Abstract

Human papillomavirus (HPV) infection remains a major global health challenge, particularly when persistent high-risk genotypes lead to oncogenic progression. While prophylactic vaccines are effective, their role in accelerating the clearance of existing infections is still being explored. This study aimed to investigate the potential efficacy of adjunctive Pidotimod therapy combined with the nonavalent HPV vaccine in reducing persistent genotypes and promoting clearance in men. This retrospective pilot study included 23 HIV-negative men with anal and/or genital HPV infections. Participants were divided into two groups: 7 received the standard nonavalent HPV vaccine alone (control), and 16 received oral Pidotimod (800 mg twice daily for 10 days surrounding each vaccine dose) in addition to the vaccine (treatment). HPV genotyping (28 types) was performed at baseline and 12 months using real-time PCR. At 12 months, the HPV-negative conversion rate was 62.5% in the Pidotimod + vaccine group compared to 28.6% in the control group (p = 0.19). While this primary difference in total clearance was not statistically significant due to the limited sample size, the treatment group showed a substantial per-patient reduction in the number of persistent genotypes, decreasing from a mean of 2.75 ± 2.05 to 0.50 ± 0.82, compared to a decrease from 3.43 ± 2.37 to 1.86 ± 1.07 in the control group. The Pidotimod group achieved a significantly lower number of persistent genotypes at 12 months compared to the control group (p = 0.008, Mann–Whitney U test). Additionally, the use of pre-exposure prophylaxis (PrEP) was significantly associated with a lower rate of HPV clearance (12.5% vs. 73.3%, p < 0.01). Adjunctive therapy with Pidotimod suggests a promising trend in facilitating the reduction in HPV strain burden when combined with the HPV vaccine in men. While larger prospective studies are needed to confirm these effects, this exploratory approach could represent a promising immunomodulatory strategy for managing multiple and persistent HPV infections, even in high-risk groups such as PrEP users.

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