Abstract

BackgroundThe high-risk human papillomavirus (HR-HPV) infection is the main cause of cervical cancer development, and the most common types were included in the last approved nonavalent vaccine (9vHPV). Geographical, socioeconomic and ethnic barriers in developing countries challenge primary and secondary prevention measures of cervical cancer. We aimed to determine the prevalence of HPV infection and the viral load of HR-HPV 9vHPV-related types black women resident in rural semi-isolated communities.MethodsA descriptive study was conducted with 273 cervical samples of women from rural communities of Southeastern Brazil. Viral DNA was amplified by PCR, the genotype was identified by Reverse Line Blot (RLB) and Restriction Fragment Length Polymorphism (RFLP), and real-time PCR was applied to determine the viral load.ResultsHPV frequency was 11.4% (31/273), associated with the presence of cytological abnormalities (32.3%; p < 0.001). Thirty-one distinct genotypes were detected; HR-HPV occurred in 64.5% (20/31) of the samples and the most prevalent type were HPV52 > 58, 59. Multiple infections occurred with up to nine different genotypes. The viral load of HR-HPV 9vHPV-related types was higher in lesions than in normal cytology cases (p = 0.04); “high” and “very high” viral load occurred in HSIL and LSIL, respectively (p = 0.04).ConclusionsWe highlight that despite the low HPV frequency in the black rural women population, the frequency of HR-HPV was high, particularly by the HR-HPV52 and 58 types. Moreover, the HR-HPV viral load increased according to the progression from normal to lesion, being a potential biomarker to identify those women at higher risk of developing cervical lesions in this population.

Highlights

  • The high-risk human papillomavirus (HR-Human papillomavirus (HPV)) infection is the main cause of cervical cancer development, and the most common types were included in the last approved nonavalent vaccine (9vHPV)

  • Control measures are based on the primary prevention with the bivalent HPV (16/18), tetravalent HPV (4vHPV6/11/16/18), and nonavalent (9vHPV- 6/11/16/18/31/33/ 45/52/58) vaccines, and on the secondary prevention by Pap test screening for precursor lesions, which reduced the cervical cancer in developed countries with organized screening programs [6]

  • A total of 273 black women participated in this study and HPV DNA was detected in 11.4% (31/273) of them

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Summary

Introduction

The high-risk human papillomavirus (HR-HPV) infection is the main cause of cervical cancer development, and the most common types were included in the last approved nonavalent vaccine (9vHPV). Human papillomavirus (HPV) is the most common sexually transmitted infection (STI), and the main cause of cervical cancer development [1]. Control measures are based on the primary prevention with the bivalent HPV (16/18), tetravalent HPV (4vHPV6/11/16/18), and nonavalent (9vHPV- 6/11/16/18/31/33/ 45/52/58) vaccines, and on the secondary prevention by Pap test screening for precursor lesions, which reduced the cervical cancer in developed countries with organized screening programs [6]. Additional secondary tests based on the detection of HPV DNA have been introduced in the cervical cancer screening associated with cytology (co-test) or as primary screening in some developed countries [7]. Brazil has adopted Pap test as control measure for decades, besides 4vHPV since 2014, cervical cancer remains the third most common cancer in women, with approximately 16,370 new cases in 2018, corresponding to 41% of all cervical cancers cases in South America [4, 8]

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