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We investigated human papillomavirus (HPV)

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We assess the prevalence of human papillomavirus (HPV) and cofactors for cervical severe disease, as contribution for vaccine strategies at the right moment in which Brazilian health authorities have approved an anti-HPV vaccine. A case-control study was undertaken with 201 women who attended a public health service with previous abnormal cytology. The HPV status was ascertained by consensus primers My09/11 and typed by 6, 11, 16, 18, 31, 33, 35, and 58 specific primers. Patients diagnosed with high-grade squamous intraepithelial lesions (HSIL) and cervical cancer were referred as cases (n = 84). Patients with normal/inflammatory cervix or carrying benign cervical lesions were included in controls (n = 117). The overall prevalence of HPV infection was 75.6%, with 91.7% among cases. In spite of HPV 16 being the most frequent type (53.3%), 27.6% of infections were attributed to nonvaccine types. High-risk HPV were strongly associated to older women (OR = 6.7). Otherwise, age at the first intercourse (OR = 7.10), three or more parities (OR = 3.05), abortion episodes (OR = 4.80), and smoking (OR = 3.83) conferred a heavy effect in younger women. Among mediators affecting the progress from HSIL to cancer, age played the main role in easing the progression (OR = 1.09, P = 0.002) followed by education level (OR = 4.20, P = 0.066). White ethnia showed to be a protective factor (OR = 0.32, P = 0.055). Predictors from HPV exposure to malignant disease include demographic and behavioral factors. Public policies such as improvement of education and continued prevention campaigns might contribute to reduce this picture. This work also gives background, in identifying a target population, for implementing future vaccine strategies.

The analyzed sample represents an epidemiological source of uncommon infection. Due to high HPV prevalence, more frequent cytological screening and/or liberal colposcopic evaluations should be performed in HIV-positive patients.

This study indicates that the Family Medical Program effectively provides cervical cancer screening coverage for its eligible population, at the level mandated by the WHO and the Brazilian Health Ministry. Fully 96.3 % of the women in our study had normal or benign inflammation on cytology. Understanding of barriers to care-seeking behavior that limit program adherence is one way to facilitate communication between providers and patients regarding the benefits of cancer screening.

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

INTRODUCTION: The aim of this work was to survey HPV information from a random population of young women from Rio de Janeiro, Brazil. METHODS: This cross-sectional study included cervical samples from 241 female students. To determine human papillomavirus status, polymerase chain reaction amplification was performed. HPV typing was determined by restriction fragment length polymorphism analysis. Demographic data, life style, sexual and gynecological history were obtained through use of a structured questionnaire. RESULTS: The average age of the women was 19.6 years-old (SD=3.4 years). HPV prevalence was 27.4%. Nineteen different HPV genotypes were detected, including 13 high risk types. HPV 16 was the most prevalent type (6.2%), followed by 31 (4.1 %) and 66 (3.7%). Most of the oncogenic types belonged to the A9 species (28/48). The frequency of women infected by at least one oncogenic type was significantly higher than those only infected by low risk types (18.7% versus 7.5%). Cervical changes were detected in 12.5% of the sample and were significantly linked to infection with HPV types of the A9 species. Demographic variables, sexual initiation, or number of sexual partners were not associated with HPV prevalence, variety of HPV genotypes or oncogenic types. CONCLUSIONS: The relative frequency of HPV genotypes other than vaccine types in young females should be taken into account when evaluating vaccination strategies. Due to the high prevalence of HPV infection among the population studied, implementation of sex education in schools, promotion of condom use and an organized screening program to prevent cervical cancer must be encouraged for this age group.