Prof. Dr. Radka Argirova is the chairman of the National Virology Expert Board of the Bulgarian Medical Union and the chairman of the Bulgarian Society of Medical Virology. Prof. Argirova is also a co-founder of the HPV Coalition, whose goal is the eradication of diseases related to the human papilloma virus. We talk to Bulgaria’s leading virologist about how to change healthcare to achieve prevention for HPV-related diseases. The interview is part of the “Protect their future!” campaign – Prof. Argirova, which types of HPV are dangerous to health and why? All types of human papillomaviruses are dangerous. The term papilloma itself means a malignant growth. But not all HPVs are equally malignant. We separate the 14 most dangerous types associated with different types of carcinomas. In the first place are types 16 and 18. Recently, they have been actively joined by types 31, 33 and 53. But the most carcinogenic are a total of fourteen types of HPV. – What are the ways to prevent HPV-related diseases? Prevention of HPV-related diseases is primary when control is achieved and the cause of the disease is eliminated; secondary, in which precancerous and early neoplastic changes are detected and eliminated, and tertiary – to prevent relapses and metastases in already treated cancer. Primary prevention aims to avoid getting infected with the virus at all. However, this is almost impossible, since HPV is not airborne, nor is it a blood or food infection, but is transmitted exclusively sexually. That is why almost every person encounters this virus in their lifetime. Fortunately, primary prevention against HPV-related diseases is possible through a vaccine. Currently, the vaccine, which is used all over the world, and since September also in Bulgaria, protects against nine of the most carcinogenic types of HPV. Secondary prevention is screening when we do not yet have cancer. Screening for a woman means actively going to get screened by having a pap smear (or liquid biopsy) and testing for the presence of the papilloma virus. The goal is, if the presence of HPV or pre-cancerous changes is detected, to apply the necessary treatment in order to prevent the development of an oncological disease at all. There is a well known and used worldwide program for both vaccination and screening. The screening program is approved and validated by the WHO. She tests for all 14 of the most carcinogenic papillomaviruses. This is done by PCR, which looks for the DNA of the virus. Under this program, screening is performed worldwide in a standardized way. – Where in Bulgaria can you be tested for the presence of HPV? In Bulgaria, there are many laboratories that do this research, even more than necessary. HPV tests are done in all major hospitals that have laboratories. – If the test shows that there is an infection with HPV that has not yet caused cancer,is there a way to clear the virus from the body? Yes of course. You should go to a gynecologist, an ENT specialist or a dermatologist, because HPV is associated not only with cancer of the cervix, but also cancer of the vulva, penis, anus, oropharynx, and various other skin formations (warts) for the relevant specialist to see and assess how to act. There is a way to intervene on this finding so that cancer does not develop at all. For example, if a cancerous papilloma virus is detected in a woman, a colposcopic examination of the cervix is ??performed. If precancerous changes are found there, conization is performed and the precancerous cells are removed. After this procedure, the woman will not develop cervical cancer, but this procedure does not cancel the next screening. – If a person has once been infected with HPV, but the papilloma virus has been cleared, and the precancerous changes of the cervix have been removed, is there any benefit to this person being vaccinated? Yes, there is benefit to getting vaccinated. Although he has already fought off one type of HPV, he can become infected with another type of papillomavirus. The most carcinogenic are 14 types and you cannot be infected with all of them at the same time. However, it is possible that after one comes another. What’s more, it’s possible to have two or three types of HPV at the same time. These cases are not frequent, but we have seen them. Therefore, it makes sense for everyone to get the nine-valent HPV vaccine. It has a very broad protective effect. – What is the new 9-valent HPV vaccine? What are its advantages compared to the old one? The biggest advantage of the vaccine is that it protects against 9 types of HPV and is thus virtually omnipotent against papillomaviruses. At the very beginning of HPV prevention, there was a bivalent vaccine, then a quadrivalent vaccine was used. They only protected against HPV types that mainly cause cervical cancer. Now the vaccine also includes the remaining types of HPV that cause other types of cancer that I have already listed and that affect not only women but also men. – What needs to change in health care to make the National Program for Primary Prevention of Cervical Cancer really effective? First, this program needs to be promoted. Second, it should not just be said, “Go and get vaccinated”, but explain in detail what the benefit of the vaccine is. People need to know that cervical cancer is the fourth most common and deadliest cancer in women, and that there is a way to avoid this disease. And this way to prevent cancer is HPV vaccination. This is how you save yourself illness, treatment and all the associated suffering. What stronger argument in favor of vaccination?! I am well aware that some people have reservations about vaccines. In my opinion, they just don’t know the advantages of getting vaccinated. Indeed, the effect of the HPV vaccine does not come immediately and will be proven late in a person’s life.This is not a flu vaccine, the effect of which will be seen already this flu season by not getting the flu. The HPV vaccine is a guarantor of a future without several types of oncological diseases, long-term advance planning for a healthy life. – How can the primary prevention program itself be updated? The program will be updated step by step. First of all, we need to pay attention and train the people who will do the vaccination itself. These are general practitioners and also gynecologists – very often people ask them because they associate HPV primarily with cervical cancer. The other important task is serious work with parents. And with the students, of course, but especially with the parents. Because the target group for vaccination under the Program, for which the HPV vaccine is fully reimbursed, are girls from 10 to 13 years old. And for these children, the important decisions for their lives are made by the parents. Of course, the boys’ parents should also be worked with, explaining to them that males are also affected by HPV-related cancers. The virus does not distinguish between boys and girls. Boys cannot get cancer of the cervix, but they can develop cancer of the penis, anus, throat, skin growths. Even with severe pneumonia, although rarely, HPV is the cause.