Prevalence of human papillomavirus infection among women from quilombo communities in northeastern Brazil

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Abstract

Background

Human papillomavirus (HPV) is a member of the Papillomaviridae family. The prevalence of HPV genotypes may vary according to the region and the population studied. Quilombo communities are ethnic and racial groups with difficult access to health services compared to the general population in Brazil. The aim of this study was to identify specific HPV types correlating with sociodemographic/behavioral characteristics and cervical smear cytological abnormalities in Quilombola women.

Methods

This cross-sectional study included 395 Quilombola women users of the Unified Health System of the Municipalities of Maranhão for the screening of cervical cancer. The samples were analyzed for the presence of cytological abnormalities by conventional methods and tested for 37 HPV genotypes using polymerase chain reaction with primers PGMY09/11 followed by reverse line blot hybridization performed with the Linear Array HPV Genotyping Test kit by Roche Molecular System®. The association between HPV types and cytological diagnosis was investigated according to the different age groups.

Results

HPV infection was detected in 12.6% (50/395) of the women. Infections by high-risk HPV types were more frequent. Genotypes 68 (26.0%); 58 and 52 (20.0%); 31 (10.0%) and 62 (8.0%) were the most prevalent. The highest prevalence (42.0%) of HPV infection occurred in women diagnosed with high-grade squamous intraepithelial lesion. There was a statistically significant association between HPV infection and the detection of cytological abnormalities in all age groups except in women over 60 years. There was a statistically significant association between the municipality of origin and the number of partners with HPV infection.

Conclusions

It is important to incorporate new cervical cancer screening techniques incorporating the cervical-vaginal cytology. For further studies, it is necessary to determine the level of knowledge of Quilombola population on health-related issues including HPV infection and cervical cancer. This will contribute to the continuous improvement of healthcare coverage among the population and enhance the implementation of cancer care in the state of Maranhão.

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Most cited references 29

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Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia.

F. BOSCH, Ann Burchell, Mark Schiffman … (2008)

Worldwide human papillomavirus (HPV) prevalence in women with normal cytology at any given point in time is approximately 10% indicating that HPV is one of the most common sexually transmitted infections. HPV-16 is consistently the most common type and HPV-18 the second with some minor regional differences. Furthermore, across the spectrum of cervical lesions, HPV-16 is consistently the most common HPV type contributing to 50-55% of invasive cervical cancer cases strongly suggesting that this viral type has a biological advantage for transmission, persistency and transformation. The same phenomenon is observed albeit at a lower level for HPV-18 and HPV-45. Sexual behavioral patterns across age groups and populations are central to the description of the HPV circulation and of the risk of infection. The concept of group sexual behavior (in addition to individual sexual behavior) is important in exploring HPV transmission and has implications for defining and monitoring HPV and cancer prevention strategies. In natural history studies, the pattern of HPV DNA prevalence by age groups is similar to the patterns of HPV incidence. Rates of exposure in young women are high and often include multiple types. There is a spontaneous and rapid decrease of the HPV DNA detection rates in the middle-age groups followed by a second rise in the post-menopausal years. This article reviews: 1) the evidence in relation to the burden of HPV infections in the world and the contributions of each HPV type to the spectrum of cervical cellular changes spanning from normal cytology to invasive cervical cancer; 2) the critical role of the patterns of sexual behavior in the populations; and 3) selected aspects of the technical and methodological complexity of natural history studies of HPV and cervical neoplasia.

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Improved amplification of genital human papillomaviruses.

P E Gravitt, C Peyton, T Alessi … (2000)

Genital human papillomaviruses (HPVs) are commonly detected from clinical samples by consensus PCR methods. Two commonly used primer systems, the MY09-MY11 (MY09/11) primers and the GP5+-GP6+ (GP5+/6+) primers, amplify a broad spectrum of HPV genotypes, but with various levels of sensitivity among the HPV types. Analysis of the primer-target sequence homology for the MY09/11 primers showed an association between inefficient amplification of HPV types and the number and position of mismatches, despite accommodation of sequence variation by inclusion of degenerate base sites. The MY09/11 primers were redesigned to increase the sensitivity of amplification across the type spectrum by using the same primer binding regions in the L1 open reading frame. Sequence heterogeneity was accommodated by designing multiple primer sequences that were combined into an upstream pool of 5 oligonucleotides (PGMY11) and a downstream pool of 13 oligonucleotides (PGMY09), thereby avoiding use of degenerate bases that yield irreproducible primer syntheses. The performance of the PGMY09-PGMY11 (PGMY09/11) primer system relative to that of the standard MY09/11 system was evaluated with a set of 262 cervicovaginal lavage specimens. There was a 91.5% overall agreement between the two systems (kappa = 0.83; P < 0.001). The PGMY09/11 system appeared to be significantly more sensitive than the MY09/11 system, detecting an additional 20 HPV-positive specimens, for a prevalence of 62.8% versus a prevalence of 55.1% with the MY09/11 system (McNemar's chi(2) = 17.2; P < 0.001). The proportion of multiple infections detected increased with the PGMY09/11 system (40. 0 versus 33.8% of positive infections). HPV types 26, 35, 42, 45, 52, 54, 55, 59, 66, 73, and MM7 were detected at least 25% more often with the PGMY09/11 system. The PGMY09/11 primer system affords an increase in type-specific amplification sensitivity over that of the standard MY09/11 primer system. This new primer system will be useful in assessing the natural history of HPV infections, particularly when the analysis requires HPV typing.

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Chapter 1: HPV in the etiology of human cancer.

Nubia Muñoz, Xavier Castellsagué, Amy Berrington de Gonzalez … (2006)

The causal role of human papillomavirus (HPV) in all cancers of the uterine cervix has been firmly established biologically and epidemiologically. Most cancers of the vagina and anus are likewise caused by HPV, as are a fraction of cancers of the vulva, penis, and oropharynx. HPV-16 and -18 account for about 70% of cancers of the cervix, vagina, and anus and for about 30-40% of cancers of the vulva, penis, and oropharynx. Other cancers causally linked to HPV are non-melanoma skin cancer and cancer of the conjunctiva. Although HPV is a necessary cause of cervical cancer, it is not a sufficient cause. Thus, other cofactors are necessary for progression from cervical HPV infection to cancer. Long-term use of hormonal contraceptives, high parity, tobacco smoking, and co-infection with HIV have been identified as established cofactors; co-infection with Chlamydia trachomatis (CT) and herpes simplex virus type-2 (HSV-2), immunosuppression, and certain dietary deficiencies are other probable cofactors. Genetic and immunological host factors and viral factors other than type, such as variants of type, viral load and viral integration, are likely to be important but have not been clearly identified.

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Author and article information

Contributors

Maria do Desterro Soares Brandão Nascimento: +55-98-3272-8535 , cnsd_ma@uol.com.br

Flávia Castello Branco Vidal: flavidaly@yahoo.com.br

Marcos Antonio Custódio Neto da Silva: marcos_antonio456@hotmail.com

José Eduardo Batista: jbatistaufma@gmail.com

Maria do Carmo Lacerda Barbosa: carminha13032009@hotmail.com

Walbert Edson Muniz Filho: walbert.muniz@hotmail.com

Geusa Felipa de Barros Bezerra: geusabezerra@yahoo.com.br

Graça Maria de Castro Viana: gracaviana@globo.com

Rebeca Costa Castelo Branco: bebecacastelo@hotmail.com

Luciane Maria Oliveira Brito: luciane2406@yahoo.com.br

Journal

Journal ID (nlm-ta): BMC Womens Health

Journal ID (iso-abbrev): BMC Womens Health

Title: BMC Women's Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6874

Publication date (Electronic): 2 January 2018

Publication date PMC-release: 2 January 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 1

Affiliations

[1 ]ISNI 0000 0001 2165 7632, GRID grid.411204.2, Department of Pathology, Center of Biological and Health Sciences, , Federal University of Maranhão, ; São Luís, Brazil

[2 ]ISNI 0000 0001 2165 7632, GRID grid.411204.2, Department of Morphology, Center of Biological and Health Sciences, , Federal University of Maranhão, ; São Luís, Brazil

[3 ]ISNI 0000 0001 2165 7632, GRID grid.411204.2, Federal University of Maranhão, ; São Luís, Brazil

[4 ]ISNI 0000 0001 2165 7632, GRID grid.411204.2, Post-graduate Program in Adult and Child Health, , Federal University of Maranhão, ; São Luís, Brazil

[5 ]ISNI 0000 0001 2165 7632, GRID grid.411204.2, Department of Medicine I, Center of Biological and Health Sciences, , Federal University of Maranhão, ; São Luís, Brazil

[6 ]ISNI 0000 0001 2165 7632, GRID grid.411204.2, Department of Medicine III, Center of Biological and Health Sciences, , Federal University of Maranhão, ; São Luís, Brazil

[7 ]Núcleo de Imunologia Básica e Aplicada, Avenida dos Portugueses, 1966, Bacanga. Prédio do CCBS, Bloco 3, Sala 3A, São Luís – MA, CEP 65080-805 Brazil

Article

Publisher ID: 499

DOI: 10.1186/s12905-017-0499-3

PMC ID: 5748955

PubMed ID: 29291721

SO-VID: add3c891-6748-474c-bb7c-3a8a234378ba

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 15 September 2016

Date accepted : 15 December 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100003758, Fundação de Amparo à Pesquisa e ao Desenvolvimento Científico e Tecnológico do Maranhão;

Award ID: 01363/2009

Award Recipient : Maria do Desterro Soares Brandão Nascimento

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: human papillomavirus (hpv),prevalence,risk factors,genotypes,cervical cancer,pap smear,quilombola women

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: human papillomavirus (hpv), prevalence, risk factors, genotypes, cervical cancer, pap smear, quilombola women

Prevalence of human papillomavirus infection among women from quilombo communities in northeastern Brazil

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Abstract

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Conclusions

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Karger: Oncology

Most cited references 29

Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia.

Improved amplification of genital human papillomaviruses.

Chapter 1: HPV in the etiology of human cancer.

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