamous intraepithelial lesions in long-term followed patients. Most of the analyzed works assessed the clinical efficacy of inosine pranobex in combination with cryotherapy and various surgical procedures.

Findings on Inosine Pranobex

Although studies show significant clinical efficacy of inosine pranobex in combination with other approaches as well as in monotherapy, combined therapy was more effective in most cases of patients with HPV-induced cervical changes in preventing disease progression and pathogen elimination. For instance, a multicenter prospective randomized placebo-controlled study with fifty patients demonstrated that the administration of 3 g of inosine pranobex daily for 4 weeks improves the clinical efficacy of conventional therapy (podophyllin or trichloroacetic acid) in women with genital warts. Another study indicated that combined treatment with inosine pranobex immunotherapy eliminates HPV in 98% of cases and reduces the relative risk of relapse threefold. Review articles describe the efficacy of inosine pranobex against HPV infection between 87.5% and 97.0% in combination therapy; in the case of monotherapy, the efficacy ranges from 72.4% to 95.0%.

Summary and Conclusion

Inosine pranobex enhances the immune system's activity in fighting HPV, supports virus elimination, and slows or stops the oncogenesis of cervical cancer. Studies confirm the high efficacy of combined therapy and monotherapy in patients with persistent HPV infection.

Intraepithelial neoplasias and cervical cancers caused by HPV have high morbidity and mortality rates. Long-term research into HPV infections, their epidemiology, pathogenesis, treatment, and prophylaxis is therefore crucial for reducing the incidence and severity of these diagnoses. Inosine pranobex shows good clinical efficacy in patients with HPV infections, and available findings also suggest that this therapy reduces the recurrence of cervical dysplasia and precancerous states caused by chronic HPV infection of the cervix.

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Source: Kovachev S. M. A review on inosine pranobex immunotherapy for cervical HPV-positive patients. Infect Drug Resist 2021 Jun 2; 14: 2039−2049, doi: 10.2147/IDR.S296709.