Abstract
BackgroundCervical cancer ranks third in prevalence and fourth as cause of death in women worldwide. In Brazil, 17,540 women were diagnosed in 2012 with the disease. Persistent infection with high-risk HPV types is a necessary condition for the development of pre-invasive and invasive cervical neoplasia. Currently, over 100 HPV types have been identified, but HPV16 and 18 are recognized as the mayor culprits in cervical carcinogenesis. Our objective was to assess the relationships between single- (ST) and multiple-type (MT) HPV infections with patients’ age and lesion pathological status.Methods328 patients with either squamous or glandular intraepithelial or invasive cervical lesion were selected. All subjects were tested for HPV genotypes with reverse hybridization for 21 high- (hr-HPV) and 16 low-risk (lr-HPV) probes. Prevalence of ST and MT HPV infections was compared across histological types and age strata.Results287 (87%) women had at least one HPV type detected and 149 (52%) had MT infections. The most prevalent HPV type was HPV16, present in 142 cases (49% of all HPV-positive cases), followed by HPV58, 52, 31, 35 and 33. HPV18, in single or multiple infections, occurred in 23 cases (8% of hr-HPV cases). Almost all glandular lesions were associated with HPV16 and 18 alone. Multiple infections were significantly more prevalent in squamous than in glandular lesion for HPV16 and 18 (P = 0.04 and 0.03 respectively). The prevalence of MT infections followed a bimodal distribution; peaking in women younger 29 years and in those aged 50 to 59.ConclusionsOur data indicate that prevention strategies for pre-invasive and invasive squamous lesions should be focused on HPV16 and a few alpha-9 HPV types. It is clear to us that in young women, prophylaxis must cover a large amalgam of HPV types beyond classic HPV16 and 18.
Highlights
Cervical cancer ranks third in prevalence and fourth as cause of death in women worldwide
Women with squamous lesions had a significantly higher prevalence of MT infections compared to women with glandular lesions (p = 0.04)
In a previous study with 1,509 Brazilian healthy young women without cervical lesions of five different centres, aged 15 to 25 years, we found an overall prevalence of HPV of 29.7%
Summary
Cervical cancer ranks third in prevalence and fourth as cause of death in women worldwide. High-grade intraepithelial lesion and invasive carcinoma, either squamous or glandular, are mostly associated with oncogenic HPV types included in alpha-9 (HPV 16, 31, 33, 35, 52, 58 and 67) and alpha-7 (HPV 18, 39, 45, 59, 68 and 70) species, considering that the types belonging to a species have 80% of genetic similarity [5]. Among these types, HPV 16 and 18 infections, followed by HPV 31 and 45 are found in more than 80% of cervical cancer specimens [6,7,8,9]. The prevalence of hr-HPV follows a bimodal distribution, peaking in women aged 20 to 24 years and in those aged 50 to 54; multiple-type (MT) HPV infection is more prevalent in women 30 years old or younger [11]
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