Associations of human papillomavirus (HPV) genotypes and related risk factors in a cohort of women living with HIV in a Brazilian countryside city.

The human papillomavirus (HPV) is associated with cervical abnormalities. People living with HIV are more susceptible to HPV. Campos dos Goytacazes implemented the quadrivalent HPV vaccine (4vHPV) for women living with HIV (WLWH) in 2011, 4 years before the Brazilian public vaccination program. We aimed to characterize the genomic diversity and predictors of HPV infection in WLWH through a prospective cohort study. After the consent form was received, a questionnaire was applied and an endocervical sample was collected. For genotyping, a microarray HPV technique was performed. Two intervention moments were performed: T1, the initial moment, with collection and vaccination; T2 moment, 2 years after T1. Univariate and multivariate analyses were performed. The T1 moment cohort was formed by 146 women,107 belonging to Group 1(HPV-negative) and 39 to Group 2 (HPV-positive). The variables age, marital status, number of children, number of sexual partners, and CD4 count were protective against HPV. The variables number of sexual partners, marital status, and the number of children lost significance in multivariate analysis. Concerning T2 moment, 42 patients were followed with three positive cases. The use of 4vHPV is beneficial for this population and should also be recommended at an age from 26 to 45 years inside the public vaccination program.

High Risk Human Papillomavirus Infection of the Foreskin in Asymptomatic Men and Patients with Phimosis.

PURPOSE: There has been increasing interest in understanding the natural history of HPV and the diseases that it causes in men. HPV infection is strongly associated with penile cancer, lack of neonatal circumcision and phimosis. We investigated the incidence of HPV infection in asymptomatic men and patients with phimosis. MATERIALS AND METHODS: We assessed 110 asymptomatic men and 30 patients who underwent circumcision due to phimosis. DNA was extracted from swabbed samples collected from asymptomatic men and from foreskin samples collected at circumcision. Polymerase chain reaction using consensus primers for detecting HPV-MY09/11 was performed to detect generic HPV DNA. HPV genotyping was done by polymerase chain reaction amplification with primers for the E6 gene DNA sequences HPV6, HPV11, HPV16, HPV18, HPV31, HPV33, HPV35, HPV45 and HPV58. RESULTS: HPV was present in 46.66% of patients with phimosis, of whom 50% had high risk HPV genotypes. Of asymptomatic cases 16.36% were HPV positive but only 1 sample showed high risk HPV. We detected a significantly high rate of HPV genital infection in patients presenting with phimosis compared with asymptomatic men (p = 0.00167). The prevalence of high risk HPV genotypes in patients with phimosis was also statistically significant (p = 0.0004). CONCLUSIONS: We found a robust association between phimosis and the genital HPV prevalence in men and a significant frequency of high risk HPV. Other studies are needed to investigate the occurrence of factors that can increase the incidence of penile carcinoma and determine its impact on female genital infection in cervical cancer.

Barriers to cervical cancer screening in women attending the Family Medical Program in Niterói, Rio de Janeiro.

BACKGROUND: The Family Medical Program is a health care system in the Rio de Janeiro state. Women's health services offered by the Family Medical Program include preventive exams and screening, family planning, and prenatal follow-up. Although cervical cancer screening is offered, barriers to care still hinder the full success of the program, and we are attempting to identify these barriers. METHODS: We undertook a cross-sectional and prospective study involving 351 women who were referred to the Family Medical Program between March 2009 and November 2010. Demographic data were obtained through a structured household questionnaire. The dependent variable was defined as the non-realization of the Pap smear test following the protocol of the Health Ministry. Cervical samples for screening were collected after clinical examination. RESULTS: Women who had undergone Pap smear testing at least once every 3 years comprised 282 of the participants (80.3 %). Most of the women had normal or inflammatory cytology (96.3 %). Illiteracy and the absence of symptomatic episodes of sexually transmitted disease were independent barriers to having cancer screening at regular intervals. Illiterate women were more likely to be older, not to be using any contraceptive method, and on average had more than two children, more than four pregnancies, and more than two abortions. Embarrassment was the greatest barrier to seeking professional care reported by all women, regardless of level of educational attainment. Other important barriers to seeking care and/or screening included time constraints, due to work or childcare. CONCLUSION: This study indicates that the Family Medical Program effectively provides cervical cancer screening coverage for its eligible population, at the level mandated by the WHO and the Brazilian Health Ministry. Fully 96.3 % of the women in our study had normal or benign inflammation on cytology. Understanding of barriers to care-seeking behavior that limit program adherence is one way to facilitate communication between providers and patients regarding the benefits of cancer screening.

Human papillomavirus genotypes distribution in cervical samples from women living with human immunodeficiency virus.

BACKGROUND: The aim of this study was to determine the prevalence and relationship of human papillomavirus (HPV) genotypes in cervical samples from 140 human immunodeficiency virus (HIV)-seropositive women routinely attending an outpatient public gynecological service in the state of Rio de Janeiro, Brazil. METHODS: MY09/11 consensus primers were used to detect generic HPV DNA. HPV typification was performed by restriction fragment length polymorphism analysis following polymerase chain reaction amplification. RESULTS: The overall HPV prevalence was 60.0%. The identification of 24 different HPV genotypes including uncommon types was performed. A9 oncogenic genotypes were present in 54.02% of HIV-positive women. Abnormal cervical lesions, the time since HIV diagnosis and the number of sexual partners contributed independently to the high oncogenic HPV prevalence. The oncogenic and non-oncogenic group were similarly affected by risk factors in contrast to negative HPV women. The frequency of multiple infections was 20%; furthermore, all of them presented at least one oncogenic type. CONCLUSION: The analyzed sample represents an epidemiological source of uncommon infection. Due to high HPV prevalence, more frequent cytological screening and/or liberal colposcopic evaluations should be performed in HIV-positive patients.

Detection of human herpesvirus 6 and 7 DNA in saliva from healthy adults from Rio de Janeiro, Brazil.

In this study, we aimed to evaluate virus shedding in the saliva of healthy adults from the metropolitan region of the city of Rio de Janeiro, Brazil, in order to verify the prevalence of both human herpesviruses 6 and 7 (HHV-6, HHV-7). The studied group comprised 182 healthy individuals at Pedro Ernesto University Hospital, who were being seen for annual odontologic revisions. Saliva specimens were subjected to a multiplex polymerase chain reaction (PCR) to detect the presence of HHV-6A, HHV-6B and HHV-7. The total Roseolovirus DNA prevalence was 22.4%. The PCR detected a HHV-6 prevalence of 9.8%, with HHV-6A detected in 7.1% of the samples and HHV-6B in 2.7%. HHV-7 DNA was revealed in 12.6% of the studied cases. Multiple infections caused by HHV-6A and 7 were found in 2.1% of the samples. No statistical differences were observed regarding age, but for HHV-7 infection, an upward trend was observed in female patients. Compared to studies from other countries, low prevalence rates of herpesvirus DNA were detected in saliva from the healthy individuals in our sample. PCR methodology thus proved to be a useful tool for Roseolovirus detection and it is important to consider possible geographic and populations differences that could explain the comparatively low prevalence rates described here.

Prevalence of human papillomavirus infection in the genital tract determined by hybrid capture assay.

Human Papillomavirus (HPV) infection is the most prevalent sexually-transmitted virus worldwide. It is known to be the etiological agent of cervical cancer and cervical intraepithelial neoplasia (CIN). Consequently, there is strong motivation to evaluate HPV testing in cervical cancer screening. Recently developed, the second generation of the hybrid capture test (HCA II) is a non-radioactive, relatively rapid, hybridization assay, designed to detect 18 HPV types divided into high and low-risk groups. We evaluated 7,314 patients (5,833 women and 1,481 men) for HPV infection by HCA II. Among them, 3,008 (41.1%) presented HPV infection: 430 (14.2%) had HPV DNA of low risk for cancer, 1,631 (54.2%) had high risk HPV types and 947 (31.5%) had both types. The prevalence in females was 44.9%. The prevalence of HPV DNA in the group for which cytological results were available was slightly higher: 55.3% (1007/1824). Significant differences were detected in the frequency of HPV infection of the cervix between normal cases and those with high-grade squamous-intraepithelial lesions (HSIL)(P<0.0001). Among males, the prevalence was 26.2%, composed of 9.1% in Group A, 9.7% in Group B and 7.4% with multiple infections. We observed that male prevalence was lower and that low-risk types were more frequent than in females. HPV viral load was significantly greater in SILs than in normal or inflammatory cases (P<0.0001), suggesting an association between high viral load values and risk of SIL. Because of high costs, the HCA II test cannot be recommended for routine mass screening for cervical infection in poor countries. Nevertheless, it was found to be a useful tool, when combined with cytology, discovering high-risk infections in apparently normal tissues and revealing silent infections that may be responsible for the maintenance of HPV in the general population. These findings point to the need for close and careful management of patients, thereby reducing overtreatment, allowing analysis of both sexual partners and finally contributing to the control of genital infections associated with a risk for cancer.

Human papillomavirus status and cervical abnormalities in women from public and private health care in Rio de Janeiro State, Brazil.

This article reports the HPV status and cervical cytological abnormalities in patients attended at public and private gynecological services from Rio de Janeiro State. It also comments the performance of each HPV DNA tests used. A set of 454 women from private health clinics was tested by routine Capture Hybrid II HPV DNA assay. Among these, 58.4% presented HPV and nearly 90% of them were infected by high risk HPV types. However, this group presented few premalignant cervical lesions and no invasive cervical cancer was registered. We also studied 220 women from low income class attended at public health system. They were HPV tested by polymerase chain reaction using My09/11 primers followed by HPV typing with E6 specific primers. The overall HPV prevalence was 77.3%. They also showed a high percentage of high squamous intraepithelial lesion-HSIL (26.3%), and invasive cervical carcinoma (16.3%). HPV infection was found in 93.1% and 94.4% of them, respectively. The mean ages in both groups were 31.5 and 38 years, respectively. In series 1, HPV prevalence declined with age, data consistent with viral transient infection. In series 2, HPV prevalence did not decline, independent of age interval, supporting not only the idea of viral persistence into this group, but also regional epidemiological variations in the same geographic area. Significant cytological differences were seen between both groups. Normal and benign cases were the most prevalent cytological findings in series 1 while pre-malignant lesions were the most common diagnosis in the series 2. HPV prevalence in normal cases were statistically higher than those from series 1 (p<0.001), indicating a higher exposure to HPV infection. Women from both samples were referred for previous abnormal cytology. However, socio-demographic evidence shows that women from series 1 have access to treatment more easily and faster than women from series 2 before the development of pre-malignant lesions. These data provides baseline support for the role of social inequalities linked to high risk HPV infection leading to cervical cancer. Broadly screening programs and the development of safe and effective vaccines against HPV would diminish the toll of this disease that affect mainly poor women.

Detection of human papillomavirus DNA by the hybrid capture assay.

Human Papillomavirus (HPV) infection is the main cause of cervical cancers and cervical intraepithelial neoplasias (CIN) worldwide. Consequently, it would be useful to evaluate HPV testing to screen for cervical cancer. Recently developed, the second-generation Hybrid Capture (HCA II) test is a non-radioactive, relatively rapid, liquid hybridization assay designed to detect 18 HPV types, divided into high and low-risk groups. We evaluated 1055 women for HPV infection with the HCA II test. Five hundred and ten (48.3%) of these women had HPV infection; 60 (11.8%) had low cancer-risk HPV DNA; 269 (52.7%) had high-risk HPV types and 181 (35.5%) had both groups. Hence, 450 women (88.2%) in this HPV-infected group had at least one high risk HPV type, and were therefore considered to be at high risk for cancer. Among the group with Papanicolaou (Pap) test results, the overall prevalence of HPV DNA was 58.4%. Significant differences in HPV infection of the cervix were detected between Pap I (normal smears) and Pap IV (carcinomas) (p<0.0001). Values of HPV viral load obtained for Pap I and SILs were significantly different, with an upward trend (p<0.0001), suggesting a positive correlation between high viral load values and risk of SIL. Because of the high costs of the HCA II test, its use for routine cervical mass screening cannot be recommended in poor countries. Nevertheless, it is a useful tool when combined with cytology, diagnosing high-risk infections in apparently normal tissues. Use of this technique could help reduce the risk of cancer.

Human papillomavirus infections and renal transplantation: a review / Infecções causadas por papilomavírus humanos e transplante renal: uma revisão

The immune suppressive therapy in renal allograft recipients provides a favorable environment to the development of viral infections. Among them,human papillomavirus (HPV) infections are usually related to potential life-threatening mucocutaneous neoplasias. Data from clinical surveys suggestthat transplant recipients may have up to 5-fold increased risk of developing multiple malignancies due to the increased susceptibility to persistent HPV infection. High risk HPV induced oncogenesis is a multi-step process in which a persistent infection is the initiating causative event, though subsequentgenetic and epigenetic alterations may be necessary for malignant transformation. The main tumoral types associated with persistent HPV infection areanogenital, oral and skin cancers, common conditions in transplant recipients and responsible for substantial morbidity and mortality. Since prophylactic vaccines with high rates of efficacy have been approved for human population, studies to evaluate its immunogenicity and efficacy should be considered forlong-term survivors after allogeneic transplantation. Hence, we conducted an extensive revision published data for the last 10 years regarding the theme.To achieve our objectives, we searched in diverse data basis such as Lilacs, ScIELO, Medline, Scopus. We concluded that, concerning the increase in thepopulation of transplant recipients as well as in the incidence of HPV associated diseases, measures for prevention and control are necessary, and includecapaciting human resources and the use of last generation methodologies of diagnosis and prophylaxis.

A terapia imunossupressora em pacientes receptores de transplante renal fornece um ambiente favorável ao desenvolvimento de infecções virais. Dentreestas infecções, aquelas causadas pelos papilomavírus humanos (HPV) são geralmente associadas a neoplasias mucocutâneas que podem ameaçar asobrevida pós-transplante. Pesquisas clínicas sugerem que receptores de transplante podem apresentar um risco até cinco vezes maior de desenvolverem quadros de doenças malignas múltiplas, devido à maior frequência da persistência do HPV. A oncogênese induzida por HPV de alto risco é um processo demúltiplos estágios, no qual a infecção persistente é o evento fundamental, apesar de alterações genéticas e epigenéticas adicionais serem necessárias para a transformação maligna. Os principais tipos tumorais relacionados à infecção persistente por HPV são os cânceres anogenitais, orais e de pele, comunsem receptores de transplante e responsáveis por grande morbidade e mortalidade. Uma vez que vacinas profiláticas de alta eficácia contra a infecçãopelo HPV foram aprovadas para uso na população humana, estudos para avaliar a imunogenicidade e eficácia destas vacinas em imunossuprimidos são recomendáveis. Assim, objetivamos fazer extensa revisão sobre o tema. Para tal, pesquisamos o assunto nas bases de dados Lilacs, ScIELO, Medline,Scopus nos últimos 10 anos. Concluímos que, com o aumento na população de receptores de transplantes e a crescente incidência das doenças associadasao HPV, medidas de prevenção e controle se fazem necessárias e englobam desde a formação de profissionais capacitados até a aplicação de metodologias de diagnóstico e profilaxia, de última geração.

Infecções causadas pelos papilomavírus humanos: atualização sobre aspectos virológicos, epidemiológicos e diagnóstico / Human papillomavirus infection: update on virological and epidemiological aspects and diagnosis

Papilomavírus humanos são pequenos vírus de DNA capazes de infectar epitélio da pele e mucosas. Mais de 100 tipos já foram descritos, sendo que cerca de 40 causam doenças sexualmente transmissíveis. É também no trato genital que alguns tipos exercem poder oncogênico, sendo 13 considerados agentes etiológicos do câncer cervical, responsável pela morte de 200.000 mulheres em todo o mundo, anualmente. O diagnóstico disponível para o controle das DST e câncer causados pelos HPV baseia-se no tripé colposcopia, citologia e histopatologia, podendo ser confirmado laboratorialmente por técnicas de biologia molecular. Dentre elas: PCR e captura do híbrido. Recentemente, duas vacinas profiláticas contra os tipos 6, 11, 16 e 18 (Merck) e 16 e 18 (Glaxo) foram desenvolvidas. São compostas de VLPs (Vírus-like particles) expressas em leveduras. Resultados promissores vêm sendo publicados, embora alguns mecanismos imunológicos de defesa contra o HPV não estejam ainda esclarecidos.

Human papillomavirus are small DNA viruses capable of infecting the epithelium of skin and mucosa. More than a hundred types have already been described, and nearly 40 promote sexually transmitted diseases. It is in the genital tract that 13 HPV types exert their oncogenic potential, being responsible by the death of 200,000 women worldwide, annualy. The available diagnosis to STD and cancer control is based upon the colposcopy, cytology and histopathology tools, and can be laboriatorially confirmed by molecular biology techniques: PCR and hybrid capture. Recently, two prophylactic vaccines against HPV types 6, 11, 16 e 18 (Merck) and 16 e 18 (Glaxo) were developed. They are composed by VLP (Virus-like particles) expressed in yeasts. Promissing results have been published. Nevertheless, immunological mechanisms for human defense are not well elucidated.

Prevalence of human papillomavirus infection in the genital tract determined by hybrid capture assay

Human Papillomavirus (HPV) infection is the most prevalent sexually-transmitted virus worldwide. It is known to be the etiological agent of cervical cancer and cervical intraepithelial neoplasia (CIN). Consequently, there is strong motivation to evaluate HPV testing in cervical cancer screening. Recently developed, the second generation of the hybrid capture test (HCA II) is a non-radioactive, relatively rapid, hybridization assay, designed to detect 18 HPV types divided into high and low-risk groups. We evaluated 7,314 patients (5,833 women and 1,481 men) for HPV infection by HCA II. Among them, 3,008 (41.1 percent) presented HPV infection: 430 (14.2 percent) had HPV DNA of low risk for cancer, 1,631 (54.2 percent) had high risk HPV types and 947 (31.5 percent) had both types. The prevalence in females was 44.9 percent. The prevalence of HPV DNA in the group for which cytological results were available was slightly higher: 55.3 percent (1007/1824). Significant differences were detected in the frequency of HPV infection of the cervix between normal cases and those with high-grade squamous-intraepithelial lesions (HSIL)(P<0.0001). Among males, the prevalence was 26.2 percent, composed of 9.1 percent in Group A, 9.7 percent in Group B and 7.4 percent with multiple infections. We observed that male prevalence was lower and that low-risk types were more frequent than in females. HPV viral load was significantly greater in SILs than in normal or inflammatory cases (P<0.0001), suggesting an association between high viral load values and risk of SIL. Because of high costs, the HCA II test cannot be recommended for routine mass screening for cervical infection in poor countries. Nevertheless, it was found to be a useful tool, when combined with cytology, discovering high-risk infections in apparently normal tissues and revealing silent infections that may be responsible for the maintenance of HPV in the general population. These findings point...

Human papillomavirus status and cervical abnormalities in women from public and private health care in Rio de Janeiro State, Brazil / Papilomavírus humano e anormalidades cervicais em mulheres do sistema de saúde privado e público no Estado do Rio de Janeiro, Brasil

This article reports the HPV status and cervical cytological abnormalities in patients attended at public and private gynecological services from Rio de Janeiro State. It also comments the performance of each HPV DNA tests used. A set of 454 women from private health clinics was tested by routine Capture Hybrid II HPV DNA assay. Among these, 58.4 percent presented HPV and nearly 90 percent of them were infected by high risk HPV types. However, this group presented few premalignant cervical lesions and no invasive cervical cancer was registered. We also studied 220 women from low income class attended at public health system. They were HPV tested by polymerase chain reaction using My09/11 primers followed by HPV typing with E6 specific primers. The overall HPV prevalence was 77.3 percent. They also showed a high percentage of high squamous intraepithelial lesion-HSIL (26.3 percent), and invasive cervical carcinoma (16.3 percent). HPV infection was found in 93.1 percent and 94.4 percent of them, respectively. The mean ages in both groups were 31.5 and 38 years, respectively. In series 1, HPV prevalence declined with age, data consistent with viral transient infection. In series 2, HPV prevalence did not decline, independent of age interval, supporting not only the idea of viral persistence into this group, but also regional epidemiological variations in the same geographic area. Significant cytological differences were seen between both groups. Normal and benign cases were the most prevalent cytological findings in series 1 while pre-malignant lesions were the most common diagnosis in the series 2. HPV prevalence in normal cases were statistically higher than those from series 1 (p < 0.001), indicating a higher exposure to HPV infection. Women from both samples were referred for previous abnormal cytology. However, socio-demographic evidence shows that women from series 1 have access to treatment more easily and faster than women from series 2 before the development of pre-malignant lesions...

Este artigo analisa a infecção por HPV e anormalidades citológicas cervicais encontradas em pacientes atendidas em serviços ginecológicos dos sistemas de saúde público e privado do estado do Rio de Janeiro. O trabalho também avalia os testes utilizados para detecção de DNA do HPV em cada população estudada. Um grupo de 454 mulheres oriundas de serviços da rede privada de saúde foi testado por Captura do Híbrido II. Destas, 58,4 por cento apresentaram infecção por HPV e cerca de 90 por cento delas estavam infectadas por HPV de alto risco. Este grupo, entretanto, apresentava poucos casos de lesões cervicais pré-malígnas e nenhum caso de câncer. Estudamos, também, 220 mulheres de baixo nível econômico atendidas no serviço de saúde pública que foram testadas para HPV pela reação da polimerase em cadeia utilizando-se os oligonucleotídeos My09/My11. A identificação dos tipos foi efetuada por amplificação com oligonucleotídeos específicos para a região E6 do genoma viral. A prevalência de HPV nesta população foi de 77.3 por cento, observando-se uma alta porcentagem de casos de neoplasias intraepiteliais cervicais de alto grau (26,3 por cento) e de carcinoma cervical invasivo (16,3 por cento). A infecção por HPV foi achada em, respectivamente, 93,1 por cento e 94,4 por cento destes casos. A média de idade em ambos os grupos era de 31,5 e 38 anos, respectivamente. Na série 1, a prevalência da infecção por HPV decresce com a idade, enquanto na série 2 ela não desaparece, dando suporte não só à idéia de persistência viral neste grupo, mas também a variações epidemiológicas na mesma área geográfica. Diferenças significativas foram vistas nos dois grupos. Casos normais e benignos foram incidentes na série 1, enquanto as lesões malígnas predominaram na série 2. Ao contrário, casos normais infectados por HPV eram prevalentes na série 2 (p < 0.001), indicando maior exposição ao vírus. Embora as mulheres de ambos os grupos tenham sido incluídas no estudo por apresentarem citologia anormal, evidências sócio-demográficas demonstram que mulheres da série 1 tem acesso mais fácil e rápido ao tratamento do que as mulheres da série 2 antes que as lesões pré-malígnas se desenvolvam...

Hepatitis B infection among patients attending a sexually transmitted diseases clinic in Rio de Janeiro, Brazil

Hepatitis B virus (HBV) has a low endemicity in Rio de Janeiro, Brazil. Sexual transmission must play an important role in this virus, but the prevalence and risk factors have never been properly investigated. The aim of this paper is to determine the prevalence and risk factors for HBV infection in patients attending a Sexually Transmitted Diseases Clinic of the Universidade Federal Fluminense, from the State of Rio de Janeiro, Brazil. In a retrospective study, HBV seroprevalence was investigated in 440 patients. Serum of each patient was assayed for antibodies against hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg) and antibodies against hepatitis B surface antigen (anti-HBs). Demographic and risk factor data were extracted from clinic notes. The overall seroprevalence of exposure markers for HBV (anti-HBc, HBsAg and anti-HBs) were 13 percent, 3.4 percent and 8.5 percent respectively. Homo/bisexual behaviour, anal intercourse, HIV infection, positive serology for syphilis and blood transfusion were predictors of the HBV exposure. Among demographic data, age and place of birth were associated with the anti-HBc seropositivity

Use of MAC-ELISA for evaluation of yellow fever vaccination

An evaluation of the IgM antibody immune response against yellow fever using strain 17D was carried out by MAC-ELISA and PRNT. The results showed an agreement of 97% between both tests and the authors conclude that MAC-ELISA can be used as a specific and sensitive assay to replace the PRNT for detecting yellow fever antibodies in human sera, after vaccination programs

Dengue epidemic in the state of Rio de Janeiro, Brazil: virological and epidemiological aspects

Laboratory studies were carried out on 3178 patients with signs and symptoms suggestive of dengue infection from April 1986 to December 1987 in the State of Rio de Janeiro, Brazil. The epidemic had two peaks following the first virus isolation and affected the inhabitants of 17 counties. Both sex and all age groups were affected. Dengue virus type 1 was isolated from 1039 sera and the number of confirmed cases was increased to 1874 (59) by MAC-ELISA. Isolation rate confirmed cases reached 80 in the specimens obtained until the 4th day after the onset of disease and viraemia ranged from 10(3.0) to 10(8.5) TCID50/ml.

Detection of human papillomavirus DNA by the hybrid capture assay

Human Papillomavirus (HPV) infection is the main cause of cervical cancers and cervical intraepithelial neoplasias (CIN) worldwide. Consequently, it would be useful to evaluate HPV testing to screen for cervical cancer. Recently developed, the second-generation Hybrid Capture (HCA II) test is a non-radioactive, relatively rapid, liquid hybridization assay designed to detect 18 HPV types, divided into high and low-risk groups. We evaluated 1055 women for HPV infection with the HCA II test. Five hundred and ten (48.3 percent) of these women had HPV infection; 60 (11.8 percent) had low cancer-risk HPV DNA; 269 (52.7 percent) had high-risk HPV types and 181 (35.5 percent) had both groups. Hence, 450 women (88.2 percent) in this HPV-infected group had at least one high risk HPV type, and were therefore considered to be at high risk for cancer. Among the group with Papanicolaou (Pap) test results, the overall prevalence of HPV DNA was 58.4 percent. Significant differences in HPV infection of the cervix were detected between Pap I (normal smears) and Pap IV (carcinomas) (p<0.0001). Values of HPV viral load obtained for Pap I and SILs were significantly different, with an upward trend (p<0.0001), suggesting a positive correlation between high viral load values and risk of SIL. Because of the high costs of the HCA II test, its use for routine cervical mass screening cannot be recommended in poor countries. Nevertheless, it is a useful tool when combined with cytology, diagnosing high-risk infections in apparently normal tissues. Use of this technique could help reduce the risk of cancer

Human papillomavirus infection and cervical cancer in Brazil: a retrospective study

Two hundred and thirty paraffin-embedded biopsies obtained from female cervical lesions were tested for the presence of human papillomavirus (HPV) types 6/11, 16/18 and 31/33/35 DNA using non-isotopic in situ hybridization. Specimens were classified according to the Bethesda System in low grade squamous intraepithelial lesion (LSIL), high grade SIL (HSIL) and squamous cell carcinoma (SCC). HPV prevalence ranged from 92.5 per cent in LSIL to 68.5 per cent in SCC. Benign types were prevalent in LSILs while oncogenic types infected predominantly HSILs and SCC. HPV infection showed to be age-dependent, but no significant relation to race has been detected. Patients were analyzed through a five-year period: 20.7 per cent of the lesions spontaneously regressed while 48.9 per cent persisted and 30.4 per progressed to carcinoma. Patient submitted to treatment showed a 19.4 per cent recurrence rate. High risk types were present in 78.6 per cent (CrudeOR 13.8, P=0.0003) of the progressive lesions, and in 73.7 per cent of the recurrent SILs (COR 19.3, P=0.0000001). Possible co-factors have also been evaluated: history of other sexually transmitted diseases showed to be positively related either to progression (Adjusted OR 13.0, P=0.0002) or to recurrence (AOR 17.2, P=0.0002) while oral contraceptive use and tobacco smoking were not significantly related to them (P>0.1). Association of two or more co-factors also proved to be related to both progression and recurrence, indicating that they may interact with HPV infection in order to increase the risk of developing malignant lesions.

Detecção de papilomavírus humanos pela técnica de captura do híbrido no trato genital masculino / Human papillomavirus detection by the hybrid capture assay in the male genital tract

Estudo das infecções genitais causadas pelo HPV, determinando a prevalência dos tipos de HPV noa pacientes masculinos

Detecçäo e tipagem viral para papilomavírus humanos: progressos recentes e perspectivas clínicas / Human papillomavirus detection and typing: recent progress and clinical perspectives

A biologia molecular e tecnologias relacionadas tiveram um avanço espectacular nos últimos anos, ao contrário da microscopia de rotina. A contribuiçäo dos testes de DNA para HPV como triagem de mulheres com anormalidades de baixo grau ou diagnóstico impreciso em esfregaços de colo uterino parece ser valiosa, auxiliando na conduta clínica. U uso em larga escala dos testes para HPV necessita de estudos prospectivos em andamento utilizando grandes populaçöes de pacientes de rotina clínica. É esperado que os resultados tragam dados para as expectativas em relaçäo ao valor dos testes para HPV na triagem de precursores de cåncer de colo uterino, sua contribuiçäo na triagem diagóstica de pacientes com laudos de citologia inconclusivos e para o controle de qualidade da excelência em citopatologia

Human papillomavirus infection: correlation of colposcopy, cytology, hystopathology and in situ hybridization

Duzentas e vinte e cinco biópsias de lesoes cervicais, obtidas de pacientes atendidas no Hospital Luíza Gomes de Lemos (INCa), foram analisadas pelas seguintes metodologias: colposcopia, citologia, histopatologia e hibridizaçao in situ (IS). O diagnóstico citológico apresentou alta sensibilidade (97,6 por cento) e especificidade (78,9 por cento) quando comparado à histopatologia, método padrao de diagnóstico de lesSes cervicais. Entretanto, resultados falso-positivos foram demonstrados em 26,7 por cento dos casos de alteraçoes reativas/reparativas à citologia. A colposcopia também mostrou alta sensibilidade (81,7 por cento) e especificidade (80 por cento) mas 16,7 por cento dos exames resultaram em diagnóstico inconclusivo. A infecçao por papilomavírus humanos (HPVs) foi demosntrada pelo emprego da HIS usando sondas biotiniladas específicas para os HPVs 6, 11, 16, 18, 31, 33 e 35. Os HPVs 6 e 11, de baixo risco, prevaleceram em lesoes intrapteliais escamosas de baixo grau (LSILs)(30/49; 61,2 por cento), enquanto HPVs 16 e 18, oncogênicos, predominaram em lesoes de alto grau (HSILs)(33/81;40,7 por cento) e carcinomas (21/37,56,8 po cento). Os tipos 31, 33 e 35 foram detectados em 17,6 por cento das lesoes estudadas, predominando naquelas de alto grau. Esta alta prevalência indica a ocorrência de peculiaridades geográficas na distribuiçao de tipos de HPV em nosso país. A reaçao em cadeia da Polimerase (PCR) foi empregada afim de avaliar a eficácia da HIS e 91,7 por cento) dos casos testados resultaram concordantes. Comparando os três métodos empregados na rotina diagnóstica (citologia, colposcopia e histopatologia), encontramos uma taxa de concordância de 61,2 por cento. Resultados conflitantes foram apontados em 39,8 por cento das lesoes, sugerindo o emprego da HIS como um procedimento recomendável na elucidaçao de resultados inconclusivos, podendo assim contribuir para a prevençao do câncer cervical