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.

A pilot study on the identification of human papillomavirus genotypes in tongue cancer samples from a single institution in Ecuador

The relationship between human papillomavirus (HPV) and oropharyngeal squamous cell carcinoma has been established. However, data from Ecuador is limited. The objective of this study was to characterize HPV infection in Ecuadorian patients with tongue cancer. Fifty-three patients with tongue cancer treated at the tertiary referral center Sociedad de Lucha Contra el Cancer (SOLCA), Guayaquil, between 2006 and 2011 were identified. Linear Array® HPV genotyping was used to identify the presence and types of HPV on formalin-fixed paraffin-embedded biopsy samples from these patients with tongue cancer. HPV was identified in 42% (n=22) and high-risk (HR) HPV in 17% (n=9), with 18 different HPV types identified. The most common types were the HR HPV 33 (14%) and low-risk HPV 67 (14%), followed by the HR HPV 58. More than one HPV type was identified in 27.3% of cases. HPV 33 was frequently associated with other HPV types. No statistically significant differences in gender (P=0.58) and age (P=0.12) were observed between HPV-positive and HPV-negative cases. HPV was identified in almost half of the tongue cancer samples, with subtypes 33 and 67 being the most common. This suggested that HPV played an important role in this disease in the population studied. Given these results, current HPV vaccines may not be as effective in reducing tongue cancer rates in this population.

Human papillomavirus type distribution and HPV16 intratype diversity in southern Brazil in women with and without cervical lesions

BACKGROUND Increasing evidence suggests that human papillomavirus (HPV) intratype variants (specific lineages and sublineages) are associated with pathogenesis and progression from HPV infection to persistence and the development of cervical cancer. OBJECTIVES This study aimed to verify the prevalence of HPV infection and distribution of HPV types and HPV16 variants in southern Brazil in women with normal cytology or intraepithelial lesions. METHODS HPV typing was determined by L1 gene sequencing. To identify HPV16 variants, the LCR and E6 regions were sequenced, and characteristic single nucleotide variants were identified. FINDINGS A total of 445 samples were studied, with 355 from cervical scrapes and 90 from cervical biopsies. HPV was detected in 24% and 91% of these samples, respectively. The most prevalent HPV types observed were 16 (cervical, 24%; biopsies, 57%) and 58 (cervical, 12%; biopsies, 12%). Seventy-five percent of the HPV16-positive samples were classified into lineages, with 88% defined as lineage A, 10% as lineage D, and 2% as lineage B. MAIN CONCLUSIONS This study identified a high frequency of European and North American HPV16 lineages, consistent with the genetic background of the human population in southern Brazil.

Papillomavirus infections in the oral and genital mucosa of asymptomatic women

Abstract Human papillomavirus (HPV) has been found in several regions of the body, including the oral cavity. Recently, this virus has been associated with oropharyngeal cancer, but little is known about HPV transmission to the oral cavity. We carried out a study to investigate concurrent oral and cervical infections in 76 asymptomatic women attending a healthcare program. Demographic and behavior data were obtained through a structured questionnaire. Oral and cervical mucosa scrapings were collected and stored for DNA extraction. HPV DNA amplification was performed by polymerase chain reaction assay (PCR) using both primers My09/My11 and FAP59/64, followed by HPV typing with restriction fragment length polymorphism analysis (RFLP) and sequencing. The data collected revealed no risk factors for HPV infection in these 76 women. HPV prevalence of 9.2 and 5.3% was found in cervical and oral mucosa, respectively. Concurrent infections by discordant types were detected in one case only. Sequencing procedures allowed us to detect a new putative HPV 17 subtype from the Betapapillomavirus genus. Our results support the view that cervical and oral HPV infections are independent events. The observed low prevalence of both oral and cervical HPV infections could be associated with attendance in a healthcare program.

Higher prevalence and gene amplification of HPV16 in oropharynx as compared to oral cavity

ABSTRACT Objective The objective of this study was to clarify differences regarding HPV16 infection and gene amplification between the oral cavity and oropharynx in healthy individuals. Material and Methods The subjects were 94 healthy asymptomatic individuals (41 males, 53 females; mean age 58.6 years, range 16-97 years) who visited the Department of Oral and Maxillofacial Reconstructive Surgery of the Hiroshima University Hospital from 2014 to 2015. Oral epithelial cells were collected from oral rinse and pharynx gargle samples and placed in saline. The human endogenous retrovirus gene ERV3-1 was used as a reference to estimate the number of human cells in each sample. DNA samples were extracted from approximately 10,000 human cells and tested for HPV16 DNA by PCR using a type-specific primer. Similarly, we analyzed the HPV16 viral copy number in HPV16-positive cases using real-time PCR to examine genomic amplification. Results The percentage of HPV16-positive cases was higher in the gargle (28.7%) as compared to the rinse (16.0%) samples. In the oral rinse samples, males (26.8%) showed a significantly higher rate of HPV16 than females (7.5%) (P=0.021). Importantly, in older subjects (aged 60-89 years), gargle samples showed a significantly higher rate of HPV16 (33.3%) than oral rinse samples (13.7%) (P=0.034). The average number of viral copies was approximately 8 times higher in the gargle than in the oral rinse samples (0.16±0.27 vs. 1.35±1.26 copy numbers per cell), a significant difference (P<0.001). Conclusion Our findings suggest that the oropharynx is more susceptible to HPV16 infection as compared to the oral cavity, while HPV16 gene amplification is also more commonly found in the oropharynx.

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.

Epidermodisplasia verruciforme / Epidermodysplasia verruciformis

La epidermodisplasia verruciforme (EV) es una genodermatosis rara, caracterizada por el desarrollo de verrugas planas y lesiones similares a pitiriasis versicolor, asociada a infección crónica por Virus Papiloma Humano. Se reporta el caso de EV. Mujer de 49 años con múltiples lesiones verrucosas de larga evolución distribuidas en las cuatro extremidades y antecedente familiar de cuadro similar. Biopsia a los 19 años evidenció verrugas sin atipia. Nuevo estudio histológico informó carcinoma escamoso, decidiéndose extirpación de lesiones. La clínica inicia en edades tempranas, con elevado riesgo de transformación maligna. No existe tratamiento específico. Es esencial la fotoprotección estricta y manejo precoz de lesiones para prevención de progresión a carcinoma.

Epidermodysplasia verruciformis (EV) is a rare genodermatosis, characterized by the development of plane warts and pityriasis versicolor-like lesions, associated with chronic infection caused by the Human Papilloma virus. An EV case is reported. 49 year-old woman with multiple long standing warty lesions distributed on the four limbs and family background of similar cases. Biopsy at 19 years old evidenced warts without atypia. New histological study reported squamous cell carcinoma, deciding the removal of the lesions. The clinic begins at early age, with high risk of malignant transformation. There is no specific treatment. Strict photoprotection and early management of the lesions is essential to prevent the progression to carcinoma.

Uncommon non-oncogenic HPV genotypes, TP53 and MDM2 genes polymorphisms in HIV-infected women in Southern Brazil

Background: It is believed that Human Papillomavirus (HPV) and Human Immunodeficiency Virus coinfection contributes to increase the risk for cervical intraepithelial injuries. Several factors may contribute to cervical cancer (CC) development, including genetic variants such as TP53 and MDM2 gene polymorphisms. Materials and methods: A hundred HIV-infected women were examined for HPV detection and its genotypes, as well as the frequencies of the SNPs Arg72Pro and SNP309 and their associations with CC risk factors. Nested Polymerase Chain Reaction (nPCR) was used for HPV detection and PCR-RFLP for TP53 and MDM2 SNP309 genotyping. Results: HPV DNA was detected in 68% of samples. A higher frequency of low-risk HPV genotypes (66.7%) was observed when compared to high-risk genotypes (33.3%). Nine different HPV genotypes were identified, with the highest prevalence of HPV-6, followed by HPV-16 and 31. p53 Arg72Arg and SNP309 TG genotype were the most prevalent. HPV genotyping was performed by sequencing. Conclusion: The data obtained suggest that HIV-infected women are more susceptible to be infected by low-risk HPV (LR-HPV) genotypes than by high-risk (HR-HPV), and Pro72Pro of TP53 gene and TG of MDM2 SNP309 genotypes apparently seem to be protective factors among HIV-infected women for HPV acquisition and HR-HPV infection, respectively, in a sample of Southern Brazilian woman. Future investigations in larger populations are necessary to better understand the potential roles of these SNPs and the behavior of non-oncogenic HPV genotypes in HIV-mediated immunosuppression cases. .

Human papillomavirus detection in cervical scrapes from women attended in the Family Health Program / Detecção do papilomavírus humano em citologias cervicais de mulheres atendidas no Programa Saúde da Família / Detección del papilomavirus humano en citologías cervicales de mujeres atendidas en el Programa de Salud de la Familia

OBJECTIVES: to survey the prevalence of human papillomavirus, associated risk factors and genotype distribution in women who were referred to cervical cancer screening when attended in a Family Health Program. METHOD: we conducted a cross-sectional survey, investigating 351 women. Polymerase chain reaction for DNA amplification and restriction fragment length polymorphism analysis were used to detect and typify the papillomavirus. RESULTS: virus infection was detected in 8.8% of the samples. Among the 21 different genotypes identified in this study, 14 were high risk for cervical cancer, and the type 16 was the most prevalent type. The infection was associated with women who had non-stable sexual partners. Low risk types were associated with younger women, while the high risk group was linked to altered cytology. CONCLUSION: in this sample attended a Family Health Program, we found a low rate of papillomavirus infection. Virus frequency was associated to sexual behavior. However, the broad range of genotypes detected deserves attention regarding the vaccine coverage, which includes only HPV prevalent types. .

OBJETIVOS: identificar a prevalência do papilomavírus humano, os fatores de risco associados e a distribuição dos genótipos nas mulheres referenciadas para rastreamento do câncer cervical, durante o atendimento no Programa de Saúde da Família. MÉTODO: foi realizado levantamento de corte transversal com 351 mulheres. A amplificação do DNA por reação da cadeia da polimerase e a análise do polimorfismo de fragmentos de restrição foram aplicadas para detectar e tipificar o papilomavírus. RESULTADOS: a infecção pelo vírus foi detectada em 8,8% das amostras. Entre os 21 genótipos diferentes identificados neste estudo, 14 foram de alto risco para o câncer cervical, e o tipo 16 foi o mais prevalente. A infecção foi associada a mulheres com parceiros sexuais diversos. Os tipos de baixo risco foram associados com mulheres mais novas, enquanto o grupo de alto risco foi vinculado a alterações citológicas. CONCLUSÃO: nesta amostra, atendida por um Programa de Saúde da Família, encontraram-se níveis baixos de infecção pelo papilomavírus. Foi detectada, também, associação entre a frequência do vírus e o comportamento sexual. Porém, a grande variedade de genótipos detectados merece atenção relacionada à cobertura vacinal, que abrange somente tipos prevalentes de HPV. .

OBJETIVOS: identificar la prevalencia del papilomavirus humano, los factores de riesgo asociados y la distribución de los genotipos en las mujeres referenciadas para rastreo del cáncer cervical durante la atención en el Programa de Salud de la Familia. MÉTODO: fue efectuado un levantamiento trasversal con 351 mujeres. La amplificación del DNA por reacción de la cadena de la polimerasa y el análisis del polimorfismo de fragmentos de restricción fueron aplicadas para detectar y tipificar el papilomavirus. RESULTADOS: la infección por el virus fue detectada en el 8,8% de las muestras. Entre los 21 genotipos diferentes identificados en este estudio, 14 fueron de alto riesgo para el cáncer cervical, y el tipo 16 fue el más prevalente. La infección fue asociada con mujeres con parejas sexuales diversas. Los tipos de bajo riesgo fueron asociados con mujeres más nuevas, mientras el grupo de alto riesgo fue simplemente vinculado a alteraciones citológicas. CONCLUSIÓN: en esta muestra atendida por un Programa de Salud de la Familia, encontramos niveles bajos de infección por el papilomavirus. Fue encontrada una asociación entre la frecuencia del virus y el comportamiento sexual. Sin embargo, la gran variedad de genotipos detectados merece atención relacionada a la cobertura de vacunación, que abarca solamente tipos prevalentes de HPV. .

Human Papilloma Virus: Prevalence, distribution and predictive value to lymphatic metastasis in penile carcinoma

Objectives To evaluate the prevalence, distribution and association of HPV with histological pattern of worse prognosis of penile cancer, in order to evaluate its predictive value of inguinal metastasis, as well as evaluation of other previous reported prognostic factors. Material and Methods Tumor samples of 82 patients with penile carcinoma were tested in order to establish the prevalence and distribution of genotypic HPV using PCR. HPV status was correlated to histopathological factors and the presence of inguinal mestastasis. The influence of several histological characteristics was also correlated to inguinal disease-free survival. Results Follow-up varied from 1 to 71 months (median 22 months). HPV DNA was identified in 60.9% of sample, with higher prevalence of types 11 and 6 (64% and 32%, respectively). There was no significant correlation of the histological characteristics of worse prognosis of penile cancer with HPV status. Inguinal disease-free survival in 5 years did also not show HPV status influence (p = 0.45). The only independent pathologic factors of inguinal metastasis were: stage T ≥ T1b-T4 (p = 0.02), lymphovascular invasion (p = 0.04) and infiltrative invasion (p = 0.03). conclusions HPV status and distribution had shown no correlation with worse prognosis of histological aspects, or predictive value for lymphatic metastasis in penile carcinoma. .

Detección de Virus Papiloma Humano en el fluido gingival de pacientes con inmunodeficiencia humana y enfermedad periodontal / Detection of Human Papillomavirus in gingival fluid of Venezuelan HIV patients with periodontal disease

Evidencias sugieren que los virus pueden participar en la activación de la enfermedad periodontal, permitiendo el sobrecrecimiento de bacterias periodontopatógenas. El objetivo del estudio fué la detección molecular de VPH en fluido gingival (FG) de pacientes VIH+ con enfermedad periodontal. Se evaluaron muestras de FG de 20 pacientes VIH+ con enfermedad periodontal que asistieron al Centro de Atención de Pacientes con Enfermedades Infecciosas (CAPEI) de la Facultad de Odontología de la Universidad Central de Venezuela, 13 bajo terapia antirretroviral (HAART) y 7 VIH+ sin HAART. Se incluyeron 7 pacientes seronegativos con periodontitis crónica y como grupo control 7 pacientes seronegativos periodontalmente sanos. Se extrajo el ADN, se amplificó la región L1 de VPH con primers MY09 y MY11. Las muestras VPH+ fueron genotipificadas para los tipos 6, 11, 16, 18, 31 y 45. VPH fue detectado en 46% de los pacientes VIH+ bajo terapia. El contaje CD4+ en la población VPH+ no presentó diferencias con el grupo VPH-, y la carga viral mostró valores promedio significativamente mayores (200.470± 324.244 copias/mL) con respecto a los pacientes VPH- (10.246±23.805 copias/mL). Las muestras VPH+ presentaron los genotipos 6 y 11, de los cuales 66,6% estaban coinfectados con ambos tipos. Las condiciones periodontales no presentaron diferencias entre los individuos con doble infección viral por VPH y VIH, y los que solo portaban VIH. VPH fue detectado solamente en fluido gingival de pacientes VIH+ con HAART, indicando que esta terapia puede influir en el estado inmunológico independientemente de las condiciones periodontales.

Evidence suggests that viruses may be involved in the activation of periodontal disease, allowing the overgrowth of periodontal pathogens. The purpose of the present study was to detect the presence of Human Papillomavirus (HPV) in gingival crevicular fluid (GCF) in HIV+ Venezuelan patients with periodontal disease. We evaluated GCF samples from 20 HIV+ patients with periodontal disease from the Infectious Disease Center, Faculty of Dentistry, Central University of Venezuela, and were clinically examined to establish their periodontal conditions, 13 under HAART (antiretroviral therapy) and 7 without HAART. Seven seronegative patients with chronic periodontitis and 7 seronegative patients, without periodontal disease were included. DNA extraction was performed, the consensus primers MY09 and MY11 for the HPV L1 region were used for PCR amplification. Genotipification was made for the 6, 11, 16, 18, 31 and 45 genotypes. HPV were detected in 46% of HIV+ patients under therapy. The CD4 cell counts in the HPV+ patients were not significantly different from the HPV-group. The viral load in the HPV+ group was significantly higher (200,470 ± 324,244 copy/mL) than in the HPV- patients (10,246 ± 23,805 copy/mL). Genotypes 6 and 11 were observed in the HPV positive samples, of which 4/6 (66.6%) presented coinfection with both types. No significant differences in the periodontal conditions were observed between patients with HPV-HIV infection related to patients with only HIV. HPV was detected only in the gingival crevicular fluid of HIV+ patients under HAART independently of the periodontal conditions.

Human papillomavirus genotypes and their prevalence in a cohort of women in Trinidad / Genotipos del papilomavirus humano y su prevalencia en una cohorte de mujeres en Trinidad

OBJECTIVE: Human papillomavirus (HPV) genotypes and their relative prevalences were determined in a cohort of 310 sexually active women in Trinidad, West Indies. METHODS: Cervical samples were collected with Ayre's spatulas and endocervical brushes. Samples were used for the conventional Papanicolaou test and for determining HPV genotypes by amplification of a section of the viral L1 gene, followed by DNA sequencing and probe hybridization. RESULTS: HPV infections were identified in 126 of 310 (40.6 percent) women. Of them, 83 (65.8 percent) were infected with high-risk HPV, 16 (12.7 percent) with low-risk HPV, and 27 (21.4 percent) with HPV types of unknown risk. HPV 52 (12.7 percent) was the most frequently occurring high-risk type, followed by HPV 66 (10.3 percent), HPV 16 (9.5 percent), and HPV 18 (8.6 percent). High-risk types HPV 16 and HPV 66 were each found in 3 (20.0 percent) and HPV 18 was found in 1 (6.6 percent) of the 15 women with abnormal cytology. CONCLUSIONS: Cervical HPV prevalence and heterogeneity of HPV genotypes are high in this Trinidad cohort. The relative importance of HPV genotypes in the development of cervical lesions needs further investigation in Trinidad in order to better understand the epidemiology of HPV infections as well as to determine the role of HPV testing in the screening, prevention, and control of cervical cancer. This pilot study provided important information on the prevalence of HPV genotypes, which will be used in future nationwide studies.

OBJETIVO: Se determinaron los genotipos del papilomavirus humano (PVH) y su prevalencia relativa en una cohorte de 310 mujeres sexualmente activas de Trinidad, en la zona de las Indias Occidentales. MÉTODOS: Se tomaron muestras del cuello uterino con espátula de Ayre y cepillo endocervical. Las muestras se usaron para llevar a cabo la prueba convencional de Papanicolaou y para determinar los genotipos de PVH mediante la amplificación de una sección del gen vírico L1, seguida de secuenciación del ADN e hibridación con sonda. RESULTADOS: Se encontró una infección por PVH en 126 de las 310 mujeres (40,6 por ciento). De ellas, 83 (65,8 por ciento) estaban infectadas con PVH de alto riesgo, 16 (12,7 por ciento) con PVH de bajo riesgo, y 27 (21,4 por ciento) con tipos de PVH de riesgo desconocido. De los PVH de alto riesgo, el más frecuente fue el PVH 52 (12,7 por ciento), seguido por el PVH 66 (10,3 por ciento), el PVH 16 (9,5 por ciento) y el PVH 18 (8,6 por ciento). Entre las 15 mujeres con citología anormal se encontraron los PVH de alto riesgo 16 y 66 en 3 (20,0 por ciento) mujeres cada uno, y el PVH 18 en 1 (6,6 por ciento). CONCLUSIONES: Tanto la prevalencia de PVH en el cuello uterino como la heterogeneidad de los genotipos de PVH son elevadas en esta cohorte de Trinidad. La importancia relativa de los genotipos de PVH en la aparición de las lesiones cervicales requiere de mayor investigación en Trinidad para conocer más a fondo las características epidemiológicas de las infecciones por PVH, así como para determinar el papel del estudio de los PVH en la detección sistemática, la prevención y el control del cáncer del cuello uterino. Este estudio piloto suministró información importante sobre la prevalencia de los genotipos de PVH, que se usará en futuros estudios que se lleven a cabo en todo el país.

Infecção cervical por papilomavírus humano: genotipagem viral e fatores de risco para lesão intraepitelial de alto grau e câncer de colo do útero / Human papillomavirus cervical infection: viral genotyping and risk factors for high-grade squamous intraepithelial lesion and cervix cancer

OBJETIVO: analisar, em mulheres com HPV em colo do útero, as características da infecção viral e os fatores de risco para lesão intraepitelial de alto grau e carcinoma cervical. MÉTODOS: realizou-se um estudo caso-controle com mulheres com HPV em colo do útero atendidas em serviço de Ginecologia de referência vinculado ao SUS, em Recife, Nordeste do Brasil. No grupo de casos (72 mulheres com lesão intraepitelial de alto grau ou carcinoma cervical) e de controles (176 mulheres com colpocitologia normal ou com alterações benignas), foram pesquisados seis genótipos virais (HPV 16, 18, 31, 33, 6 e 11) em material da ecto- e endocérvice com primers MY09/MY11. As variáveis independentes foram hierarquizadas em três níveis de determinação: distal (sociodemográficas), intermediário (comportamentais) e proximal (realização anterior de colpocitologia). A homogeneidade das proporções foi testada (χ2). Obtiveram-se ORs não ajustadas e, na modelagem final, realizou-se regressão logística hierarquizada com o ajuste do efeito de cada variável sobre o desfecho pelas variáveis do mesmo nível e de níveis anteriores de causalidade. RESULTADOS: em 76,6 por cento das 248 mulheres participantes do estudo, o genótipo viral da infecção cervical foi identificado. Predominaram genótipos de alto risco oncogênico (83,4 por cento nos casos e 67,1 por cento nos controles), principalmente HPV 16 e 31. Foram identificados como fatores de risco (a) distais: residir em zona rural (OR=2,7; IC95 por cento: 1,1-6,2), menos de três anos de estudo (OR=3,9; IC95 por cento: 2,0-7,5) e renda familiar inferior a dois salários mínimos (OR=3,3; IC95 por cento: 1,0-10,5); (b) intermediário: número de gestações igual ou superior a quatro (OR=2,0; IC95 por cento: 1,0-3,7); (c) proximal: ausência de colpocitologia anterior (OR=9,7; IC95 por cento: 2,4-38,2). CONCLUSÕES: em mulheres usuárias do SUS do Nordeste do Brasil predominam os genótipos virais 16 e 31 em infecções cervicais ...

PURPOSE: to analyze the characteristics of viral infection and the risk factors for high-grade squamous intraepithelial lesion and cervical carcinoma in women with cervical HPV infection. METHODS: a case-control study was conducted on women with cervical HPV at a Gynecology reference service enrolled at the Public Health System, located in Recife, Northeastern Brazil. The groups of cases (72 women with high-grade squamous intraepithelial lesion or cervical cancer) and controls (176 women with normal Pap smear or benign alterations) were investigated for six viral genotypes (HPV 16, 18, 31, 33, 6, 11) in ecto- and endocervical material using MY09/MY11 primers. The independent variables were ranked in three levels of determination: distal (sociodemographic), intermediate (behavioral) and proximal (previous Pap smear). The homogeneity of proportions was tested (χ2), unadjusted Odds Ratios (OR) were obtained and hierarchical logistic regression was applied to the final model, with adjustment of the effect of each variable to the outcome based on the variables in the same and previous levels of causality. RESULTS: the viral genotype of cervical infection was identified in 76.6 percent of the 248 women participating in the study. High-risk HPV genotypes (83.4 percent of cases and 67.1 percent of controls) were predominant, especially HPV 16 and 31. The distal risk factors identified were: living in a rural area (OR=2.71, 95 percentCI: 1.18-6.23), less than three years of study (OR=3.97, 95 percentCI: 2.09-7.54) and family income below two minimum wages (OR=3.30, 95 percentCI: 1.04-10.51); intermediate: four or more pregnancies (OR=2.00, 95 percentCI: 1.06-3.76); and proximal: absence of a previous Pap smear (OR=9.74, 95 percentCI: 2.48-38.28). CONCLUSIONS: genotypes 16 and 31 of cervical HPV infection are predominant among women assisted by the Public Health System in Northeastern Brazil. Socioeconomic and reproductive factors, as well ...

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.

Prevalencia de la infección genital por virus papiloma humano en hombres universitarios voluntarios de la IX Región, Chile / Prevalence of human papillomavirus genital infection among male university students

Background: Human papillomavirus (HPV) infection is the most common sexually transmitted disease. Aim: To determine prevalence of HPV genital infection in voluntary asymptomatic male university students. Material and methods: A cross-sectional study in 62 asymptomatic, sexually active male students. Exfoliated cells were obtained from the penüe shaft and coronal sulcus. Samples were analyzed for HPV DNA detection and genotyping by polymerase chain reaction and Reverse Line Blot. Results: The prevalence of HPV infection was 84 percent. HPV detection was 77 percent in penile shaft and 66 percent in coronal sulcus. The most commonly detected types were HPV-16 (45 percent), HPV-11 (19 percent), HPV-6 (10 percent) and HPV-18 (9 percent). Múltiple infection wasfoundin 54 percent. The most frequent combinations were VPH11/16 (18 percent) and VPH16/18 (5 percent). Conclusions: HPV infection is highly frequent in asymptomatic male university students, high rísk HPV types were greatly predominant.

Human Papillomavirus infection in men residing in Brazil, Mexico, and the USA / Infección por Virus de Papiloma Humano en hombres de Brasil, México y EUA

OBJECTIVE: To assess Human Papillomavirus (HPV) type distribution among men ages 18 years and older recruited from three different countries utilizing a common protocol for sampling HPV detection, and to evaluate whether HPV detection differs by age and country. MATERIAL AD METHODS: The study protocol includes a pre-enrollment run-in visit, a baseline (enrollment) visit, and nine additional visits after enrollment scheduled six months apart. For this analysis, the first 1160 men who completed both the run-in and baseline visit were included. To maximize sampling and prevent fraying of applicators, three different applicators were utilized to sample the external genitalia of participants among different anatomic sites. These samples were later combined to form a single sample for the detection of HPV using polymerase chain reaction (PCR) for amplification of a fragment of the HPV L1 gene. RESULTS: Among 1160 men from Brazil, Mexico, and the United States (U.S.), overall HPV prevalence was 65.2 percent; with 12.0 percent oncogenic types only, 20.7 percent non-oncogenic types only, 17.8 percent both oncogenic and non-oncogenic, and 14.7 percent unclassified infections. Multiple HPV types were detected in 25.7 percent of study participants. HPV prevalence was higher in Brazil (72.3 percent) than in the U.S. (61.3 percent) and Mexico (61.9 percent). HPV 16 (6.5 percent), 51 (6.5 percent), and 59 (5.3 percent) were the most commonly detected oncogenic infections, and HPV 84 (7.7 percent), 62 (7.3 percent), and 6 (6.6 percent) were the most commonly detected non-oncogenic infections. Overall HPV prevalence was not associated with age. However, significant associations with age were observed when specific categories of oncogenic, non-oncogenic, and unclassified HPV infections were considered. CONCLUSIONS: Studies of HPV type distribution among a broad age range of men from multiple countries is needed to fill the information gap internationally ...

OBJETIVO: Evaluar la distribución tipo específica de infección por Virus del Papiloma Humano (VPH) entre hombres de 18 años o más de tres países con un protocolo común para el muestreo de la detección de VPH, y evaluar si la detección de VPH varía de acuerdo con la edad y el país. MATERIAL Y MÉTODOS: El estudio incluye diversas etapas que inician con la identificación de hombres susceptibles, una medición basal (visita de enrolamiento) y nueve visitas adicionales programadas cada seis meses. En este artículo, se presenta el análisis de los primeros 1160 hombres que fueron incluídos en el estudio. Para maximizar la posibilidad de detección de VPH se utilizó un cepillo de dacrón que muestreó en forma combinada diferentes sitios anatómicos. Para la determinación de ADN de VPH se utilizó ión en cadena de polimerasa (PCR) por amplificación de un fragmento del gen de VPH L1. RESULTADOS: Entre 1160 hombres de Brasil, México y EUA, la prevalencia global de VPH fue de 65.2 por ciento, con solamente 12 por ciento de tipos oncogénicos, 20.7 por ciento de tipos de VPH no oncogénicos, 17.8 por ciento de muestras positivas a tipos oncogénicos y no oncogénicos; y finalmente 14.7 por ciento de infecciones no clasificadas. Múltiples tipos de VPH fueron detectados en 25.7 por ciento de los participantes en el estudio. La prevalencia de VPH fue más alta en Brasil (72.3 por ciento), comparada con la observada en EUA (61.3 por ciento) y México (61.9 por ciento). Los tipos de VPH 16 (6.5 por ciento), 51 (6.5 por ciento) y 59 (5.3 por ciento) fueron los más comúnmente observados con poder oncogénico. El VPH 84 (7.7 por ciento), 62 (7.3 por ciento) y 6 (6.6 por ciento) fueron las infecciones no oncogénicas más comunes. CONCLUSIONES: Son necesarios estudios de la distribución de VPH en un amplio margen de edad entre hombres de múltiples países, para establecer con mayor precisión, el conocimiento de la historia natural de la infección por VPH en hombres.

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.