Genital Human Papillomavirus Infection in women from Florianópolis - Santa Catarina, Brazil / Infecção genital pelo Papilomavírus Humano em mulheres de Florianópolis - Santa Catarina, Brasil

Introduction: Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in women. About 80% of sexually active women will have contact with this virus at some age in their lives. Most infections will be transient, but when the infection becomes persistent, associated with high oncogenic risk HPV, there may be progression to cancer, especially cervical cancer. The best way to prevent HPV infection is through the use of vaccines. Objective: To assess which are the most prevalent types of HPV in the city of Florianópolis, Brazil and if the majority of the diagnosed types are contained in the HPV vaccines currently available on the market and in the public health sector. Methods: More than 14,727 HPV tests were evaluated for the diagnosis of genital HPV infection in women from Florianópolis. The prevalence of infection was evaluated according to age of the women. HPV detection was performed using molecular biology tests, such as hybrid capture (for diagnosis of the HPV group, high or low oncogenic risk) and PCR (viral genotyping) techniques. Results: The diagnosis of HPV infection was made for women between one and 102 years of age. The highest positivity of the exams was observed in women aged 20­25 years (51% of the exams). The most prevalent age group was 31­35 years old (23.5%), and the lowest was for women aged 70 and above (0.6%). High oncogenic risk HPV was detected in 94.1% of positive samples and was the most frequent in all age groups. Mixed infection (high- and low-risk HPV) was more prevalent in the 66­70 age group (25.6%). The most frequent genotypes were non-16/18 high oncogenic risk HPV (77% of positive cases). HPV 16 was found in 17.1% of positive cases, and HPV 18 in 6.5%. Conclusion: The most prevalent types of HPV in Florianópolis in the last 6 years are non-16/18 high oncogenic risk HPV types, viral types not covered by the current HPV vaccine available in the public health sector in Brazil.

Introdução: A infecção pelo Papilomavírus Humano (HPV)é a infecção sexualmente transmissível mais frequente na mulher. Cerca de 80% das mulheres sexualmente ativas irão entrar em contato com este vírus em algum momento da sua vida. A maioria das infecções será transitória, mas quando a infecção se torna persistente, associada aos HPV de alto risco oncogênico, poderá haver a progressão para o câncer, principalmente o câncer de colo de útero. A melhor forma de prevenção da contaminação pelo HPV é através da utilização das vacinas. Objetivo: Avaliar quais são os tipos de HPV mais prevalentes na cidade de Florianópolis, Brasil, e se a maioria dos tipos diagnosticados estão contidos nas vacinas contra o HPV atualmente disponíveis no mercado e no setor público de saúde. Métodos: Foram avaliados 14.727 exames para diagnóstico da infecção genital pelo HPV em mulheres de Florianópolis, de acordo com a idade das mulheres. A detecção do HPV foi realizada através dos exames de biologia molecular pelas técnicas de captura híbrida (para diagnóstico do grupo de HPV, alto ou baixo risco oncogênico) e PCR (genotipagem viral). Resultados: Foram avaliados exames para diagnóstico da infecção de mulheres entre um e 102 anos de idade. A maior positividade dos exames foi observada em mulheres dos 20­25 anos (51% dos exames). A faixa etária de maior prevalência foi dos 31­35 anos (23,5%), e a menor, após os 70 anos (0,6%). O HPV de alto risco oncogênico foi detectado em 94,1% dos casos positivos e foi o mais frequente em todas as faixas etárias. A infecção mista (HPV de alto e baixo risco) foi mais prevalente na faixa etária dos 66­70 anos (25,6%). Os genótipos mais frequentes foram os HPV de alto risco oncogênico não 16/18 (77% dos casos positivos). O HPV 16 foi encontrado em 17,1% dos casos positivos, e o HPV 18 em 6,5%. Conclusão: Os tipos de HPV mais prevalentes em Florianópolis nos últimos 6 anos são os HPV de alto risco oncogênico não 16/18, tipos virais não cobertos pela atual vacina contra o HPV disponível no setor público de saúde do Brasil.Palavras-chave: HPV. Tipos de HPV. Câncer de colo de útero. Cobertura vacinal.

Relationships of interleukin-10 with the regulatory T cell ratio and prognosis of cervical cancer patients

OBJECTIVE: This study investigated serum interleukin-10 (IL-10) levels, changes in peripheral blood CD4+CD25+ regulatory T cell (PBCDT) ratios, and the prognosis of cervical cancer (CC) patients. METHODS: Seventy patients with CC composed the observation group, and 70 healthy subjects composed the control group. The PBCDT ratios in the CC patients and healthy subjects were calculated. Serum IL-10 levels were detected with a double antibody sandwich enzyme-linked immunosorbent assay (ELISA). RESULTS: The PBCDT ratio was higher in the patients with active CC [12.16±2.41%] than in the control subjects [6.34±1.05%]. Serum IL-10 levels were higher in the patients with CC [384±106 pg/ml] than in the control subjects [104±50 pg/ml]; the differences in both PBCDT ratio and IL-10 level were statistically significant (p<0.01). Serum IL-10 levels were positively correlated with PBCDT ratios (r=0.375, p<0.05). The 5-year patient survival rate was significantly higher in the low serum IL-10 group (64.2%) than in the high serum IL-10 group (42.8%, p=0.012). CONCLUSIONS: PBCDT ratios and serum IL-10 levels are related to CC activity. These factors are reciprocally related and influence one another, and both are involved in the development and progression of CC. Low IL-10 expression is beneficial regarding the survival of patients with CC.

Prevalence and risk factors for human papillomavirus infection among Chinese ethnic women in southern of Yunnan, China

ABSTRACT Background: Dai is a major Chinese ethnic minority group residing in rural areas of the southern part of Yunnan. However, no data exist on the Human Papillomavirus (HPV) prevalence and genotype distribution among Dai women. Method: A total of 793 participants (Dai = 324, Han = 251, other ethnic = 218) were included in this study. PCR was performed to detect the HPV-positive samples, and genotyping was performed with an HPV Geno-Array. Result: The overall HPV prevalence was very low among Dai women compared to the others. The prevalence of high-risk-HPV infections was significantly higher (p = 0.001) among other ethnic women (22.0%) than that among Han (13.1%) and Dai women (7.1%). The overall HPV, high-risk-HPV, single and multiple infection prevalence among rural women were 12.9%, 12.1%, 12.3%, and 0.5%, respectively. HPV-16 (5.5%) was shown to be the most prevalent genotype, followed by HPV-52 (2.6%) and HPV-58 (2.4%). Urban women had relatively higher rates of overall HPV (16.0%), high-risk-HPV (14.1%), single genotype (11.9%), and multiple genotype (4.1%) infections. In urban women, HPV-52 (3.6%) was the most prevalent genotype, followed by HPV-39 (2.7%) and HPV-16 (1.2%). In the urban area, HPV prevalence was highest in women aged <29 years, but declined with increasing age. However, in rural women, the highest HPV prevalence was observed among women at older age (>50 years). Education and smoking habit were significantly associated with HPV infection among both rural and urban area women (p < 0.001). Conclusion: The prevalence and genotype distribution of HPV varied among ethnic women in urban and rural area of Yunnan Province.

Representações sociais das adolescentes acerca da vacinação contra o HPV: repercussões na adesão à profilaxia / Social representations of adolescents about HPV vaccination: repercussions on adherence to prophylaxis

Esta pesquisa teve como objeto de estudo: "os saberes e as práticas das adolescentes frente à vacinação contra o HPV" e utilizou a teoria as Representações Sociais. Foram delineados os seguintes objetivos: Identificar o entendimento que as adolescentes têm acerca do HPV; Acessar os conteúdos que organizam as representações sociais das adolescentes sobre a vacinação contra o HPV; Analisar as aproximações e distanciamentos entre as representações sociais produzidas pelas adolescentes que aderiram e não aderiram à vacinação contra o HPV e Discutir as implicações dessas representações nas atitudes/tomadas de decisões frente à vacinação contra o HPV. Para o alcance dos objetivos foi realizado um estudo descritivo com abordagem qualitativa, utilizando a Representação Social (RS) não somente enquanto teoria, mas também como método, baseado na vertente processual. Os cenários foram dois colégios públicos da cidade do Rio de Janeiro, com 29 participantes adolescentes, entre 10 a 19 anos. Os aspectos éticos foram cumpridos baseados na Resolução no 466/2012. O Projeto foi aprovado pelo Comitê de Ética em Pesquisa da EEAN/HESFA/UFRJ sob o número 1.083.743 e CAAE: 4414.1515.0.0000.5238. As técnicas de coleta de dados e sua organização para a análise: Teste de Associação Livre de Idéias (ALI), com a aplicação da técnica de análise de conteúdo temático de Bardin; instrumento para traçar o perfil sociodemográfico, tratado por meio estatístico; e entrevista individual semi-estruturada, submetida ao software IRAMUTEQ®, para a análise estatística de fontes textuais, que obteve como aproveitamento total 77,97%, representando um bom rendimento. Emergiram dois blocos temáticos sendo o primeiro denominado: Imagens sociais do HPV, quando discute a Classe 1: Explicando os meios de transmissibilidade e prevenção do HPV e a Classe 4: Conteúdos e saberes acerca do HPV, o segundo bloco intitulado: Sentidos e práticas da vacinação contra o HPV, que discute a Classe 5: Meios de circulação da informação sobre a vacinação; a Classe 3: A vacinação contra o HPV: saberes sociais; e a Classe 2: Dimensão atitudinal frente à vacinação do HPV Partindo das representações sociais constituídas pelas adolescentes vacinadas e não vacinadas do estudo. Os resultados demonstram que as representações que as entrevistadas têm acerca da vacinação contra o HPV, ilustram conteúdos e sentidos que emergem de seu meio social quando buscam explicar e compreender as formas de contaminação e prevenção do HPV. As mesmas indicam que as informações circulantes advêm da família, colégio e amigas, além da mídia. A representação da vacinação e trazida na percepção, da prevenção da doença, e nos questionamentos sobre a oferta vacinal. A dimensão atitudinal é posta mediante suporte dos pais, para as que foram vacinadas, e para as que não foram na não adesão por não se verem representadas. Desta maneira percebe-se a necessidade de atenção pelos governantes, enquanto políticas públicas, nas estratégias e abordagens da população de adolescentes, compreendendo as suas questões sobre a infecção e vacina, como também, no apoio escolar, da família e comunidade, referente às orientações, esclarecimentos e estimulo objetivando uma maior adesão à vacinação contra o HPV.

This research had as its object of study: "the knowledge and practices of adolescents regarding vaccination against HPV" and used the Social Representations theory. The following objectives were outlined: To identify the adolescents' understanding of HPV; Access the content that organizes the adolescents' social representations about HPV vaccination; Analyze the approximations and distances between the social representations produced by the adolescents who adhered and did not adhere to the HPV vaccination and Discuss the implications of these representations in the attitudes / decision-making regarding the HPV vaccination. To achieve the objectives, a descriptive study with a qualitative approach was carried out, using Social Representation (RS) not only as a theory, but also as a method, based on the procedural aspect. The scenarios were two public schools in the city of Rio de Janeiro, with 29 adolescent participants, between 10 and 19 years old. Ethical aspects were met based on Resolution 466/2012. The Project was approved by the Research Ethics Committee of EEAN/HESFA/UFRJ under number 1.083.743 and CAAE: 4414.1515.0.0000.5238. The techniques of data collection and their organization for analysis: Free Association of Ideas Test (ALI), with the application of Bardin's thematic content analysis technique; instrument to trace the sociodemographic profile, treated by statistical means; and semi-structured individual interview, submitted to the IRAMUTEQ® software, for the statistical analysis of textual sources, which obtained a total utilization of 77.97%, representing a good performance. Two thematic blocks emerged, the first being named: Social images of HPV, when discussing Class 1: Explaining the means of transmissibility and prevention of HPV and Class 4: Contents and knowledge about HPV, the second block entitled: Senses and practices of HPV vaccination, which discusses Class 5: Means of circulating vaccination information; Class 3: HPV vaccination: social knowledge; and Class 2: Attitudinal dimension towards HPV vaccination Based on the social representations of the vaccinated and unvaccinated adolescents in the study. The results demonstrate that the representations that the interviewees have about HPV vaccination, illustrate contents and meanings that emerge from their social environment when they seek to explain and understand the forms of HPV contamination and prevention. They indicate that the circulating information comes from family, school and friends, in addition to the media. The representation of vaccination is brought about in the perception, in the prevention of the disease, and in the questions about the vaccine offer. The attitudinal dimension is supported by parents, for those who have been vaccinated, and for those who have not been in non- adherence because they are not represented. In this way, it is perceived the need for attention by government officials, as public policies, in the strategies and approaches of the adolescent population, understanding their questions about the infection and vaccine, as well as in school, family and community support, regarding the guidelines, clarifications and stimulation aiming at greater adherence to HPV vaccination.

Esta investigación tuvo como objeto de estudio: "los conocimientos y prácticas de los adolescentes sobre la vacunación contra el VPH" y utilizó la teoría de las Representaciones Sociales. Se delinearon los siguientes objetivos: Identificar la comprensión de los adolescentes sobre el VPH; Acceder al contenido que organiza las representaciones sociales de los adolescentes sobre la vacunación contra el VPH; Analizar las aproximaciones y distancias entre las representaciones sociales producidas por los adolescentes adheridos y no adheridos a la vacunación contra el VPH y Discutir las implicaciones de estas representaciones en las actitudes / toma de decisiones respecto a la vacunación contra el VPH. Para lograr los objetivos se realizó un estudio descriptivo con enfoque cualitativo, utilizando la Representación Social (RS) no solo como teoría, sino también como método, a partir del aspecto procedimental. Los escenarios fueron dos escuelas públicas de la ciudad de Río de Janeiro, con 29 participantes adolescentes, entre 10 y 19 años. Los aspectos éticos se cumplieron en base a la Resolución 466/2012. El Proyecto fue aprobado por el Comité de Ética en Investigación de EEAN/HESFA/UFRJ con el número 1.083.743 y CAAE: 4414.1515.0.0000.5238. Las técnicas de recolección de datos y su organización para el análisis: Prueba de Asociación Libre de Ideas (ALI), con la aplicación de la técnica de análisis de contenido temático de Bardin; instrumento para trazar el perfil sociodemográfico, tratado por medios estadísticos; y entrevista individual semiestructurada, sometida al software IRAMUTEQ®, para el análisis estadístico de fuentes textuales, que obtuvo una utilización total del 77,97%, lo que representa un buen desempeño. Surgieron dos bloques temáticos, el primero se nombró: Imágenes sociales del VPH, al discutir la Clase 1: Explicando los medios de transmisibilidad y prevención del VPH y la Clase 4: Contenidos y conocimientos sobre el VPH, el segundo bloque titulado: Sentidos y prácticas de Vacunación contra el VPH, que trata sobre la Clase 5: Medios de hacer circular la información sobre vacunación; Clase 3: Vacunación contra el VPH: conocimiento social; y Clase 2: Dimensión actitudinal hacia la vacunación contra el VPH Basado en las representaciones sociales de los adolescentes vacunados y no vacunados del estudio. Los resultados demuestran que las representaciones que los entrevistados tienen sobre la vacunación contra el VPH, ilustran contenidos y significados que emergen de su entorno social cuando buscan explicar y comprender las formas de contaminación y prevención del VPH. Indican que la información que circula proviene de familiares, colegio y amigos, además de los medios de comunicación. La representación de la vacunación se produce en la percepción, en la prevención de la enfermedad y en las preguntas sobre la oferta de vacunas. La dimensión actitudinal es apoyada por los padres, por las que se han vacunado y por las que no han estado en incumplimiento por no estar representadas. De esta manera, se percibe la necesidad de atención por parte de los funcionarios de gobierno, como políticas públicas, en las estrategias y enfoques de la población adolescente, entendiendo sus interrogantes sobre la infección y vacuna, así como en el apoyo escolar, familiar y comunitario, en cuanto a los lineamientos. , aclaraciones y estímulos para lograr una mayor adherencia a la vacunación contra el VPH.

Análise do exame citopatológico e captura híbrida em mulheres atendidas em unidades básicas de saúde / Analysis of cytopathologic examination and hybrid capture in women receiving care in basic health units

Cervical cancer is one of the most frequent cancers among Brazilian women and its relationship with the human papillomavirus (HPV) is well established. Objective: To analyze the presence of DNA/HPV using Hybrid Capture method for women in the city of Uruguaiana (RS). Methods: During the period of January to December 2015, 51 cervicovaginal samples were collected from patients who sought care at Basic Health Units in the city. After the collection, conventional and liquid-based cytological analysis was performed. Results: The results of the study indicate the prevalence of genital HPV infection in 5.9% of the samples; low-risk DNA/HPV was detected in 3.9% of patients of reproductive age (PIR); and 2.0% of PIR presented highrisk DNA/HPV. By stratifying the prevalence of HPV in age, we found positivity between 16 and 31 years. Conclusion: Conventional cytology is often inconclusive and, in such cases, using molecular biology methods that detect the DNA/HPV presence would be very useful.

O câncer de colo de útero é um dos mais frequentes entre as mulheres brasileiras e a sua relação com o Papilomavírus Humano (HPV) é bem estabelecida. Objetivo: Analisar a presença de DNA/HPV por meio do método de captura híbrida em mulheres no município de Uruguaiana (RS). Métodos: No período compreendido entre janeiro e dezembro de 2015, foram coletadas 51 amostras cervicovaginais de pacientes que buscaram atendimento nas Unidades Básicas de Saúde do município. Após a coleta, foi realizada a análise citológica convencional e em base líquida. Resultados: Os resultados encontrados no estudo indicam a prevalência de infecção genital por HPV em 5,9% das amostras analisadas, sendo DNA/HPV de baixo risco em 3,9% e DNA/HPV de alto risco em 2,0% das infecções. Ao estratificar a prevalência de HPV por faixa etária, observou-se positividade entre 16 e 31 anos. Conclusão: A citologia convencional pode ser, muitas vezes, inconclusiva e, nesses casos, utilizar uma metodologia de biologia molecular que detecte a presença do DNA/HPV seria muito útil.

Bonafide, type-specific human papillomavirus persistence among HIV-positive pregnant women: predictive value for cytological abnormalities, a longitudinal cohort study

This study investigated the rate of human papillomavirus (HPV) persistence, associated risk factors, and predictors of cytological alteration outcomes in a cohort of human immunodeficiency virus-infected pregnant women over an 18-month period. HPV was typed through L1 gene sequencing in cervical smears collected during gestation and at 12 months after delivery. Outcomes were defined as nonpersistence (clearance of the HPV in the 2nd sample), re-infection (detection of different types of HPV in the 2 samples), and type-specific HPV persistence (the same HPV type found in both samples). An unfavourable cytological outcome was considered when the second exam showed progression to squamous intraepithelial lesion or high squamous intraepithelial lesion. Ninety patients were studied. HPV DNA persistence occurred in 50% of the cases composed of type-specific persistence (30%) or re-infection (20%). A low CD4+T-cell count at entry was a risk factor for type-specific, re-infection, or HPV DNA persistence. The odds ratio (OR) was almost three times higher in the type-specific group when compared with the re-infection group (OR = 2.8; 95% confidence interval: 0.43-22.79). Our findings show that bonafide (type-specific) HPV persistence is a stronger predictor for the development of cytological abnormalities, highlighting the need for HPV typing as opposed to HPV DNA testing in the clinical setting.

Cervical human papillomavirus infection and persistence: a clinic-based study in the countryside from South Brazil

Abstract Human papillomavirus (HPV) infection is common in sexually active women and viral persistence may cause intraepithelial lesions and eventually progress to cervical cancer (CC). The present study aimed to investigate epidemiological factors related to HPV infection and to evaluate viral persistence and CC precursor lesions frequencies in women from a city in the countryside of South Brazil. Three hundred women were recruited from a primary public health care clinic. The patients were interviewed and underwent sampling with cervical brushes for HPV-DNA detection/typing by a PCR-based assay and cytological analysis by Pap smear test. HPV was detected in 47 (15.7%) women. HPV infection was significantly associated with young age (<30 years) and low socio-economic status. Seventeen (5.7%) women presented cytological abnormalities, three of them with precursor CC intraepithelial lesions. A subgroup of 79 women had been previously analyzed and thirteen (16.4%) were persistently infected, two with precursor CC intraepithelial lesions and high-risk HPV types infection (both of them without cervical abnormalities in the first exam). In conclusion, HPV infection was associated with young age (<30 years) and low family income; viral persistence was low (16.4%) but related to CC precursor lesions; and HPV-DNA high risk types detection would help to screen CC in the population.

Prevalência de atipias citológicas e infecção pelo papilomavírus humano de alto risco em mulheres indígenas Panará, povo indígena do Brasil Central / Prevalence of cytological atypia and high-risk human papillomavirus infection in Panará indigenous women in Central Brazil / Prevalencia de atipias citológicas e infección por el virus del papiloma humano de alto riesgo en mujeres indígenas Panará, pueblo indígena de Brasil Central

O objetivo do estudo foi analisar a prevalência das atipias citológicas e infecção pelo papilomavírus humano em mulheres indígenas Panará no período de 2006 a 2007. Trata-se de estudo observacional transversal, com dados obtidos por coleta de amostras cérvico-vaginais para colpocitologia oncótica e captura híbrida, exame de colposcopia e biópsia. O trabalho incluiu 86 mulheres com idades de 12 anos ou mais, com história de vida sexual ativa ou pregressa. Os resultados mostraram que 10,7% das mulheres tinham atipias citológicas e que 28,6% estavam infectadas pelo HPV de alto risco oncogênico, principalmente entre as mais jovens (média = 25,6 anos). Dessas, 41,7% foram positivas para um ou mais dos tipos de HPV de alto risco dos genótipos 16, 18 ou 45, e a maioria, 58,3%, para outros tipos de HPV de alto risco. Conclui-se que é uma população especial, susceptível ao desenvolvimento das lesões precursoras do câncer do colo do útero e vulnerável às DST. Medidas preventivas como o rastreamento populacional sistemático para o câncer cervical e imunização contra o HPV são necessárias.

The aim of this study was to analyze the prevalence of cytological atypia and human papillomavirus infection in Panará indigenous women in 2006-2007. This was a cross-sectional observational study with data obtained from vaginal cervical samples for Pap smear and hybrid capture, colposcopy, and biopsy. The study included 86 females 12 years or older with a history of sexual activity. 10.7% of the women were diagnosed with cytological atypia and 28.6% were infected with high-risk HPV genotypes, which were more common among young women (mean = 25.6 years). Of these, 41.7% were positive for high-risk HPV genotypes 16 and/or 18 and/or 45, and the majority (58.3%) for other high-risk HPV genotypes. The study concludes that this group of indigenous women constitutes a special population, susceptible to develop precursor lesions for cervical cancer and vulnerable to STDs. Preventive measures are required, such as systematic cervical cancer screening and HPV immunization.

El objetivo del estudio fue analizar la prevalencia de atipias citológicas y la infección por el virus del papiloma humano en mujeres indígenas, Panará, durante el periodo 2006-2007. Se trata de estudio observacional, transversal, descriptivo, con datos obtenidos de la recogida de muestras cervicovaginales para examen de Papanicolaou y captura híbrida, además del examen de colposcopia y biopsia. El estudio incluyó a 86 mujeres de 12 años o mayores con antecedentes de actividad sexual actual o pasada. Los resultados mostraron una prevalencia de un 10,7% en mujeres con atipias citológicas y un 28,6% de infección por VPH de alto riesgo, particularmente entre las mujeres jóvenes (promedio 26,5 años). De estas, un 41,7% fueron positivas en uno o más de los tipos de VPH de alto riesgo (16/18/45) y un 58,3% en otros tipos de VPH de alto riesgo. Llegamos a la conclusión de que es una población particularmente susceptible al desarrollo de lesiones precursoras del cáncer de cuello de útero y, por ello, se requieren medidas preventivas como: pruebas de Papanicolaou de forma sistemática y campañas de vacunación.

Determinacao da prevalencia de HPV em amostras de mucosa oral/orofaringea em um distrito rural de Sao Paulo / Determination of HPV prevalence in oral/oropharyngeal mucosa samples in a rural district of Sao Paulo

OBJETIVO: Averiguar a eficácia da metodologia para coleta de amostras em cavidade oral e orofaringe e determinar a prevalência do HPV na cavidade oral e orofaringe de adultos e crianças. MÉTODO: A população estudada foi atendida por um programa assistencial em um distrito rural de São Paulo. Os indivíduos foram convidados a doar amostras independentemente de queixas. RESULTADOS E CONCLUSÃO: Foram incluídos no estudo 47 homens, 77 mulheres e 22 crianças, dos quais amostras da cavidade oral foram obtidas por bochecho e gargarejo com antisséptico oral comercial. Foram encontrados três resultados positivos (2,4%) em adultos, duas amostras de HPV 55 e uma amostra de HPV 58. Não foram observados resultados positivos em crianças. Além disso, concluímos que o método de coleta com o enxágue bucal com antisséptico mostrou-se eficaz e rápido para a detecção de HPV na cavidade oral e orofaríngea na população geral. .

Knowledge about HPV infection in the oral cavity/oropharynx may contribute to the elucidation of the role it plays in Head and Neck Squamous Cell Carcinoma (HNSCC). OBJECTIVE: To determine the effectiveness of the methodology used for sampling the oral cavity and oropharynx mucosae and to determine the prevalence of HPV in the oral cavity and oropharynx of adults and children. METHOD: The study population was served by an assistance program in a rural district of São Paulo. The subjects were asked to donate samples regardless of complaints. RESULTS AND CONCLUSION: The study included 47 men, 77 women and 22 children, of which the oral cavity samples were obtained by gargling with commercially-available antiseptic mouthwash. We found 3 positive samples (2.4%) in adults: 2 HPV 55 and one HPV 58. No positive results were found in children. Furthermore we concluded that the sampling method with the mouthwash proved effective and fast for the detection of HPV in the oral cavity and oropharynx in the general population. .

Aceptabilidad y conocimientos sobre la vacunación contra el virus del papiloma humano (VPH) en médicos ginecólogos de la Argentina

OBJETIVO: Evaluar entre los ginecólogos argentinos la aceptabilidad y prescripción de la vacuna contra el virus del papiloma humano (VPH), los conocimientos sobre sus características y uso, y las nociones médico-biológicas sobre infección por VPH y cáncer cervicouterino. MATERIAL Y MÉTODOS: Entre noviembre de 2009 y marzo de 2010 se encuestaron a 686 ginecólogos vía internet. RESULTADOS: Más de 80% de los encuestados prescribe la vacuna, conoce sus características y administración, y considera la necesidad de continuar con el tamizaje cervical en mujeres vacunadas. El 37% posee un conocimiento global de la relación entre vacuna y detección/tratamiento de la patología cervical. De los encuestados, 25% subestima la magnitud de la infección, ≈30% no reconoce el rol etiológico del VPH en la enfermedad, y ≈40% posee un conocimiento global del manejo de la infección. CONCLUSIONES: La aceptabilidad de la vacuna contra el VPH es alta. Debe reforzarse la capacitación de los profesionales sobre vacunación y patología cervical, así como las nociones médico-biológicas sobre infección por VPH y cáncer cervicouterino.

OBJECTIVE: To evaluate HPV vaccine acceptability and prescription; knowledge about HPV vaccine; and knowledge about HPV infection and cervical cancer among Argentinean gynecologists. MATERIALS AND METHODS: Between November 2009 and March 2010 we carried out an internet survey of 686 gynecologists. RESULTS: More than 80% of gynecologists prescribed HPV vaccine, knew characteristics of HPV vaccines, and knew that women will still need regular cervical cancer screening after HPV vaccination; 37% had global knowledge about relationship between vaccine, detection and treatment of cervical cancer; 25% underestimated the epidemiological extent of HPV infections, ≈30% was not aware of the causative relationship between HPV infection and cervical cancer and ≈40% had global knowledge about management of HPV infection. CONCLUSIONS: HPV vaccine acceptability is high. Physicians need to be fully informed on HPV vaccination and cervical cancer as well as HPV infection management.

Clinical and laboratorial study of HPV infection in men infected with HIV

OBJECTIVES: To determine the prevalence of precursor lesions of penile cancer, to establish the concordance of diagnostic techniques (PCR, Hybrid Capture (HC) and peniscopy with acetic acid 5%) in the diagnosis of Human Papilloma Virus (HPV) of the penis of men infected with HIV and to evaluate the influence of the immune status. PATIENTS, METHODS AND RESULTS: 276 men were studied, with a median age of 34.6 years. Prevalence of High Risk HPV, Low Risk HPV and infection with both, according to HC, was 43%, 32% and 22%, respectively. PCR showed 50% of positivity for HPV DNA. Peniscopy was positive in 27% of individuals. Peniscopy showed good specificity and low sensitivity for the detection of penile HPV, and low concordance with PCR. Men with white lesions had a 3.6 higher relative risk of positivity for HPV. The most common clinical lesion observed was vegetation, identified in 29% of patients. PCR and HC techniques showed high sensitivity for HPV DNA and there was an excellent correlation between them. Immunosuppressed individuals with CD4< 200 cells/mm3 had the highest prevalence of pre-malignant lesions that were observed in 10% of the studied individuals. CONCLUSIONS: Peniscopy was important for identification and treatment of subclinical lesions. PCR and HC techniques were sensitive methods for the detection of HPV DNA with high concordance. Severely immunosuppressed individuals showed a higher prevalence of pre-malignant lesions of the penis.

Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women

OBJECTIVES: To evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN) among HIV-infected women. METHODS: Cross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors. RESULTS: CIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1). Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5-10.1), with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2-3.5), and with age < 34 years old (OR 1.5, 95% CI 1.0-2.4). HIV viral load and antiretroviral use were not independent risk factors for CIN. CONCLUSIONS: Severity of immunosupression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women.

Avaliação de métodos diagnósticos, morfológicos e biomoleculares em mulheres encaminhadas com citologia alterada / The diagnostic efficacy of morphologic and molecular methods in women with abnormal citology

Introdução: o câncer do colo uterino é a neoplasia mais frequente em mulheres de países em desenvolvimento. Doença causada pela infecção persistente com diferentes tipos de papilomavírus humano (HPV) classificados em baixo e alto risco, de acordo com o potencial oncogênico. Objetivo: em mulheres com diagnóstico citopatológico anormal por ocasião de exame de rastreamento do câncer cervical, encaminhadas por diferentes postos de atendimento do Sistema Único de Saúde para serviço universitário de referência e com diagnóstico definitivo de lesão intraepitelial de alto grau ou câncer cervical, avaliara eficácia diagnóstica de métodos morfológicos e biomoleculares utilizados de maneira isolada ou em associação; e a prevalência, estratificada em duasfaixas etárias, abaixo de 30 e igual ou superior a 30 anos, do HPV tipos 16, 18 e 45. Métodos: estudaram-se 167 mulheres encaminhadas ao Ambulatório de Patologia Cervical e Colposcopia do Hospital Universitário da Universidade Federal de Juiz de Fora, no período de novembro de 2002 e dezembro de 2003,com colo uterino íntegro, não grávidas e sem história de câncer no trato genital inferior. Coletaram-se, de todas as mulheres, amostras para estudo citológico,convencional e em meio líquido, e para os testes de DNA-HPV. Considerou-se como diagnóstico histopatológico final a avaliação mais grave dentre ospossíveis espécimes, biópsia, conização ou peça cirúrgica, que a paciente pudesse ter. Resultados: não há qualquer diferença no tocante à sensibilidade,ao valor preditivo positivo e negativo e à acurácia dentre os métodos diagnósticos estudados, porém a associação da citologia com o teste DNA-HPV tem menor especificidade que o exame citológico isolado, quer convencional ou em meio líquido. A prevalência do HPV 16, 18 e 45 cai de 88,9% para 50,0%nas mulheres com 30 anos ou mais (p = 0,02). Conclusão: nas mulheres encaminhadas ao ambulatório de PTGIC do HU-UFJF com colpocitologia alteradanão se justifica a realização de qualquer exame confirmatório, devendo realizar-se imediatamente a colposcopia para se ter o desfecho diagnóstico.

Introduction: cervical cancer is the most frequent neoplasia among the women of countries in development. Great part of these cases is caused by persistent infection with different types of human papilomavirus (HPV) classified as low and high risk, according to the risk of cervical cancer development. Objectives:based on women with abnormal cytology when screening for cervical cancer who were led from different units of the Public Health System to the reference university service and with a definite diagnosis of high cervical intraepithelial neoplasia or cancer, was to evaluate the diagnostic efficacy of morphologicand molecular methods used alone or together and the prevalence of HPV types 16, 18, 45, stratified into two age brackets. Methods: 167 women went to the Cervical Pathology and colposcopy clinic of the University Hospital of the Universidade Federal de Juiz de Fora, during the period from November 2002 to December 2003, with intact uterine cervix, not pregnant and without previous chemical and/or radiotherapy treatment for the inferior genital tract.Samples for cytology study were collected from all women, with conventional and liquid-based preparations, for CH2 for high risk virus, for DNA PAP andfor Probe Pack test. The worst histologic diagnosis among the possible histologic studies through biopsy, conization or cirurgic pieces was considered as "gold standard". Results: there is no difference regarding sensibility, positive predict value and negative predict value for all methods studied, However, the DNA PAP method has less specificities than the citology exam, either with conventional or based-liquid preparation. The prevalence of HPV 16, 18, 45 decreases from 88,9% to 50% in women of 30 years old or more, being this decrease statistically significant. Conclusion: in those women led to the PTGIC of the HUUFJF with abnormal cytology it is not necessary to repeat any tests, just colposcopy in order to reach the final diagnosis.

Nuevos paradigmas y desafíos en la prevención y control del cáncer de cuello uterino en América Latina / New paradigms and challenges in cervical cancer prevention and control in Latin America

El cáncer de cuello uterino sigue siendo un problema de salud pública en Latinoamérica. El uso de la citología para la detección de lesiones pre-cancerosas no ha tenido mayor impacto en las tasas de incidencia y mortalidad, que aún se mantienen altas en la región. La disponibilidad de nuevas técnicas de tamizaje para la detección de lesiones pre-cancerosas y de vacunas altamente eficaces que previenen casi todas las lesiones relacionadas con VPH-16 y VPH-18 en mujeres no expuestas previamente al virus representan una gran oportunidad para la prevención del cáncer de cuello uterino en la región. En este manuscrito resumimos la evidencia científica y la experiencia de la región en i) el uso de pruebas de VPH y de la inspección visual después del ácido acético (IVAA) en tamizaje primario, y ii) la implementación de programas de vacunación en adolescentes. Finalmente enumeramos una serie de recomendaciones adecuadas para distintos escenarios. La factibilidad de implementar un programa nacional de prevención de cáncer de cuello uterino exitoso y sostenible en países latinoamericanos dependerá de las prioridades de salud, la infraestructura y personal de salud disponible, determinadas luego de un riguroso análisis situacional local.

Cervical cancer continues to be a significant health problem in Latin America. The use of conventional cytology to detect precancerous cervical lesions has had almost no major impact on reducing cervical cancer incidence and mortality rates, which are still high in the region. The availability of new screening tools to detect precancerous lesions provide great opportunities for cervical cancer prevention in the region, as do highly efficacious HPV vaccines able to prevent nearly all lesions associated with HPV-16 and -18 when applied before viral exposure. This paper summarizes the scientific evidence and regional experiences related to: i) the use of HPV testing and visual inspection after the application of acetic acid (VIA) in primary screening and ii) the implementation of adolescent HPV vaccination programs. Finally, we outline a number of recommendations for different resource settings. The feasibility of implementing successful and sustainable national cervical cancer prevention programs in Latin American countries in the region will depend on health priorities and the availability of infrastructure and health personnel-as determined by rigorous local situational analysis.

Risk factors associated with human papillomavirus infection in two populations from Rio de Janeiro, Brazil

We investigated human papillomavirus (HPV) infection in two female populations from diverse socio-economic strata from the state of Rio de Janeiro and we also investigated the possible co-factors related to infection and the progression to cancer. In Group I, the reference group of this study, 10.7 percent of the patients presented HPV infection, as detected by generic PCR, while in Group II (low socio-demographic conditions) HPV was detected in 31.1 percent of the samples. HPV16 was the most prevalent virus type found in both Groups I and II (5.3 percent and 10 percent, respectively), followed by HPV 18 (1.3 percent and 4.7 percent, respectively). Although only a small sample was analysed, we detected differences among the groups regarding the rates of HPV infection, HPV types, age, ethnicity, familial income, schooling, marital status, parity, tobacco smoking and oral contraceptive use. For Group I, the Papanicolaou test was the most powerful independent factor associated with HPV status, followed by an age of under 30 years old, the number of sexual partners and black ethnicity. Our data are in agreement with the co-factors that are typically described for the developed world. For Group II, the Pap test was also the most relevant variable that was analysed, but the history of other sexually transmitted diseases and the use of alcohol were additional factors that were implicated in infection. These findings point out the need for the development of general and specific strategies for HPV screening of all Brazilian women.

Frequency and types of human papillomavirus among pregnant and non-pregnant women with human immunodeficiency virus infection in Recife determined by genotyping

Women with human immunodeficiency virus (HIV) infection present a higher risk of infection by the human papillomavirus (HPV) and cervical cancer. To determine HPV genotypes and frequencies among HIV-positive women, an analytical cross-sectional study was carried out on 147 women (51 were pregnant and HIV-positive, 45 pregnant and HIV-negative and 51 HIV-positive and not pregnant), who were attended at a maternity hospital in Recife between April 2006-May 2007. They answered a questionnaire and underwent a gynaecological examination, with samples collected for HPV investigation by PCR, hybrid capture II, oncotic colpocytology (Papanicolau) and colposcopy. The frequency of HPV DNA was 85.3 percent (122/143), with a high proportion of HPV types that have been identified as high risk for cervical cancer. Among HIV-positive pregnant women, there was an HPV prevalence of 96 percent (48/50), of whom 60.4 percent (29/48) were high-risk. HPV 16, 58, 18, 66 and 31 were the most frequent types. Colpocytological abnormalities were observed in 35.3 percent (18/51) of HIV-positive non-pregnant women, 21.6 percent (11/51) of HIV-positive pregnant women and 13.3 percent (6/45) of HIV-negative pregnant women with a predominance of low-level lesions. A high prevalence of HPV infection was identified, especially with the high-risk types 16, 58, 18 and 66. This study identified high-risk HPV types in all three groups examined (HIV-positive pregnant women, HIV-negative pregnant women and HIV-positive not pregnant), characterising its distribution in this setting.

The environmental cofactors in carcinogenesis in high risk HPV/HIV-positive women

The objective of the present study was to assess the presence of human papilloma virus (HPV) in HIV-infected women, with comparison between the Papanicolaou cytologic technique and the molecular PCR technique, as well as to determine the type of HPV, to measure cellular immunocompetence and to identify the presence of risk factors for the acquisition of HPV infection. Thirty HIV-infected women were selected. Vaginal and endocervical samples were collected from 27 of them. The smears were examined by 3 experienced cytologists to diagnose the presence of HPV by the Papanicolaou technique and the results were compared to HPV detection and typing by PCR. HPV-infected patients were interviewed in order to identify the presence of risk factors for the acquisition of the virus. Eight of the 27 patients analyzed (29 percent) presented HPV in endocervical samples submitted to PCR, 6 of them (75 percent) presented HPV involving a high risk of development of cervical cancer. For 5 of these patients, the cytologic diagnosis was not confirmed by PCR. When cellular immunocompetence was related to HPV infection, PCR revealed a diagnosis of HPV in 37.50 percent of the patients at intermediate risk for HPV infection and in 83.33 percent of the patients at high risk for HPV infection. These immunologically compromised HPV-infected patients are at higher risk of developing cervical neoplasia. We showed here that PCR is adequate for HPV detection and that, if only the Papanicolaou method is used for the follow-up of these patients, we will not provide good prevention of cervical cancer.

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...