Abstract
BackgroundHuman Papillomavirus (HPV) genotype distribution and co-infection occurrence was studied in cervical cytologic specimens from Murcia Region, (southeast Spain), to obtain information regarding the possible effect of the ongoing vaccination campaign against HPV16 and HPV18.MethodsA total of 458 cytologic specimens were obtained from two outpatient gynecological clinics. These included 288 normal benign (N/B) specimens, 56 atypical squamous cell of undetermined significance (ASC-US), 75 low-grade squamous intraepithelial lesions (LSIL) and 39 high-grade squamous intraepithelial lesions (HSIL). HPV genotyping was performed using PCR and tube array hybridization.ResultsThe most frequent genotype found was HPV16 (14.9% in N/B; 17.9% in ASC-US; 29.3% in LSIL and 33.3% HSIL). Distribution of other genotypes was heavily dependent on the cytologic diagnoses. Co-infections were found in 15.3% of N/B, 10.7% of ASC-US, 48% of LSIL and 25.6% of HSIL cases (significantly different at p < 0.001). Strikingly, in N/B diagnoses, genotypes from A5 species were found as coinfecting in all cases. Genotypes from A7 or A9 species appeared in co-infections in 56.5% and 54% respectively whereas genotypes from A6 species appeared in 25.1% of cases.ConclusionHPV vaccination might prevent 34.6% and 35.8% of LSIL and HSIL, respectively. Co-infection rate is dependent on both cytologic diagnosis and HPV genotype. Moreover, genotypes belonging to A5, A7 and A9 species are more often found as co-infections than genotype pertaining to A6 species. This suggests that phylogenetically related genotypes might have in common similar grades of dependency for cervical epithelium colonization.
Highlights
Human Papillomavirus (HPV) genotype distribution and co-infection occurrence was studied in cervical cytologic specimens from Murcia Region, to obtain information regarding the possible effect of the ongoing vaccination campaign against HPV16 and HPV18
The percentage of samples positive for an HPV infection increased with the severity of the lesion, from normal benign (N/B) (49.7%) to low-grade squamous intraepithelial lesions (LSIL) (82.7%) and high-grade squamous intraepithelial lesions (HSIL) (87.2%) (p < 0.0001) (Table 1)
HPV genotype distribution changes in cytologic diagnoses The specific HPV genotypes changed depending on cytologic diagnoses (Figure 1)
Summary
Human Papillomavirus (HPV) genotype distribution and co-infection occurrence was studied in cervical cytologic specimens from Murcia Region, (southeast Spain), to obtain information regarding the possible effect of the ongoing vaccination campaign against HPV16 and HPV18. In a substantial percentage of HPV infections, ranging from 20–30%, and depending on the HPV typing assay used, two or more different HPV genotypes may be found [7,8,9,10]. These coinfections seem to have a higher rate of occurrence than expected by chance [10,11] suggesting a synergy amongst the coinfecting HPV genotypes. Whether certain types of HPV are more or less likely to be acquired together still remains unknown [11]
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