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PURPOSE: Persistent human papillomavirus infection (PHPVI) causes cutaneous, anogenital, and mucosal warts. Cutaneous warts include common warts, Treeman syndrome, and epidermodysplasia verruciformis, among others. Although more reports of monogenic predisposition to PHPVI have been published with the development of genomic technologies, genetic testing is rarely incorporated into clinical assessments. To encourage broader molecular testing, we compiled a list of the various monogenic etiologies of PHPVI. METHODS: We conducted a systematic literature review to determine the genetic, immunological, and clinical characteristics of patients with PHPVI. RESULTS: The inclusion criteria were met by 261 of 40,687 articles. In 842 patients, 83 PHPVI-associated genes were identified, including 42, 6, and 35 genes with strong, moderate, and weak evidence for causality, respectively. Autosomal recessive inheritance predominated (69%). PHPVI onset age was 10.8 ± 8.6 years, with an interquartile range of 5 to 14 years. GATA2,IL2RG,DOCK8, CXCR4, TMC6, TMC8, and CIB1 are the most frequently reported PHPVI-associated genes with strong causality. Most genes (74 out of 83) belong to a catalog of 485 inborn errors of immunity-related genes, and 40 genes (54%) are represented in the nonsyndromic and syndromic combined immunodeficiency categories. CONCLUSION: PHPVI has at least 83 monogenic etiologies and a genetic diagnosis is essential for effective management.
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Epidermodisplasia Verruciforme , Infecções por Papillomavirus , Verrugas , Humanos , Pré-Escolar , Criança , Adolescente , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/genética , Verrugas/genética , Verrugas/complicações , Epidermodisplasia Verruciforme/genética , Epidermodisplasia Verruciforme/complicações , Pele , Síndrome , Proteínas de Membrana/genética , Fatores de Troca do Nucleotídeo GuaninaRESUMO
Resumen OBJETIVO: Determinar la prevalencia de alteraciones en la citología anal, infección anal por virus del papiloma humano y en la neoplasia intraepitelial anal; además, explorar los factores de riesgo y los serotipos asociados en pacientes con lesión intraepitelial cervical de alto grado, a partir de la hipótesis de que esta población tiene mayor riesgo de lesiones precursoras o cáncer anal. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo y transversal, con componente analítico, efectuado en pacientes con diagnóstico de lesión intraepitelial cervical de alto grado (LIEAG) en dos instituciones de salud: una privada y otra pública de Bogotá, atendidas entre enero de 2017 y febrero de 2018. Se efectuó un muestreo no probabilístico, por conveniencia. RESULTADOS: Se incluyeron 119 participantes, en 4 de ellas se evidenció, en la citología anal, el hallazgo de células anormales en el tejido que reviste la parte exterior del cuello uterino. Se encontraron 14 anoscopias anormales que dieron una prevalencia de neoplasia intraepitelial anal del 6.7%. Siete eran neoplasia intraepitelial anal de bajo grado y una de alto grado. Se encontró infección por VPH anal en 45 participantes (37.8%) y se detectaron genotipos de VPH-AR en 29 participantes (24.4%). Más de 3 compañeros sexuales, más de 3 hijos y tener menos de 21 años antes del primer embarazo tuvieron un valor de p < 0.05 que confiere mayor riesgo de infección por VPH anal. CONCLUSIÓN: Es importante establecer en Colombia protocolos para la detección de la neoplasia intraepitelial anal en grupos de alto riesgo, como las pacientes con neoplasia intraepitelial cervical o cáncer de cuello uterino, e incentivar el adiestramiento en la anoscopia de alta resolución en especialistas relacionados con el diagnóstico de patología anogenital.
Abstract OBJECTIVE: To determine the prevalence of alterations in anal cytology, anal human papillomavirus infection, and anal intraepithelial neoplasia, and to explore the risk factors and associated serotypes in patients with high-grade cervical intraepithelial lesion, based on the hypothesis that this population is at higher risk for precancerous lesions or anal cancer. MATERIALS AND METHODS: Observational, descriptive, cross-sectional study, with analytical component, performed in patients diagnosed with high-grade cervical intraepithelial lesion (HG-CIL) in two health institutions: one private and one public in Bogota, visited between January 2017 and February 2018. A non-probabilistic sampling was performed, by convenience, with a sample calculated in 124 patients. RESULTS: 119 participants were included, in 4 of them it was evidenced in the anal cytology, the finding of abnormal cells in the tissue lining the outside of the cervix. Fourteen abnormal anoscopies were found, giving a prevalence of anal intraepithelial neoplasia of 6.7%. Seven were low-grade anal intraepithelial neoplasia and one was high-grade. Anal HPV infection was detected in 45 participants (37.8%) and HR-HPV genotypes were detected in 29 participants (24.4%). More than 3 sexual partners, more than 3 children and being younger than 21 years before first pregnancy had a p-value < 0.05 conferring an increased risk of anal HPV infection. CONCLUSION: It is important to establish protocols in Colombia for the detection of anal intraepithelial neoplasia in high-risk groups, such as patients with cervical intraepithelial neoplasia or cervical cancer, and to promote training in high-resolution anoscopy in specialties related to the diagnosis of anogenital pathology.
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BACKGROUND: A persistent infection by high-risk human papillomavirus (HR-HPV) is a prerequisite for the development of cervical neoplasms; however, most studies have focused on risk factors associated with HPV-16 and HPV-18 only. OBJECTIVES: We assessed the association of risk factors with the prevalence of HPV-16, HPV-18, and non-16/18 HR-HPV infection and with the occurrence of cervical lesions in the baseline of a cohort study of HPV persistence in a Mexican population. METHODS: Cross-sectional study within the baseline of a 5-year dynamic cohort study of HR-HPV persistence in women with an abnormal cytology study result from 2015 to 2021. HPV DNA was detected using the Anyplex II HPV 28 kit. Data on lifestyle, sociodemographic, and reproductive factors were assessed using bivariate and multivariate analyses to determine the association of risk factors with HR-HPV infection status and histopathologic diagnosis. RESULTS: A total of 373 women were included in the study. The overall prevalence of HR-HPV infection was 69.97%. The most prevalent HR-HPV genotypes, including single and multiple infections, were HPV-53 (13.4%), HPV-16 (11.8%), HPV-58 (10.9%), HPV-31 (10.9%), and HPV-66 (10.7%). We found 90 multiple HR-HPV infection patterns, all of them with α-6 and -9 species. Significant associations of multiple HPV-16 and non-16/18 HR-HPV infections were found with marital status, number of lifetime sexual partners, and smoking history. The most prevalent genotype in CIN1 and CIN2 patients was HPV-16. No association was found between biological plausibility risk factors and cervical lesions. CONCLUSIONS: The risk factors for non-16/18 HR-HPV multiple infections are no different than those linked to HPV-16 multiple infections.
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Infecções por Papillomavirus , Feminino , Humanos , Papillomavirus Humano , Estudos de Coortes , Prevalência , Estudos Transversais , Fatores de Risco , Papillomaviridae/genética , Papillomavirus Humano 16 , GenótipoRESUMO
OBJECTIVES: The purpose of this study was to investigate the effect of aspirin on epithelial HPV16-transformed cells and its antitumor effects, in an experimental HPV16-positive tumor model. DESIGN: The design of the study is experimental (in vitro and in vivo). PARTICIPANTS/MATERIALS, SETTING, AND METHODS: SiHa and BMK-16/myc cells were treated with aspirin and cell proliferation was determined by MTT; Caspase-Glo 3/7 Assay was used to determine apoptosis. The tumor-bearing mice group was treated with 50 mg/gr/day of aspirin (orally) during 30 days and the antitumor effect was determined. RESULTS: Here, we provide evidence that aspirin has a negative effect on proliferation and induces apoptosis in the human (SiHa) and murine (BMK-16/myc) HPV16 cells. Furthermore, aspirin showed inhibition of tumor growth, and in mice treated with aspirin prior to implantation of tumor cells, the tumor growth was delayed. Also, the effect of aspirin increased survival in tumor-bearing mice and in mice pre-treated with aspirin. LIMITATIONS: It is necessary to carry out in vitro and in vivo studies of the molecular mechanisms involved in the effects of aspirin on tumor cells. CONCLUSION: Aspirin showed antiproliferative effects in tumor cells and inhibited tumor progression and could be effective as a chemopreventive agent. Thus, aspirin deserves further exploration for the treatment of cervical cancer and other neoplasms.
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Apoptose , Aspirina , Proliferação de Células , Papillomavirus Humano 16 , Neoplasias do Colo do Útero , Animais , Feminino , Humanos , Camundongos , Apoptose/efeitos dos fármacos , Aspirina/farmacologia , Aspirina/uso terapêutico , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Papillomavirus Humano 16/efeitos dos fármacos , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/patologiaRESUMO
Patients with systemic lupus erythematosus have a higher incidence of neoplasms associated with human papillomavirus infections, such as those that affect the vulva, the vagina, and the cervix; however, little is known about the frequency of anal cancer among these patients. Although there are recommendations for screening for this cancer in immunosuppressed individuals, it is possible that this procedure is not strictly followed. We describe the case of a 47-year-old woman with systemic lupus erythematosus who was treated with immunosuppressants and developed advanced anal squamous cell carcinoma after adequate treatment and healing of a high-grade cervical squamous intraepithelial lesion. Five years after the completion of the anal cancer treatment, the patient presented with cystic hepatic lesions that were histopathologically confirmed to be metastatic squamous cell carcinoma. This report aimed to highlight the need for anal cancer screening in patients with lupus, particularly if there was a history of cervical cytopathological alterations. (AU)
Resumo Pacientes com lúpus eritematoso sistêmico apresentam maior incidência de neoplasias associadas a infecções por HPV, como aquelas que acometem a vulva, a vagina e o colo do útero, mas pouco se sabe sobre a frequência de câncer anal entre essas pacientes. Embora existam recomendações para o rastreamento desse câncer em indivíduos imunossuprimidos, é possível que esse procedimento não esteja sendo rigorosamente seguido. Descrevemos uma mulher de 47 anos com lúpus eritematoso sistêmico, tratada com imunossupressores, que desenvolveu um carcinoma escamocelular anal avançado após tratamento adequado e cicatrização de lesão intraepitelial escamosa cervical de alto grau. Cinco anos após o término do tratamento do câncer anal, a paciente apresentou lesões císticas hepáticas cujo resultado citopatológico confirmou ser carcinoma escamocelular metastático. O presente relato teve como objetivo chamar atenção para a necessidade do rastreamento do câncer anal em pacientes com lúpus, principalmente se houver história prévia de alterações citopatológicas cervicais. (AU)
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Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias do Ânus/diagnóstico , Carcinoma Adenoescamoso , Lúpus Eritematoso Sistêmico , Infecções por Papillomavirus , Neoplasias Hepáticas/secundárioRESUMO
Resumen Introducción: El cáncer de cérvix es el segundo en frecuencia y el tercero en mortalidad; la infección por el virus del papiloma humano (VPH) está asociada al riesgo de cáncer; sin embargo, no se conoce el riesgo acumulado a 1, 2, 3, 5 y 10 años. Objetivo: Determinar el riesgo de las pacientes VPH positivo con evaluación inicial citológica negativa para desarrollar lesión intraepitelial de alto grado a lo largo del tiempo. Método: Se realizó una revisión sistemática de artículos en inglés y español de los últimos 20 años, usando las bases de datos PubMed, Cochrane, LILACS, ProQuest y Embase. Se incluyeron ensayos clínicos aleatorizados en los que se determinaba el estado VPH y se realizaba seguimiento con citología cervicovaginal a 1, 2, 3, 5 y 10 años en mujeres de 20-64 años. Resultados: Se incluyeron siete ensayos clínicos aleatorizados, con un total de 98.521 mujeres, de ellas 8820 VPH positivo y 89.701 VPH negativo al ingreso, seguidas hasta por 10 años con citología cervicovaginal, encontrando que la infección por VPH es un factor de riesgo para desarrollar lesiones intraepiteliales de alto grado a 2, 5 y 10 años, con un riesgo relativo de 110.94 (79.41-154.97), 83.65 (55.22-126.73) y 29.71 (5.72-154.33), respectivamente. Conclusiones: La infección por VPH es un factor de riesgo importante para el desarrollo de lesiones intraepiteliales de alto grado a 2, 5 y 10 años.
Abstract Introduction: Cervical cancer is the second in frequency and the third in mortality, infection by the human papillomavirus (HPV) is associated with the risk of increased cancer; however, the cumulative risk of 1, 2, 3, 5 and 10 years is not known. Objective: To determine the risk of HPV-positive patients with negative initial cytological evaluation for developing high-grade intraepithelial lesion over time. Method: A systematic review of articles in English and Spanish in the last 20 years was carried out, using the PubMed, Cochrane, LILACS, ProQuest and Embase databases. Randomized clinical trials were included in which HPV was performed and subsequent follow-up with cervicovaginal cytology at 1, 2, 3, 5 and 10 years in women aged 20-64 years. Results: Seven randomized clinical trials were included, a total of 98,521 women, 8820 with positive HPV and 89701 negative on admission and followed up for up to 10 years with cervicovaginal cytology. Finding that HPV infection is a risk factor for developing high-grade intraepithelial lesion at 2, 5 and 10 years with a relative risk of 110.94 (79.41-154.97), 83.65 (55.22- 126.73) and 29.71 (5.72-154.33), respectively. Conclusions: HPV infection is an important risk factor for the development of high-grade intraepithelial lesion at 2, 5 and 10 years.
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Humanos , Feminino , /diagnóstico , /epidemiologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Programas de Rastreamento , Fatores de Risco , Medição de Risco , Testes de DNA para Papilomavírus Humano , Teste de Papanicolaou , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/epidemiologiaRESUMO
BACKGROUND: The role of human papillomavirus (HPV) as single or multiple infections in pregnant women would be relevant to determine the time to progression and/or the time to regression of cervical lesions. OBJECTIVE: In this preliminary study, we determined the prevalence of HPV as single or multiple infections in pregnant women from Northeastern Mexico. MATERIALS AND METHODS: Samples from 31 pregnant and 62 nonpregnant women were examined between January 2015 and November 2015 at UMAE-23 of the Instituto Mexicano del Seguro Social (IMSS). The samples of cervicovaginal exudate were obtained for HPV DNA detection using the INNO-LiPA test, and HPV infections were analyzed as single or multiple infections. Participants completed a questionnaire on sociodemographic, gynecological, obstetric, and sexual behavior characteristics. RESULTS: The mean age of the pregnant women was 25.7 ± 4.8 yr, with an average time of pregnancy of 6 ± 1 months at the time of the study. With respect to age, parity, smoking history, or oral contraceptive use no statistically significant differences between the two studied groups was observed. The HPV infection was 2.7 times higher in pregnant women (35%) than in the control group (13%). In total, 78% of the pregnant women who were HPV-positive presented with single infections compared with 28% of the nonpregnant women. CONCLUSION: A higher prevalence of HPV as a single infection was found in this sample of pregnant Mexican women. Follow-up is necessary to evaluate the persistence or regression of the infection.
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AIM: Antiretrovirals of the protease inhibitor (PI) class tend to achieve low concentrations in biological fluids. This study aimed to analyze possible changes in the vaginal microbiome and frequency of cervical human papillomavirus (HPV)-DNA and HPV-related lesions associated with the use of PI in antiretroviral therapy (ART). METHODS: Eighty-eight women with human immunodeficiency virus infection were divided in two groups: ART with PI and without PI. All the participants underwent anamnesis with demographic data collection. The total DNA, used as the template in the polymerase chain reaction-based assays for the detection of HPV-DNA, was extracted from cervical samples during cervical cytopathology. RESULTS: There were no differences between the groups with respect to HPV-related lesions. Despite the higher prevalence of bacterial vaginosis (BV) in the PI group (33.96% vs 17.14%), the difference was insignificant when considering all women (P = 0.066). When women with a detectable viral load and a CD4+ T-cell count <200 were excluded in both groups, BV was found to be more prevalent in the PI group (odds ratio, 3.349; 95% confidence interval, 1.113-11.41, P = 0.049). No associations were found between BV and age, condom use, cervical HPV, time with current ART regimen, unprotected receptive anal intercourse and cervical HPV-related lesions. CONCLUSION: The use of PI did not alter the frequencies of HPV-DNA and HPV-related lesions. However, an increased frequency of BV was found in women using PI after excluding women with a detectable viral load and a CD4+ T-cell count of <200.
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Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Infecções por Papillomavirus/complicações , Inibidores de Proteases/administração & dosagem , Vaginose Bacteriana/microbiologia , Adulto , Brasil , Estudos Transversais , Feminino , Infecções por HIV/complicações , Humanos , Microbiota/efeitos dos fármacos , Pessoa de Meia-Idade , Estudos Prospectivos , Vagina/efeitos dos fármacosRESUMO
ABSTRACT Aim: to evaluate the presence of subclinical HPV-induced anal lesions with anal cytology, High-Resolution Anoscopy (HRA) and HPV genotyping by polymerase chain reaction (PCR) in the follow-up of treated condylomata acuminata (CA). Methods: seventy-nine male patients were included. One month after anal CA eradication, the patients underwent brush samples collection for anal cytology and PCR, and HRA with biopsy of acetowhite lesions. These methods were compared within all patients and between groups, according to Human Immunodeficiency Virus (HIV) infection status: HIV-negative; HIV-positive with TCD4 count above and below 350 cells/mm3. Results: the most frequent HPV types were 6 and 16. HPV DNA was isolated in 92%. HIV infection was associated with a higher number of oncogenic HPV types (p=0.038). All patients with negative PCR had negative HRA and cytology. There were no differences in cytological, HRA or histopathological findings between groups. Conclusion: the association of the findings of cytopathology, HRA and genotyping of HPV refined the diagnosis of HPV-induced lesions. The degree of immunodeficiency was not associated with increase in remnant HPV-induced anal lesions.
RESUMO Objetivo: avaliar a presença de lesões anais subclínicas HPV-induzidas com citologia anal, colposcopia anal e genotipagem de HPV por reação em cadeia da polimerase (PCR) no seguimento de condilomas anais tratados. Método: foram incluídos 79 pacientes do sexo masculino. Após um mês da erradicação de lesões condilomatosas anais, os participantes voltaram em consulta para coleta de amostras com escova para citologia anal e PCR, e colposcopia anal com biópsia de lesões acetobrancas. Os métodos de detecção das lesões foram comparados entre os pacientes e entre grupos, de acordo com o status de infecção pelo vírus da imunodeficiência humana (HIV): HIV-negativo; HIV-positivo com TCD4 acima ou abaixo de 350 células/mm3. Resultados: os tipos de HPV mais frequentes foram 6 e 16. Infecção pelo HIV foi associada a maior número de tipos de HPV oncogênicos (p=0,038). Todos os pacientes com PCR negativo apresentaram colposcopia e citologia negativos. Não houve diferença nos achados citológico, colposcópico ou histopatológico entre grupos. Conclusão: a associação dos achados citopatológico, colposcópico e PCR melhorou a acurácia do diagnóstico de lesões anais HPV-induzidas. O grau de imunodeficiência não foi associado a maior frequência de lesões anais HPV-induzidas remanescentes.
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Humanos , Masculino , Neoplasias do Ânus , Papillomaviridae/genética , Condiloma Acuminado , Infecções por Papillomavirus , Canal Anal , DNA , Infecções por HIV , Reação em Cadeia da Polimerase , Seguimentos , GenótipoRESUMO
Resumen OBJETIVO: Estimar la prevalencia de infección por genotipos del virus del papiloma humano en mujeres con atipia de células escamosas de significado incierto. MATERIALES Y MÉTODO: Estudio transversal, descriptivo y retrospectivo efectuado mediante el análisis de los registros de la prueba 21-PVH-Genoarray de Hybriobio en mujeres mayores de 18 años, referidas al servicio de Ginecología del Hospital Nacional Carlos Alberto Seguín, durante el año 2018, debido a atipia de células escamosas de significado incierto. Se utilizó el sistema Genoarray-Hybribio para el genotipado. Variables de estudio: genotipos de VPH de alto riesgo, VPH de bajo riesgo y edad. Se estimaron proporciones y razón de momios con IC95%. RESULTADOS: Se estudiaron 227 pacientes: 95 resultaron con prueba positiva para VPH (41.8%). La prevalencia de genotipos de alto riesgo fue de 33.9%. Los más frecuentes fueron: 16, 31, 52 y 53. La prevalencia fue de 4.8% para los genotipos de bajo riesgo: 81, 6, 43 y 11, y 3.1% fueron infecciones mixtas. Se registraron 38 mujeres con infección con al menos dos genotipos. Las mujeres mayores de 30 años tuvieron 3 veces más riesgo de infección por genotipos de alto riesgo. La razón de momios fue 3.32 (IC95%: 1.21-9.10) en relación con las menores de 30 años, asociación estadística significativa p < 0.01. CONCLUSIONES: La prevalencia global fue: 41.8%, la infección por VPH de alto riesgo en mujeres con atipia de células escamosas de significado incierto fue 33.9%. Los genotipos más prevalentes en infecciones únicas fueron: 16, 31, 52 y 53.
Abstract OBJECTIVE: To estimate the prevalence of infection by genotypes of the human papilloma virus in women with squamous cell atypia of unknown significance (ASCUS). MATERIALS AND METHOD: Transversal and cross-sectional study of patients referred to the Carlos Alberto Seguín National Hospital, during 2018, for presenting ASCUS cytology, the Genoarray-Hybribio system for genotyping was reported. The study variables were: high-risk HPV genotypes, low-risk HPV, and age. Proportions and odds ratios were estimated with 95% confidence intervals. RESULTS: 227 patients were studied, of which 95 had a positive test for HPV (41.8%). The prevalence for high-risk genotypes was 33.9%. The most frequent being 16, 31, 52 and 53. The prevalence was 4.8% for low-risk genotypes: 81, 6, 43, and 11, and 3.1% were mixed infections. 38 women had infection with less than two genotypes, women older than 30 years were 3 times more at risk of infection due to high-risk genotypes, Odss ratio 3.32 (95% CI 1.21-9.10) in relation to those younger than 30 years, statistical association significant p <0.01. CONCLUSIONS: The overall prevalence was 41.8%, the high-risk HPV infection in women with ASCUS was 33.9%, with the genotypes most prevalent in single infections being 16, 31, 52, and 53.
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Resumen: OBJETIVO: Evaluar la inmunogenicidad de los distintos tipos de vacunas terapéuticas y de su efecto en las lesiones causadas por el virus del papiloma humano (VPH) después de su aplicación. Además, analizar los estudios de seguridad y las perspectivas de las vacunas terapéuticas contra el VPH. METODOLOGÍA: Estudio retrospectivo efectuado mediante la búsqueda bibliográfica sistemática en la base de datos PubMed, sin restricción de fecha de publicación. Criterio de inclusión: ensayos clínicos aleatorizados (metanálisis y revisiones sistemáticas). Criterios de exclusión: ensayos clínicos en fase preclínica del desarrollo y publicaciones en idiomas distintos al inglés o español. RESULTADOS: Se seleccionaron 30 artículos publicados entre 2000 y 2020. Entre ellos, 5 ensayos clínicos aleatorizados con vacunas terapéuticas que ya han finalizado o aún están en estudio. Las 25 publicaciones restantes incluyen: metanálisis y revisiones sistemáticas de aspectos seleccionados con objetivos primarios y secundarios. CONCLUSIONES: Las vacunas terapéuticas contra VPH se encuentran en fase experimental; hasta ahora se han conseguido resultados prometedores con algunas de ellas. Si bien existen distintos tipos de vacunas terapéuticas, los mejores resultados se han conseguido con las basadas en ADN. Las vacunas VGX-3100 y TS, en fase III, han demostrado diferencias significativas en el aclaramiento viral y la regresión de las lesiones de alto grado en pacientes vacunadas. Una vacuna terapéutica efectiva tendría una repercusión inmediata en la morbilidad y mortalidad por lesiones asociadas al virus.
Abstract: OBJECTIVE: To assess the immunogenicity of different types of therapeutic vaccines and their effect on human papillomavirus (HPV) lesions after application. In addition, to analyze the safety studies and prospects of therapeutic HPV vaccines. METHODOLOGY: Retrospective study based on a systematic literature search of the PubMed database, with no publication date restrictions. Inclusion criteria: randomized clinical trials (meta-analyses and systematic reviews). Exclusion criteria: clinical trials in the pre-clinical phase of development and publications in languages other than English or Spanish. RESULTS: 30 articles published between 2000 and 2020 were selected. Among them, 5 randomized clinical trials with therapeutic vaccines that have already been completed or are still under study. The remaining 25 publications include: meta-analyses and systematic reviews of selected aspects with primary and secondary objectives. CONCLUSIONS: Therapeutic HPV vaccines are in the experimental phase; so far promising results have been achieved with some of them. Although different types of therapeutic vaccines exist, the best results have been achieved with DNA-based vaccines. The VGX-3100 and TS vaccines, in phase III, have demonstrated significant differences in viral clearance and regression of high-grade lesions in vaccinated patients. An effective therapeutic vaccine would have an immediate impact on morbidity and mortality from virus-associated lesions.
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OBJECTIVE: To assess the impact of HPV testing on longstanding problems faced by screening programs in Latin America, using the case of the Jujuy Demonstration Project (JDP) in Argentina. MATERIALS AND METHODS: . The study measured the level of impact produced by the introduction of HPV-testing on problems faced by cytology programs by analyzing modifications on specific problems produced during the JDP. Impact was classified as direct/indirect, and positive/negative. RESULTS: Direct/positive impact was found in issues concerning age and screening frequency,cytology laboratories and screening sensitivity, and low coverage. Direct/negative impact was mainly related to the adherence to triage cytology by HPV+ women with self-collected-tests, and the delivery and labelling of samples. Indirect impact of HPV-Test was mostly positive, and related to the programmatic reorganization which was facilitated by the introduction of HPV testing. CONCLUSIONS: HPV testing provides an opportunity window for improving primary screening, but does not solve programmatic problems.
OBJETIVO: Evaluar el impacto de la prueba deVPH (prueba de VPH) en los problemas que históricamente afectaron al tamizaje de cáncer cervical en América Latina, tomando como caso al Proyecto Demostración para la Introducción de la prueba deVPH en Jujuy (PDJ),Argentina. MATERIAL Y MÉTODOS: Se sintetizó la evidencia sobre los problemas del tamizaje cervical en la región. Se analizó el impacto en los problemas a partir de la introducción de la prueba de VPH. El impacto se clasificó en directo/indirecto y positivo/negativo. RESULTADOS: El impacto directo-positivo se dio en los problemas de adherencia a la edad/frecuencia de ta- mizaje, laboratorios de citología, baja/moderada sensibilidad de la citología y baja cobertura. El impacto directo-negativo se vinculó con el triaje de autotoma y el envío/etiquetado de muestras. El impacto indirecto-positivo se relacionó con la reorganización programática realizada para introducir la prueba de VPH. CONCLUSIONES: La prueba de VPH representa una ventana de oportunidad para el mejoramiento del tamizaje pero no resuelve los problemas programáticos.
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Testes de DNA para Papilomavírus Humano , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal , Argentina/epidemiologia , Coleta de Dados , Países em Desenvolvimento , Feminino , Fidelidade a Diretrizes , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Infecções por Papillomavirus/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/epidemiologia , Avaliação de Programas e Projetos de Saúde , Determinantes Sociais da Saúde , Problemas SociaisRESUMO
Resumen: Objetivo: Evaluar el impacto de la prueba de VPH (prueba de VPH) en los problemas que históricamente afectaron al tamizaje de cáncer cervical en América Latina, tomando como caso al Proyecto Demostración para la Introducción de la prueba de VPH en Jujuy (PDJ), Argentina. Material y métodos: Se sintetizó la evidencia sobre los problemas del tamizaje cervical en la región. Se analizó el impacto en los problemas a partir de la introducción de la prueba de VPH. El impacto se clasificó en directo/indirecto y positivo/negativo. Resultados: El impacto directo-positivo se dio en los problemas de adherencia a la edad/frecuencia de tamizaje, laboratorios de citología, baja/moderada sensibilidad de la citología y baja cobertura. El impacto directo-negativo se vinculó con el triaje de autotoma y el envío/etiquetado de muestras. El impacto indirecto-positivo se relacionó con la reorganización programática realizada para introducir la prueba de VPH. Conclusiones: La prueba de VPH representa una ventana de oportunidad para el mejoramiento del tamizaje pero no resuelve los problemas programáticos.
Abstract: Objective: To assess the impact of HPV testing on longstanding problems faced by screening programs in Latin America, using the case of the Jujuy Demonstration Project (JDP) in Argentina. Materials and methods: The study measured the level of impact produced by the introduction of HPV-testing on problems faced by cytology programs by analyzing modifications on specific problems produced during the JDP. Impact was classified as direct/indirect, and positive/ negative. Results: Direct/positive impact was found in issues concerning age and screening frequency, cytology laboratories and screening sensitivity, and low coverage. Direct/negative impact was mainly related to the adherence to triage cytology by HPV+ women with self-collected-tests, and the delivery and labelling of samples. Indirect impact of HPV-Test was mostly positive, and related to the programmatic reorganization which was facilitated by the introduction of HPV testing. Conclusions: HPV testing provides an opportunity window for improving primary screening, but does not solve programmatic problems.
Assuntos
Humanos , Feminino , Esfregaço Vaginal , Neoplasias do Colo do Útero/prevenção & controle , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/diagnóstico , Testes de DNA para Papilomavírus Humano , Argentina/epidemiologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/epidemiologia , Problemas Sociais , Avaliação de Programas e Projetos de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Coleta de Dados , Fidelidade a Diretrizes , Infecções por Papillomavirus/epidemiologia , Países em Desenvolvimento , Determinantes Sociais da SaúdeRESUMO
OBJECTIVE: The objectives of this systematic review and meta-regression were: 1) to compare the prevalence of cervical HPV infection between SLE patients and healthy controls and 2) to evaluate the relationship between cervical HPV infection and traditional and SLE-related risk factors for cervical HPV infection in these patients. METHODS: We conducted a systematic literature review (PubMed, Cochrane Library, Embase, Virtual Health Library and SciELO databases) following PRISMA guidelines and using meta-regression to investigate the pooled prevalence of cervical HPV infection in adult women with SLE. The articles included were independently evaluated by two investigators who extracted information on study characteristics, defined outcomes, risk of bias and summarized strength of evidence [Quality of evidence using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence]. Using meta-regression, we further analyzed whether factors such as multiple sexual partners and immunosuppressive therapy were associated with HPV prevalence. We evaluated the quality of evidence included using the Oxford Centre for EBM levels of evidence. Pooled odds ratios (ORs) and 95% confidence intervals (CI) were calculated for studies providing data on HPV prevalence in women with SLE and in healthy controls. RESULTS: A total of 687 articles were identified; 9 full-text articles examining the prevalence of cervical HPV infection in SLE women were included, comprising 751 SLE women. Eight studies employed PCR using general primers. The HPV prevalence varied from 3.1% to 80.7%. In the random effects meta-analysis, the pooled prevalence of cervical HPV infection in SLE vs. controls was 34.15% (95% CI: 19.6%-52.5%) vs. 15.3% (95% CI 0.79-27.8%), ORâ¯=â¯2.87 (95% CI: 2.20-3.76) pâ¯<â¯.0001, with large between-study heterogeneity (I2â¯=â¯95.4%). When only SLE women were evaluated, meta-regression showed no significant differences between patients with and without a background of multiple sexual partners and any immunosuppressive therapy. In addition, the prevalence of cervical HPV infection did not significantly differ between SLE patients on azathioprine or cyclophosphamide. CONCLUSIONS: This meta-analysis suggests that the prevalence of cervical HPV infection is higher in SLE women than in healthy controls. However, multiple sexual partners and any immunosuppressive therapy or specific immunosuppressive treatment (azathioprine and cyclophosphamide) were not associated with the prevalence of cervical HPV infection.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Infecções por Papillomavirus/etiologia , Adulto , Feminino , Humanos , Lúpus Eritematoso Sistêmico/patologia , Infecções por Papillomavirus/patologia , Prevalência , Fatores de RiscoRESUMO
Resumen ANTECEDENTES: Existen pocos reportes de neoplasias epiteliales con apariencia escamosa originadas en el cuello uterino o la vagina. Estas lesiones se clasifican, por su similitud morfológica, en lesiones similares a queratosis seborreica. Cuando ésta aparece en la mucosa de la vulva o vagina debe establecerse la diferenciación con lesiones intraepiteliales escamosas de bajo y alto grado. OBJETIVO: Describir un caso de queratosis seborreica en el saco de Douglas. CASO CLÍNICO: Paciente de 70 años, con pérdida involuntaria de orina con los esfuerzos; se le colocó una cinta suburetral para resolver este problema. Durante el procedimiento se detectó una lesión en la mucosa vaginal, a las seis del reloj, en el fondo del saco de Douglas, de 1.2 x 1 cm, color pardo y consistencia blanda. Durante el procedimiento se tomó una muestra para estudio histopatológico que se reportó como: epidermis con marcada hiperqueratosis, acantosis regular, ensanchamiento y anastomosis de las crestas con formación de perlas córneas, dermis con infiltrado inflamatorio crónico perivascular, negativo para malignidad. Se estableció el diagnóstico de queratosis seborreica hipertrófica, positiva para tinción de P16 que orientó a infección de virus del papiloma. El tratamiento fue: escisión con evolución satisfactoria y seguimiento. CONCLUSIONES: La queratosis seborreica en el fondo de saco de Douglas se reporta de manera excepcional, su comportamiento es benigno y casi siempre se asocia con tipos de virus del papiloma humano de bajo riesgo.
Abstract BACKGROUND: Thera are few repots of intraepithelial neoplasms with origins in the cervix or vagina with squamous appearance. This kind of lesions have been classified because of their morphologic similarities, in the category of "seborrheic keratoses like". When seborrheic keratoses appears in the vaginal or vulvar mucosa, it has to be differentiated from low and high grade intraepithelial squamous lesions. OBJECTIVE: To describe a case of seborrheic keratoses in the recto-uterine pouch. CLINICAL CASE: 70 years old patient, who underwent surgery for stress urinary incontinence with a sub-urethral sling. During the procedure, a lesion in the vaginal mucosa was detected, specifically in the recto-uterine pouch, of 1.2 x 1 cm length, with a light brown color and soft consistency. A specimen was taken from the lesion during the procedure for histopathological study, which reported: hyperkeratosis in the epidermis, regular acanthosis, thickening and anastomosis of the crests with formation of corneal pearls, dermis with inflammatory, chronic, perivascular infiltration, with no signs of malignancy. The diagnosis was hypertrophic seborrheic keratoses, positive for P16 stain which orients to HPV infection. The lesion was removed and the patient continued follow up with her primary care provider. CONCLUSIONS: Seborrheic keratoses in this location is uncommon, with few reports in literature. These lesions are usually benign and are associated to HPV of low risk.
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Introduction: Human papillomavirus (HPV), belonging to the Papovavirida family, is the most prevalent sexually transmitted disease (STD) agent worldwide. In Brazil, it is estimated that there are 3-6 million people infected with HPV. Aim: The aim of this study was to evaluate the knowledge of young male students about penis cancer related to HPV infection. Methods: This exploratory and quantitative study was conducted to analyze answers of 242 male students attending a private college located in Uberaba city, Minas Gerais state, Brazil, during 2015. Results: Most of the 242 participants (88.8%) affirmed having started sexual life very early, the majority (79.3%) were currently married and 69.8% had a single sexual partner. Regardless of their knowledge about HPV virus and its relationship with penis cancer, our data showed a general lack of awareness of the participants. Conclusion: Our results suggest that despite efforts to propagate information about HPV infection and its relation to penis cancer, the level of knowledge of students is low. Because of that, it is important to improve the information spread by media, emphasizing prevention and treatment of HPV infection in men.
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Objectives Our objective was to study the incidence, persistence and clearance of human papillomavirus infection in systemic lupus erythematosus women and assess risk factors for persistence of human papillomavirus infection. Methods We carried out a prospective, observational cohort study of 127 systemic lupus erythematosus women. Patients were evaluated at baseline and at three years. Traditional and systemic lupus erythematosus women-related disease risk factors were collected. Gynaecological evaluations and cervical cytology screening were made. Human papillomavirus detection and genotyping were made by polymerase chain reaction and linear array. Results The cumulative prevalence of human papillomavirus infection increased from 22.8% at baseline to 33.8% at three years; p = < 0.001: 20.1% of patients experienced 43 incident infections. The risk of any human papillomavirus infection was 10.1 per 1000 patient-months. At three years, 47 (88.6%) prevalent infections were cleared. Independent risk factors associated with incident human papillomavirus infection included more lifetime sexual partners (odds ratio = 1.8, 95% confidence interval = 1.11-3.0) and cumulative cyclophosphamide dose (odds ratio = 3.9, 95% confidence interval = 1.2-12.8). Conclusions In systemic lupus erythematosus women, the cumulative prevalence of human papillomavirus infection, including high risk-human papillomavirus and multiple human papillomavirus infections, may increase over time. Most persistent infections were low risk-human papillomavirus. The number of lifetime sexual partners and the cumulative cyclophosphamide dose were independently associated with incident human papillomavirus infection.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto , Ciclofosfamida/efeitos adversos , Feminino , Genótipo , Humanos , Imunossupressores/efeitos adversos , Incidência , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/mortalidade , Lúpus Eritematoso Sistêmico/virologia , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Parceiros Sexuais , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal/métodosRESUMO
OBJETIVO: Conhecer a percepção de mulheres infectadas pelo papilomavírus humano (HPV), acerca desta infecção sexualmente transmissível. MÉTODO: Estudo exploratório com abordagem qualitativa, realizado com 14 mulheres, usuárias de um serviço de atenção especializada em Juazeiro do Norte-Ceará-Brasil, entre março a junho de 2012, utilizando a técnica do Discurso do Sujeito Coletivo. RESULTADOS: Constatou-se percepções equivocadas a respeito do HPV, desconhecimento da não eliminação do vírus mediante a terapêutica instituída, sentimentos relatados com características negativas frente ao diagnóstico e atitudes de autoproteção e proteção aos filhos. CONCLUSÃO: As percepções encontradas tendem a prejudicar o empoderamento das mulheres para lidarem com maior segurança nesta situação. Lacunas também são apontadas na educação em saúde. Deve-se continuar a discussão sobre a temática, com informações dirigidas ao viver com o HPV através de uma abordagem singular, respeitando a individualidade de cada mulher, tornando a assistência mais humanizada e eficaz.
AIM: to understand the feelings of women infected with the human papilloma virus (HPV) regarding this sexually transmitted disease. METHOD: this is an exploratory study, with a qualitative approach, performed with 14 women who are users of a specialized care service in the municipality of Juazeiro do Norte, in the Brazilian state of Ceará, in the Northeast of Brazil, between March and June 2012, using the Collective Subject Discourse technique. RESULTS: it was observed that there were some misconceptions regarding HPV, unfamiliarity with the fact the therapies used do not eliminate the virus, feelings linked to negative characteristics of the diagnosis, and self-protecting and children-protecting attitudes. CONCLUSION: the perceptions described tend to harm the empowerment process of these women to deal with the illness with more confidence. Gaps were found in health education. The discussion about the topic must continue, with directed information regarding living with HPV in a singular approach, respecting the individuality of each woman, providing more humane and effective care.
OBJETIVO: Conocer la percepción de mujeres infectadas por el virus papiloma humano (HPV), acerca de esta infección sexualmente trasmisible. MÉTODO: Estudio exploratorio con enfoque cualitativo, realizado con 14 mujeres, usuarias de un servicio de atención especializada en Juazeiro del Norte-Ceará-Brasil, entre marzo a junio de 2012, utilizando la técnica del Discurso del Sujeto Colectivo. RESULTADOS: se encontraron percepciones equivocadas con respecto al HPV, desconocimiento de la no eliminación del virus mediante la el enfoque terapéutico, sentimientos relatados con características negativas frente al diagnóstico y actitudes de autoprotección y protección a los hijos. CONCLUSIÓN: Las percepciones encontradas tienden a perjudicar el empoderamiento de las mujeres para lidiar con mayor seguridad en esta situación. Lagunas también son mostradas en la educación en salud. Se debe continuar la discusión sobre la temática, con informaciones dirigidas al vivir con el HPV a través de un enfoque singular, respetando la individualidad de cada mujer, tornando la asistencia más humanizada y eficaz.
Assuntos
Humanos , Feminino , Adulto , Papillomaviridae , Mulheres , Saúde da Mulher , Conhecimento , Infecções por Papillomavirus , EmoçõesRESUMO
Human papillomavirus (HPV)16 is the most oncogenic human papillomavirus, responsible for most papillomavirus-induced anogenital cancers. We have explored by sequencing and phylogenetic analysis the viral variant lineages present in 692 HPV16-monoinfected invasive anogenital cancers from Europe, Asia, and Central/South America. We have assessed the contribution of geography and anatomy to the differential prevalence of HPV16 variants and to the nonsynonymous E6 T350G polymorphism. Most (68%) of the variance in the distribution of HPV16 variants was accounted for by the differential abundance of the different viral lineages. The most prevalent variant (above 70% prevalence) in all regions and in all locations was HPV16_A1-3, except in Asia, where HPV16_A4 predominated in anal cancers. The differential prevalence of variants as a function of geographical origin explained 9% of the variance, and the differential prevalence of variants as a function of anatomical location accounted for less than 3% of the variance. Despite containing similar repertoires of HPV16 variants, we confirm the worldwide trend of cervical cancers being diagnosed significantly earlier than other anogenital cancers (early fifties vs. early sixties). Frequencies for alleles in the HPV16 E6 T350G polymorphism were similar across anogenital cancers from the same geographical origin. Interestingly, anogenital cancers from Central/South America displayed higher 350G allele frequencies also within HPV16_A1-3 lineage compared with Europe. Our results demonstrate ample variation in HPV16 variants prevalence in anogenital cancers, which is partly explained by the geographical origin of the sample and only marginally explained by the anatomical location of the lesion, suggesting that tissue specialization is not essential evolutionary forces shaping HPV16 diversity in anogenital cancers.
Assuntos
Neoplasias do Ânus/virologia , Proteínas Oncogênicas Virais/genética , Papillomaviridae/classificação , Neoplasias Penianas/virologia , Proteínas Repressoras/genética , Neoplasias do Colo do Útero/virologia , Neoplasias Vaginais/virologia , Neoplasias Vulvares/virologia , Ásia/epidemiologia , América Central/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Filogenia , Polimorfismo de Nucleotídeo Único , América do Sul/epidemiologiaRESUMO
BACKGROUND AND OBJETIVE: To analyze the prevalence of human papillomavirus (HPV) infection and the possible epidemiological association with conditions of clinical relevance in women. MATERIAL AND METHODS: A cross-sectional study from Mexico City was conducted from January 2012 to December 2014. HPV molecular detection was performed on cervical samples. Data were analyzed with appropriated statistic tests. RESULTS: A total of 1,604 females (median 47, interquartile range 38-54) were analyzed. Global prevalence of infection for any HPV is 9.91% (95% CI 8.6-11.3). An association between infection with 16-HPV and number of abortions (NA) (OR=1.427; 95% CI 1.091-1.866), by univariate regression model (UVRM) was estimated. Moreover, menarche (OR=1.566; 95% CI 1.079-2.272), NA (OR=1.570; 95% CI 1.106-2.227) and number of pregnancies (NP) (OR=0.461; 95% CI 0.260-0.818) have a direct and inverse association with infection by genotype 18 of HPV, respectively. Also, infection with HR-HPV genotypes has an inverse association with NP (OR=0.791; 95% CI 0.707-0.884) by normal labor (OR=0.867; 95% CI 0.767-0.979) and NA (OR=0.715; 95% CI 0.534-0.959) (UVRM), and a direct association with number of sexual partners (OR=1.082; 95% CI 1.015-1.154). Onset of sexual activity has an inverse association with infection by genotype 16- (UVRM: OR=0.814; 95% CI 0.715-0.926; multinomial regression model (MNRM): OR=0.803; 95% CI 0.702-0.918) and HR-HPV (UVRM: OR=0.933; 95% CI 0.889-0.980, and MNRM: OR=0.912; 95% CI 0.867-0.959), all P values were lower than .03. CONCLUSIONS: Prevalence of HPV cervical infection is different according to age and it is associated with several medical conditions of clinical relevance in women.