Serological Detection Of Anti Hpv 16/18 And Its Association With Pap Smear In Adolescents And Young Women [detecção Sorológica De Anti-hpv 16 E 18 E Sua Associação Com Os Achados Do Papanicolaou Em Adolescentes E Mulheres Jovens]

OBJECTIVE. Verify the relation between HPV 16/18 antibodies and the association with cervical cytology findings in adolescents and young women. METHODS. A cross sectional study with 541 healthy and sexually active women from 15 to 25 years of age was carried on from September to November 2000. At gynecological examination, a cervical sample on liquid-base for cytology-testing and a bblood sample for ELISA identification of HPV 16 and 18 antibodies were collected and sent to a reference laboratory in Belgium. Statistical analysis estimated the prevalence and prevalence ratio with a 95% confidence interval. RESULTS. Of these young women, 150 (27.7%) were seropositive: 79 (14.6%) to HPV 16 antibody; 35 (6.4%) to HPV 18 antibody and 36 (6.6%) to both HPV 16/18 antibodies. Cytological abnormalities were detected in 107 cases (20.5%): 63 presented with atypical squamous cells of undetermined significance (ASCUS), 41 were suggestive of low grade squamous intra-epithelial lesion (LGSIL) and 3 of high grade squamous intra-epithelial lesion (HGSIL). Prevalence of abnormal cytology with a positive serology was only 1.75 times that of prevalence of abnormal cytology with a negative serology. Detection of abnormal cytology was not correlated with positive serology. CONCLUSION. Results of this study indicate a high prevalence of HPV 16 and 18 in young healthy women which showed no relation to the abnormal findings of cytology smears.5214347Walboomers, J.M.M., Iacobs, M.V., Mannos, M.M., Bosch, X.F., Kummer, A., Shah, K.V., Human papillomavirus, a necessary cause of invasive cervical cancer wordwide (1999) J Pathol, 189, pp. 12-19Bosch, F.X., Munhoz, N., Manos, M.M., Sherman, M., Iansen, Am., Peto, J., Prevalence of human papillomavirus in cervical cancer: A wordwide perspective (1995) J Natl Cancer Inst, 87, pp. 796-802Schiffman, M.H., Bauer, H.M., Hoover, R.N., Glass, A.G., Cadell, D.M., Rush, B.B., Epidemiologic evidence showing that Human Papillomavirus infection causes most cervical intraepithelial neoplasia (1993) J Natl Cancer Inst, 85, pp. 958-964Bosh, F.X., Lorinez, A., Munoz, N., Meyer, C.J.M.L., Shak, K.V., The casual relation between human papillomavirus and cervical cancer (2002) J Clin Pathol, 55, pp. 244-265Rozendaal, L., Walboomers, J.M., Van Der Linden, J.C., Voorhort, F.J., Kenemans, P., Helmerhorst, T.J., PCR-based high-risk HPV test in cervical cancer secreening gives objective risk assessment of women with cytomorphologically normal cervical smear (1996) Int J Cancer, 68, pp. 766-779Syrjänen, K., Mäntyjärvi, R., Saarikoski, S., Väyrynen, M., Syrjänen, S., Parkkinen, S., Factors associated with progression of cervical human papillomavirus (HPV) infections into carcinoma in situ during a long- Term prospective follow-up (1988) Br J Obstet Gynaecol, 95, pp. 1096-1102(1995) Internacional Agency for Research on Cancer Monograph on the Evaluation of Carcinogenic Riscks to Human. Human Papillomaviruses, 64. , LyonSwygart, C., Human papillomavirus: Disease and laboratory diagnosis (1997) Br J Biomed Sci, 54, pp. 299-303Woodman, C.B., Collins, S., Winter, H., Bailey, A., Ellis, J., Prior, P., Natural history of cervical human papillomavirus infection young women: A longitudinal cohort study (2001) Lancet, 357 (9271), pp. 1831-1836Beutner, K.R., Tyring, S., Human papillomavirus and human disease (1997) Am J Med, 102, pp. 9-15Ho, G.Y.F., Bierman, R., Beardsley, L., Chang, C.J., Burk, R.D., Natural history of cervicovaginal pappilomavirus infection in young women (1998) N Engl J Med, 338, pp. 423-428Zeferino, L.C., Amaral, R.G., Dufloth, R.M., HPV e a neoplasia do colo do útero (2002) Femina, 30, pp. 471-475De Sanjose, S., Santamaria, M., De Alonso Ruiz, P., Aristizabal, N., Guerrero, E., Castellsague, X., HPV types in woman with normal cervical cytology (1992) IARC Sci Publ, 119, pp. 75-84Fahey, M.T., Irwing, L., Macaskill, P., Meta analysis of Pap test accuracy (1995) Am J Epidemiol, 141, pp. 680-689Stoller, M.H., Advances in cervical screening tecnology (2000) Mod Pathol, 13, pp. 275-284Carvalho, J.J.M., Oyakawa, N., (1999) Papilomavírus Humano. I Consenso Brasileiro de HPV, , São RoqueCarter, J.J., Koutsky, L.A., Wipf, G.C., Christensen, N.D., Lee, S.K., Kuypers, J., Kiviat, N., Galloway, The natural history of human papillomavirus type 16 capsid antibodies among a cohort of university women (1996) J Infect Dis, 174, pp. 927-936Coursaget, P., Serology for human papillomavirus (2003) Salud Publica Mex, 45, pp. 361-366Evans, T.G., Bonnez, W., Rose, R.C., Koenig, S., Demeter, L., Suzich, J.Á., A phase 1 study of a recombinant viruslike particle vaccine against human papillomavirus type 11 in health adult volunteers (2001) J Infect Dis, 183, pp. 1485-1493Wideroff, L., Schiffman, M.H., Haderer, P., Armstrong, A., Geer, C.E., Manos, M.M., Seroreactivity to human papillomavirus type 16, 18, 31 and 45 VLP in a case control study of cervical squamous intraephitelial lesions (1999) J Infect Dis, 180, pp. 1424-1428The 1988 Bethesda system for reporting cervical/ vaginal cytologic diagnosis (1988) Acta Cytol, pp. 567-571Kinrbauer, R., Hubbert, N.L., Wheeler, C.M., Becker, T.M., Lowy, D.R., Schiller, J.T., A virus like particle enzyme-linked immunosorbent assay detects serum antibodies in a majority of women infected with human papillomavirus type 16 (1994) J Natl Cancer Inst, 86, pp. 494-49

Prevalence Of Genital Hpv Infection Among Women Screened For Cervical Cancer [prevalência Do Hpv Em Mulheres Rastreadas Para O Câncer Cervical]

Objective: To assess the prevalence of high-risk genital human papillomavirus (HPV) infection by age group and risk factors associated. Methods: Cross-sectional study in a sample of 2,300 women (15-65 years old) who self-referred to cervical cancer screening in Sao Paulo and Campinas, Southeastern Brazil, between February 2002 and March 2003. An epidemiological questionnaire was applied and cervical specimens were obtained for cytology and hybrid capture II test (HCII) for HPV detection. Statistical analysis included Pearson Chi-square and unconditional multiple logistic regression model (forward likelihood ratio). Results: High-risk genital HPV infection prevalence in this sample was 17.8% and age distribution was as follows: 27.1% (<25 years), 21.3% (25-34 years), 12.1% (35-44 years), 12.0% (45-54 years) and 13.9% (55-65 years). Subjects with the highest number of lifetime sexual partners had the highest rates of genital HPV infection. To be living with a partner, aged 35 to 44 years, and former smokers were protective factors. High-risk genital HPV infection was 14.3% in normal cytology, 77.8% in high grade squamous intraepithelial lesions and in the two cases (100%) of cervical cancer. Conclusions: High-risk HPV prevalence was high in the sample studied. The highest prevalence of HPV infection was seen in women under 25 years old and then a new increase was seen over the age of 55 and the highest rates were found among those with many sexual partners during their lifetime.421123130Baseman, J.G., Koutsky, L.A., The epidemiology of human papillomavirus infections (2005) J Clin Virol, 32 (SUPPL. 1), pp. S16-S24Bauer, H.M., Hildesheim, A., Schiffman, M.H., Glass, A.G., Rush, B.B., Scott, D.R., Determinants of genital human papillomavirus infection in low-risk women in Portland, Oregon (1993) Sex Transm Dis, 20 (5), pp. 274-278Bosch, F.X., Lorincz, A., Muñoz, N., Meijer, C.J., Shah, K.V., The causal relation between human papillomavirus and cervical cancer (2002) J Clin Pathol, 55 (4), pp. 244-265Burk, R.D., Kelly, P., Feldman, J., Bromberg, J., Vermund, S.H., DeHovitz, J.A., Declining prevalence of cervicovaginal human papillomavirus infection with age is independent of other risk factors (1996) Sex Transm Dis, 23 (4), pp. 333-341Castle, P.E., Schiffman, M., Herrero, R., Hildesheim, A., Rodriguez, A.C., Bratti, M.C., A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica (2005) J Infect Dis, 191 (11), pp. 1808-1816Clifford, G.M., Gallus, S., Herrero, R., Munñoz, N., Snijders, P.J.F., Vaccarella, S., Worldwide distribution of Human papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: A pooled analysis (2005) Lancet, 366 (9490), pp. 991-998Eluf-Neto, J., Nascimento, C.M., Cervical cancer in Latin America (2001) Semin Oncol, 28 (2), pp. 188-197Ferreccio, C., Prado, R.B., Luzoro, A.V., Ampuero, S.L., Snijders, P.J., Meijer, C.J., Population-based prevalence and age distribution of human papillomavirus among women in Santiago, Chile (2004) Cancer Epidemiol Biomarkers Prev, 13 (12), pp. 2271-2276Franco, E.L., Villa, L.L., Sobrinho, J.P., Prado, J.M., Rousseau, M.C., Désy, M., Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer (1999) J Infect Dis, 180 (5), pp. 1415-1423Giuliano, A.R., Papenfuss, M., Abrahamsen, M., Denman, C., Zapien, J.G., Henze, J.L., Human papillomavirus infection at the United States-Mexico border (2001) Cancer Epidemiol Biomarkers Prev, 10 (11), pp. 1129-1136Giuliano, A.R., Papenfuss, M.R., Denman, C.A., Guemsey de Zapien, J., Abrahamsen, M., Hunter, J.B., Human papillomavirus prevalence at the USA - Mexico Border among women 40 years of age and older (2005) Int J STD AIDS, 16 (3), pp. 247-251Herrero, R., Hildesheim, A., Bratti, C., Sherman, M.E., Hutchinson, M., Morales, J., Population based study of hpv infection and cervical neoplasia in rural Costa Rica (2000) J Natl Cancer Inst, 92 (6), pp. 464-474Herrero, R., Castle, P.E., Schiffman, M., Bratti, M.C., Hildesheim, A., Morales, J., Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica (2005) J Infect Dis, 191 (11), pp. 1796-1807Hosmer, D.W., Lemeshow, S., (1989) Applied logistic regression, , New York: Wiley;Kjaer, S.K., Svare, E.I., Worm, A.M., Walboomers, J.M., Meijer, C.J., Van den Brule, A.J., Human papillomavirus infection in Danish female sex workers: Decreasing prevalence with age despite continuously high sexual activity (2000) Sex Transm Dis, 27 (8), pp. 438-445Lazcano-Ponce, E., Herrero, R., Muñoz, N., Cruz, A., Shah, K.V., Alonso, P., Epidemiology of HPV infection among Mexican women with normal cervical cytology (2001) Int J Cancer, 91 (3), pp. 412-420Lorincz, A.T., Screening for cervical cancer: New alternatives and research (2003) Salud Publica Mex, 45 (SUPPL. 3), pp. S376-S387Matos, E., Loria, D., Amestoy, G.M., Herrera, L., Prince, M.A., Moreno, J., Prevalence of human papillomavirus infection among women in Concórdia, Argentina: A population-based study (2003) Sex Transm Dis, 30 (8), pp. 593-599Rama, C.H., Roteli-Martins, C.M., Derchain, S.F.M., Oliveira, E.Z., Mariani-Neto, C., Aldrighi, J.M., Detecção sorológica de anti HPV 16 e 18 e sua associação com achados do Papanicolaou em adolescentes e mulheres jovens. (2006) Rev Assoc Med Bras, 52 (1), pp. 43-47Sanjose, S., Almirall, R., Lloveras, B., Font, R., Diaz, M., Muñoz, N., Cervical human papillomavirus infection in the female population in Barcelona, Spain (2003) Sex Transm Dis, 30 (10), pp. 788-793Solomon, D., Davey, D., Kurman, R., Moriarty, A., O'Connor, D., Prey, M., The 2001 Bethesda System: Terminology for reporting results of cervical cytology (2002) JAMA, 287, pp. 2114-2119Syrjänen, K., Naud, P., Derchain, S., Roteli-Martins, C., Longatto-Filho, A., Tatti, S., Comparing Pap smear cytology, aided visual inspection, screening colposcopy, cervicography and HPV testing as optional screening tools in Latin America. Study design and baseline data of the LAMS study (2005) Anticancer Res, 25 (5), pp. 3469-3480Thomas, J.O., Herrero, R., Omigbodun, A.A., Ojemakinde, K., Ajayi, I.O., Fawole, A., Prevalence of papillomavirus infection in women in Ibadan, Nigeria: A population-based study (2004) Br J Cancer, 90 (3), pp. 638-645Trottier, H., Franco, E.L., The. epidemiology of genital human papillomavirus infection (2006) Vaccine, 24 (SUPPL. 1), pp. S1-15Walboomers, J.M.M., Jacobs, M.V., Manos, M.M., Bosch, F.X., Kummer, J.A., Shah, K.V., Human papillomavirus is a necessary cause of invasive cervical cancer worldwide (1999) J Pathol, 189 (1), pp. 12-1

Association Between Age At First Sexual Intercourse And Subsequent Human Papillomavirus Infection: Results Of A Brazilian Screening Program [associação Entre Idade Ao Início Da Atividade Sexual E Subsequente Infecção Por Papilomavírus Humano: Resultados De Um Programa De Rastreamento Brasileiro]

PURPOSE: to investigate women's age at their first sexual intercourse and its correlation with their present age, human papillomavirus (HFV] infection and cylological abnormalities at Pap smear. METHODS: women from the general population were invited to be screened for cervical cancer and pre-malignant lesions. After answering a behavior questionnaire, they were submitted lo screening with cervical cytology and high-risk HPV testing with Hybrid Capture 2 (HC2). This report is part of the Latin American Screening (LAMS) study, that comprises centers from Brazil and Argentina, and the data presented herein refer to the Brazilian women evaluated at the cities of Porto Alegre, São Paulo and Campinas. RESULTS: from 8,049 women that answered the questionnaire, 8,041 reported previous sexual activity and were included in this analysis. The mean age at the interview was 38.1±11.0 years and the mean age at the first sexual intercourse was 18.5±4.0 years. The age at the first sexual intercourse increased along with the age at the interview, i.e., younger women reported they had begun their sexual life earlier than older women (p<0.001). From the total of women who had already begun having sexual intercourse, 3,043 patients were tested for high-risk HPV infection and 17.3% of them had positive results. In all the centers, it became clear that the women with the first sexual intercourse at ages below the mean age of all the population interviewed presented higher rates of HPV infection (20.2%) than the women with the first sexual intercourse at ages above the mean (12.5%) - Odds Ratio (OR) 1.8 (IC95% 1.5-2.2;p<0,001). According to the cytology, the women with first sexual intercourse at ages under the mean, presented higher percentage of abnormal cytology ≥ASC-US (0.7%) than the women with the first sexual intercourse at ages above the mean (4.3%) - OR 1.6 (IC95% 1.3-2.;p<0.001). CONCLUSIONS: the high-risk HPV infection and cylological abnormalities identified during the asymptomatic population screening were significantly associated to the women's age at the first sexual intercourse. Additionally, we have also identified that the women's age at the first sexual intercourse has decreased during the last decades, suggesting an important contribution to the increase of HPV infection and the subsequent cervical lesions.2911580587Castle, P.E., Schiffmann, M., Herrero, R., Hildesheim, A., Rodríguez, A.C., Bratti, M.C., el al, A prospective study of age trends in cervical humman papillomavirus acquisition and persistence in Guanacaste, Costa Rica (2005) J Infect Dis, 191 (11), pp. 1808-1816Giuliana, A.R., Harris, R., Sedjo, R.L., Baldwin, S., Roe, D., Papenfuss, M.R., Incidence, prevalence, and clearance of type-specific human papillomavirus infections: The Young Women's Health Study (2002) J Infect Dis, 186 (4), pp. 462-469Schlecht, N.F., Kulaga, S., Robitaille, J., Ferreira, S., Santos, M., Miyamura, R.A., Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia (2001) JAMA, 286 (24), pp. 3106-3114Walboomers, J.M., Jacobs, M.V., Manos, M.M., Bosch, F.X., Kummer, J.A., Shah, K.V., Human papillomavirus is a necessary cause of invasive cervical cancer worldwide (1999) J Pathol, 189 (1), pp. 12-19(1995) Monographs on the evaluation of carcinogenic risks to humans: Human papillomaviruses, 64. , International Agency for Research on Cancer IARC, Lyon: IARC;(2005) Monographs on the evaluation of carcinogenic risks to humans: Human papillomaviruses, 90. , International Agency for Research on Cancer IARC, Lyon: IARC;Ho, G.Y.F., Bierman, R., Beardsley, L., Chang, C.J., Burk, R.D., Natural history of cervicovaginal papillomavirus infection in young women (1998) N Engl J Med, 338 (7), pp. 423-428Bosch, F.X., Lorincz, A., Muñoz, N., Meijer, C.J., Shah, K.V., The causal relation between human papillomavirus and cervical cancer (2002) J Clin Pathol, 55 (4), p. 24445Myers, E.R., McCrory, D.C., Nanda, K., Bastian, L., Matchar, D.B., Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis (2000) Am J Epidemiol, 151 (12), pp. 1158-1171Bekkers, R.L., Meijer, C.J., Massuger, L.F., Snijders, P.J., Melchers, W.J., Effects of HPV detection in population-based screening programmes for cervical cancer: A Dutch moment (2006) Gynecol Oncol, 100 (3), pp. 451-454Bory, J.P., Cucherousset, J., Lorenzato, M., Gabriel, R., Quereux, C., Birembaut, P., Recurrent human papillomavirus infection detected with the hybrid capture II assay selects women with normal cervical smears at risk for developing high grade cervical lesions: A longitudinal study of 3,091 women (2002) Int J Cancer, 102 (5), pp. 519-525Kahn, J.A., Rosenthal, S.L., Succop, P.A., Ho, G.Y., Burk, R.D., The interval between menarche and age of first sexual intercourse as a risk factor for subsequent HPV infection in adolescent and young adult women (2002) J Pediatr, 141 (5), pp. 718-723Baseman, J.G., Koulsky, L.A., The epidemiology of human papillomavirus infections (2005) J Clin Virol, 32 (SUPPL. 1), pp. S16-S24Koutsky, L., Epidemiology of genital human papillomavirus infection (1997) Am J Med, 102 (5 A), pp. 3-8Moscicki, A.B., HPV infections in adolescents (2007) Dis Markers, 23 (4), pp. 229-234Kahn, J.A., Rosenthal, S.L., Succop, P.A., Ho, G.Y., Burk, R.D., Mediators of the association between age of first sexual intercourse and subsequent human papillomavirus infection (2002) Pediatrics, 109 (1), pp. E5Villa LL, Ault KA, Giuliano AR, Costa RL, Petta CA, Andrade RP, et al. Immunologic responses following administration of a vaccine targeting human papillomavirus Types 6, 11, 16, and 18. Vaccine. 2006;24(27-28):5571-83Harper, D.M., Franco, E.L., Wheeler, C.M., Moscicki, A.B., Romanowski, B., Roteli-Martins, C.M., Sustained efficacy up to 4.5 years of a bivalent LI virus-like particle vaccine against human papillomavirus types 16 and 18: Follow-up from a randomised control trial (2006) Lancet, 367 (9518), p. 124755Bosch, X., Harper, D., Prevention strategies of cervical cancer in the HPV vaccine era (2006) Gynecol Oncol, 103 (1), pp. 21-24Syrjänen, K., Naud, P., Derchain, S., Roteli-Martins, C., Longatto-Filho, A., Tatti, S., Comparing PAP smear cytology, aided visual inspection, screening colposcopy, cervicography and HPV testing as optional screening tools in Latin America. Study design and baseline data of the LAMS study (2005) Anticancer Res, 25 (5), pp. 3469-3480Signorelli, C., Colzani, E., Age at first intercourse and HPV immunization (2007) J Prev Med Hyg, 48 (2), pp. 37-38Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: Collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies (2007) Int J Cancer, 120 (4), pp. 885-891. , International Collaboration of Epidemiological Studies of Cervical CancerCollins, S.I., Mazloomzadeh, S., Winter, H., Rollason, T.P., Blomfield, P., Young, L.S., Proximity of first intercourse to menarche and the risk of human papillomavirus infection: A longitudinal study (2005) Int J Cancer, 114 (3), pp. 498-500Moscicki, A.B., Cervical cytology screening in teens (2003) Curr Womens Health Rep, 3 (6), pp. 433-437Trottier, H., Franco, E.L., Human papillomavirus and cervical cancer: Burden of illness and basis for prevention (2006) Am J Manag Care, 12 (17 SUPPL.), pp. S462-S472Kjaer, S., Hogdall, E., Frederiksen, K., Munk, C., van den Brule, A., Svare, E., The absolute risk of cervical abnormalities in high-risk human papillomavirus-positive, cytologically normal women over a 10-year period (2006) Cancer Res, 66 (21), pp. 10630-10636Koutsky, L.A., Holmes, K.K., Critchlow, C.W., Stevens, C.E., Paavonen, J., Beckmann, A.M., A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection (1992) N Engl J Med, 327 (18), pp. 1272-1278Pereira, C.R., Rosa, M.L., Vasconcelos, G.A., Faria, P.C., Cavalcanti, S.M., Oliveira, L.H., Human papillomavirus prevalence and predictors for cervical cancer among high-risk women from Rio de Janeiro, Brazil (2007) Int J Gynecol Cancer, 17 (3), pp. 651-660Bosch, F.X., Munoz, N., De Sanjose, S., Izarzugaza, I., Gili, M., Viladiu, P., Risk factors for cervical cancer in Colombia and Spain (1992) Int J Cancer, 52 (5), pp. 750-758Moscicki AB, Schiffman M, Kjaer S, Villa LL Chapter 5: Updating the natural history of HPV and anogenital cancer. Vaccine. 2006;24 Suppl 3:S42-51Winer, R.L., Lee, S.K., Hughes, J.P., Adam, D.E., Kiviat, N.B., Koutsky, L.A., Genital human papillomavirus infection: Incidence and risk factors in a cohort of female university students (2003) Am J Epidemiol, 157 (3), pp. 218-226Snijders, P.J., Steenbergen, R.D., Heideman, D.A., Meijer, C.J., HPV-mediated cervical carcinogenesis: Concepts and clinical implications (2006) J Pathol, 208 (2), pp. 152-164Moscicki, A.B., Hills, N., Shiboski, S., Powel, K., Jay, N., Hanson, E., Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females (2001) JAMA, 285 (23), pp. 2995-3002Naud, P., Matos, J., Hammes, L., Stuckzynski, J., Brouwers, K., Magno, V., Factors predicting intermediate endpoints of cervical cancer and exposure to human papillomavirus (HPV) infections in young women screened as potential targets for prophylactic HPV vaccination in south of Brazil (2006) Eur J Obstet Gynecol Reprod Biol, 124 (1), pp. 110-118Leite APL. Sexualidade na adolescência: conhecimentos, atitudes e práticas dos adolescentes estudantes do município de Maceió. Rev Bras Ginecol Obstet. 2001;23(2):124. Crosbie EJ, Kitchener HC. Human papillomavirus in cervical screening and vaccination. Clin Sei (Lond). 2006;110(5):543-52Arbyn M, DillnerJ. Review of current knowledge on HPV vaccination: an appendix to the European Guidelines for Quality Assurance in Cervical Cancer Screening. J Clin Virol. 2007,-38(3):189-97Manhart, L.E., Holmes, K.K., Koutsky, L.A., Wood, T.R., Kenney, D.L., Feng, Q., Human papillomavirus infection among sexually active young women in the United States: Implications for developing a vaccination strategy (2006) Sex Transm Dis, 33 (8), pp. 502-508Kahn, J.A., Vaccination as a prevention strategy for human papillomavirus-relaled diseases (2005) J Adolesc Health, 37 (6 SUPPL.), pp. S10-S1

Human papillomavirus status and cervical abnormalities in women from public and private health care in Rio de Janeiro State, Brazil Papilomavírus humano e anormalidades cervicais em mulheres do sistema de saúde privado e público no Estado do Rio de Janeiro, Brasil

This article reports the HPV status and cervical cytological abnormalities in patients attended at public and private gynecological services from Rio de Janeiro State. It also comments the performance of each HPV DNA tests used. A set of 454 women from private health clinics was tested by routine Capture Hybrid II HPV DNA assay. Among these, 58.4% presented HPV and nearly 90% of them were infected by high risk HPV types. However, this group presented few premalignant cervical lesions and no invasive cervical cancer was registered. We also studied 220 women from low income class attended at public health system. They were HPV tested by polymerase chain reaction using My09/11 primers followed by HPV typing with E6 specific primers. The overall HPV prevalence was 77.3%. They also showed a high percentage of high squamous intraepithelial lesion-HSIL (26.3%), and invasive cervical carcinoma (16.3%). HPV infection was found in 93.1% and 94.4% of them, respectively. The mean ages in both groups were 31.5 and 38 years, respectively. In series 1, HPV prevalence declined with age, data consistent with viral transient infection. In series 2, HPV prevalence did not decline, independent of age interval, supporting not only the idea of viral persistence into this group, but also regional epidemiological variations in the same geographic area. Significant cytological differences were seen between both groups. Normal and benign cases were the most prevalent cytological findings in series 1 while pre-malignant lesions were the most common diagnosis in the series 2. HPV prevalence in normal cases were statistically higher than those from series 1 (p < 0.001), indicating a higher exposure to HPV infection. Women from both samples were referred for previous abnormal cytology. However, socio-demographic evidence shows that women from series 1 have access to treatment more easily and faster than women from series 2 before the development of pre-malignant lesions. These data provides baseline support for the role of social inequalities linked to high risk HPV infection leading to cervical cancer. Broadly screening programs and the development of safe and effective vaccines against HPV would diminish the toll of this disease that affect mainly poor women.<br>Este artigo analisa a infecção por HPV e anormalidades citológicas cervicais encontradas em pacientes atendidas em serviços ginecológicos dos sistemas de saúde público e privado do estado do Rio de Janeiro. O trabalho também avalia os testes utilizados para detecção de DNA do HPV em cada população estudada. Um grupo de 454 mulheres oriundas de serviços da rede privada de saúde foi testado por Captura do Híbrido II. Destas, 58,4% apresentaram infecção por HPV e cerca de 90% delas estavam infectadas por HPV de alto risco. Este grupo, entretanto, apresentava poucos casos de lesões cervicais pré-malígnas e nenhum caso de câncer. Estudamos, também, 220 mulheres de baixo nível econômico atendidas no serviço de saúde pública que foram testadas para HPV pela reação da polimerase em cadeia utilizando-se os oligonucleotídeos My09/My11. A identificação dos tipos foi efetuada por amplificação com oligonucleotídeos específicos para a região E6 do genoma viral. A prevalência de HPV nesta população foi de 77.3%, observando-se uma alta porcentagem de casos de neoplasias intraepiteliais cervicais de alto grau (26,3%) e de carcinoma cervical invasivo (16,3%). A infecção por HPV foi achada em, respectivamente, 93,1% e 94,4% destes casos. A média de idade em ambos os grupos era de 31,5 e 38 anos, respectivamente. Na série 1, a prevalência da infecção por HPV decresce com a idade, enquanto na série 2 ela não desaparece, dando suporte não só à idéia de persistência viral neste grupo, mas também a variações epidemiológicas na mesma área geográfica. Diferenças significativas foram vistas nos dois grupos. Casos normais e benignos foram incidentes na série 1, enquanto as lesões malígnas predominaram na série 2. Ao contrário, casos normais infectados por HPV eram prevalentes na série 2 (p < 0.001), indicando maior exposição ao vírus. Embora as mulheres de ambos os grupos tenham sido incluídas no estudo por apresentarem citologia anormal, evidências sócio-demográficas demonstram que mulheres da série 1 tem acesso mais fácil e rápido ao tratamento do que as mulheres da série 2 antes que as lesões pré-malígnas se desenvolvam. Estes resultados fornecem dados sobre o papel das desigualdades sociais associadas à infecção por HPV de alto risco na progressão do câncer cervical. Programas de prevenção abrangentes e o desenvolvimento de vacinas eficazes e seguras contra o HPV poderiam reduzir o tributo desta doença que afeta principalmente mulheres pobres