Abstract
Diagnosed in more than 90% of cervical cancers, the fourth deadliest cancer in women, human papillomavirus (HPV) is currently the most common pathogen responsible for female cancers. Moreover, HPV infection is associated with many other diseases, including cutaneous and anogenital warts, and genital and upper aerodigestive tract cancers. The incidence and prevalence of these pathologies vary considerably depending on factors including HPV genotype, regional conditions, the study population, and the anatomical site sampled. Recently, features of the cervicovaginal microbiota are found to be associated with the incidence of HPV-related diseases, presenting a novel approach to identify high-risk women through both blood and cervical samples. Overall, the HPV repartition data show that HPV infection and related diseases are more prevalent in developing countries. Moreover, the available (2-, 4-, and 9-valent) vaccines based on virus-like particles, despite their proven effectiveness and safety, present some limitations in terms of system development cost, transport cold chain, and oncogenic HPV variants. In addition, vaccination programs face some challenges, leading to a considerable burden of HPV infection and related diseases. Therefore, even though the new (9-valent) vaccine seems promising, next-generation vaccines as well as awareness programs associated with HPV vaccination and budget reinforcements for immunization are needed.
Highlights
Human papillomavirus (HPV) is the most common sexually transmissible infection (STI) in the world, with a high negative impact on individual social life
We summarize the current prevalence distribution of human papillomavirus (HPV) infection and related diseases worldwide and discuss the involvement of factors, the genetic and molecular characteristics of the antigenic HPV-L1 protein, and reveal microbial factors associated with the natural history of HPV
Apart from a few exceptions, the burden of HPV infection and related diseases remains high in developing countries, and factors that explain these high rates include poor living conditions, co-infections with other pathogens, poor healthcare facilities, and high cost of vaccines
Summary
Human papillomavirus (HPV) is the most common sexually transmissible infection (STI) in the world, with a high negative impact on individual social life. Unlike the HPV global distribution described earlier, HPV 16 and 18, detected in 71% of ICC, are less prevalent in developing regions (Table 1) [12], where the HPV-associated burden is high To understand this antiparallel fact, it is important to know that the occurrence risk of CIN 1/2/3 and CC depends on the geographic variability of viral variants described hereafter. Once an HR-HPV infection (red star) occurs in the 30–40% of exposed women (90%), few of them develop HPV-associated abnormalities such as low-grade cervical intraepithelial neoplasia (CIN1) or lesions, which can progress to high-grade lesion (CIN2-3) responsible in long term to invasive cervical cancers In this figure, and as previously found, the abundance of Lactobacilus spp. is associated with a regression of viral persistence and a clearance of the infection. The preventive strategies should be redirected to the specific regional features of HPV L1 protein used in developing vaccines
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