Abstract
Background Persistent human papillomavirus (HPV) infection with a high-risk oncogenic genotype is related to the development of cervical cancer. HPV genotype 16 (HPV 16) is by far the genotype most strongly associated with cervical cancer, but the viral variant and/or viral load of HPV 16 could specifically modulate this association. Our aim was to determine the association between the viral variant and viral load of HPV 16 and the presence of cervical high-grade lesions. Methods This cross-sectional study included all women in whom HPV infection was found by cervical smear during routine gynecological health checks. Women with single or multiple HPV 16 infections (n = 176) were selected for viral variant and viral load analysis. Smear results were classified using the Bethesda system. HPV types were classified according to the International Agency for Research on Cancer. Odds ratios (ORs) with their 95% confidence intervals (CIs) were estimated by logistic regression, adjusted for age, immigrant status, and co-infection with other high-risk genotypes. Results No statistically significant associations were found regarding the detected viral variants. A viral load above the median (> 1367.79 copies/cell) was associated with a significant risk of high-grade epithelial lesion or carcinoma, after adjusting for age, immigrant status, co-infections, and viral variant: (adjusted OR: 7.89; 95% CI: 2.75–22.68). This relationship showed a statistically significant dose–response pattern after categorizing by viral load tertiles: adjusted OR for a viral load greater than the third tertile was 17.23 (95% CI: 4.20–70.65), with adjusted linear P trend = 0.001. Conclusion In patients infected with HPV 16, viral load is associated with high-grade intraepithelial lesions or cervical carcinoma. This could be useful as a prognostic biomarker of neoplastic progression and as a screening test for cervical cancer.
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