**8. Conclusion**

Cervical cancer is a leading cause of morbidity and mortality in countries with the fewest resources and these resources are often already over-stretched by high levels of HIV infection. Virologic synergy between HIV and HPV infections further exacerbates the problem, and HIV-infected women are at increased risk for HPV and HPV-related diseases, including cervical cancer. Furthermore, unlike other typical opportunistic infections, there is no compelling evidence that the use of effective ART reduces the burden of HPV or HPVrelated complications, possibly leading to increased numbers of women at risk for cervical cancer as HIV treatment programs become more accessible and successful. Fortunately, cervical cancer is preceded by an extended precancerous period that can be detected and treated to prevent the development of invasive disease. Cervical cytology, which has revolutionized cervical cancer prevention in the U.S. and other developed countries over the past half-century, is simply not feasible for most countries with few resources. Alternatives such as VIA and HPV testing hold great promise as alternative screening strategies, coupled with the use of cryotherapy or LEEP to treat precancerous lesions. In the new WHO Global health sector strategy on HIV/AIDS an over-arching goal is to achieve universal access to comprehensive HIV prevention, treatment and care. Two of the four strategic directions noted in this strategy are to leverage broader health outcomes through HIV responses, including strengthening linkages between HIV and other related health programs, notably including cervical cancer screening and care, and to build strong and sustainable heath systems in which HIV and other essential services are available, accessible, affordable and sustainable. This renewed emphasis on comprehensiveness and integration of services is consistent with making further evaluation of the role of these screening techniques, individually or in concert, in the setting of HIV a research priority.

#### **9. References**

246 Cancer Prevention – From Mechanisms to Translational Benefits

protection. However, a recent review found that HIV-infected women in different geographic regions (including Zambia, Brazil, US) appear to be infected with less prevalent HR-HPV types as compared to the general population (McKenzie et al. 2010) . As yet there are limited data on safety, immune response and efficacy of the HPV vaccine in HIV+ women, although studies are on-going. Although data on the safety of the quadrivalent vaccine in HIV-infected children has been demonstrated, efficacy of the currently available HPV vaccines in women or girls with HIV has not yet been established (Levin et al. 2010). Given the high rates of HPV and cervical cancer in countries with limited health resources, initiatives to introduce HPV vaccination for young people prior to the initiation of sexual activity in these settings are critical. The HPV vaccine is the most expensive vaccine ever developed and costs must be lowered to make this a feasible intervention in the developing world. Fortunately, groups such as GAVI and others are working with governments and other potential donors, as well as with the vaccine makers, to make these vaccines more accessible in areas where they are needed most. Given the high prevalence of both HIV and HPV in many low resource settings and the virologic synergy between these two viruses, with increased rates of HPV-related disease in HIV+ individuals, HIV+ women may be a particular target group for vaccine administration. Furthermore, with improved access to antiretroviral treatment and greater longevity, an increasing number of girls who have been perinatally infected with HIV will be living into adulthood and these girls may particularly

Mathematical models estimate that reduction in incidence and mortality of cervical cancer will be greatest in low/middle income countries with no or limited screening and that HPV vaccination may be cost-effective if cost <\$10–25/vaccinated girl (Kim JJ et al. 2008). Currently, the WHO recommends including routine HPV vaccination in national immunization programs, providing prevention of cervical cancer is a public health priority, programmatically feasible, cost-effective, and has sustainable financing (WHO 2009). HIV infection is not considered a contraindication to HPV vaccination (CDC 2007; ACOG 2010;

Cervical cancer is a leading cause of morbidity and mortality in countries with the fewest resources and these resources are often already over-stretched by high levels of HIV infection. Virologic synergy between HIV and HPV infections further exacerbates the problem, and HIV-infected women are at increased risk for HPV and HPV-related diseases, including cervical cancer. Furthermore, unlike other typical opportunistic infections, there is no compelling evidence that the use of effective ART reduces the burden of HPV or HPVrelated complications, possibly leading to increased numbers of women at risk for cervical cancer as HIV treatment programs become more accessible and successful. Fortunately, cervical cancer is preceded by an extended precancerous period that can be detected and treated to prevent the development of invasive disease. Cervical cytology, which has revolutionized cervical cancer prevention in the U.S. and other developed countries over the past half-century, is simply not feasible for most countries with few resources. Alternatives such as VIA and HPV testing hold great promise as alternative screening strategies, coupled with the use of cryotherapy or LEEP to treat precancerous lesions. In the new WHO Global health sector strategy on HIV/AIDS an over-arching goal is to achieve universal access to

benefit from HPV vaccination.

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**10** 

*Athens, Greece*

**Chemopreventive Activity** 

A.C. Kaliora and A.M. Kountouri

**of Mediterranean Medicinal Plants** 

*Chemistry–Biochemistry–Physical Chemistry of Foods,* 

*Harokopio University, Department of Science of Dietetics–Nutrition, Laboratory of* 

Generally, the use of plants, herbs or other natural products in medicines is since humans inhabited earth. It was "since ever" when humans were trying to find out which plants might be useful to fight several pains and aches, fever, dyspepsia, or wounds. Through the ages, humans learned which plants would cure different illnesses, or might be poisonous and cause even death, and those that could be part of their diet. There are too many examples and references in the pharmaceutical, knowledge that passed from generation to generation. There is ample historical evidence for different usages of herbs by our ancestors. Herbs are the oldest drugs in the world. The initial use was primarily experimental similar to what applied to animals, e.g. against poisonous plants. The first record of the valuable properties of medicinal plants was by the Sumerians (6000 BC), followed by Chinese and Greek. The first book written about herbal plants was by Chinese (4000 BC). However, Greeks were these who spread the use of medicinal plants in West using the knowledge written down by Theophrastus (300 BC). Apollonios wrote about their uses in cosmetology and in religious ceremonies. Hippocrates recommended Pimbinella anisum, of the Umbelliferae family for sneezing and Theophrastus indicated the usefulness of 600 aromatic and medicinal plants in several pathologies. In ancient Rome, Galenus who was the personal physician to Roman emperors and is nowadays considered as "The Father of Pharmacy" was most devoted to aromatherapy. Reports about the uses of essential oils occur even in the Bible, and it was approximately during the 8th century AD when the Arabs improved the methods of extracting the essential oils from natural products and creating novel elixirs and medicines. During the Middle Ages, the essential oils producers were not affected by cholera and plague. During the Renaissance, the use of plants, essential oils, herbs and several other natural products was progressively neglected. The revolution of Chemistry and the synthesis of drugs resulted in almost complete abandonment. However, the impressive results of treating traumas with different botanical products during the two World Wars motivated scientists to further deal the potential of natural products in disease treatment. Aspirin (acetylsalicylic acid), perhaps the most popular painkiller, has a very long history and its medical use stretches back to antiquity. Medicines made from willow and other salicylate-rich plants date back at least to 400 BC. Willow bark extract became recognized for its specific effects on fever, pain and inflammation in the mid-

**1. Introduction** 

