The natural history of human papillomavirus infection

Therapeutic options for human papillomavirus-positive tonsil and base of tongue cancer

The incidences of human papillomavirus-positive (HPV+) tonsillar and base tongue squamous cell carcinomas (TSCC and BOTSCC) have increased in recent decades. Notably, HPV+ TSCC and BOTSCC have a significantly better prognosis than their HPV-negative counterparts when treated with current surgical options, radiotherapy, or intensified chemoradiotherapy. However, a cure is not achieved in 20% of patients with HPV+ TSCC/BOTSCC. Meanwhile, cured patients often present with severe chronic side effects. This necessitates novel tailored alternatives, such as targeted therapy, immune checkpoint inhibitors (ICIs), and treatment de-escalation, together with better follow-up. Current precision medicine therefore focuses on detecting predictive and driver cancer genes to better stratify patient treatment, provide those with poor prognostic markers targeted therapy, and select those with favorable markers for de-escalated therapy. Moreover, detecting cell-free HPV DNA (cfHPV DNA) in plasma before and after treatment has been attempted to improve follow-up. In this context, this perspective discusses the significance of optimally defining HPV+ status, which requires HPV DNA and p16INKa overexpression, using prognostic markers, such as high CD8+ T-cell counts and HPV E2 mRNA expression, tumor size, and following cfHPV DNA for patient selection for specific therapies. Clinical trials with ICI with/without chemotherapy, targeted therapy with specific inhibitors-such as phosphoinositide 3-kinase and fibroblast growth factor receptor inhibitors-or immune therapy with various HPV-based vaccines for treating recurrences have yielded promising results.

Human Papillomavirus Infections and Sequela in Women

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, with up to 90% of females infected at some point in their lifetime. While most HPV infections will be cleared by the immune system within 2 years, persistent HPV infection may result in anogenital warts, dysplasia of the cervix, vagina, vulva, and squamous cell carcinoma. This chapter will review the epidemiology, microbiology, progression, and treatment of HPV-related genital disease in women.

Effect of human papillomavirus infection on semen quality and assisted reproductive technology outcomes: a prospective observational cohort study

BACKGROUND

Human papillomavirus (HPV) adversely affects human reproduction. We aimed to evaluate the prevalence of HPV infection in men and its correlation with semen parameters and reproductive outcomes.

METHODS

In this prospective observational cohort study, 384 semen samples were collected from 237 male partners of infertile couples. The presence of HPV DNA and genotyping were analyzed in semen by quantitative PCR. A total of 186 intrauterine inseminations (IUI) in 101 couples and 186 assisted reproduction techniques (ART) cycles in 155 couples were performed. Associations between HPV positivity and semen parameters and fertility outcomes were evaluated using a generalized linear mixed model.

RESULTS

The prevalence of HPV was 22.7%. Twenty-three HPV types were detected and 69.5% of positive samples presented at least one high risk (HR)-HPV genotype. HPV-18 (14%), HPV-53 (10%), and HPV-56 (10%) were the most prevalent HR-HPV genotypes followed by HPV-16, HPV-31, and HPV-51 (8%). HPV-42 was the most prevalent low risk (LR)-HPV genotype (25%). More than one HPV type was detected in 41% of HPV + samples. After capacitation, 30% of HPV + samples remained positive. We found no relationship between HPV infection and sperm volume, sperm concentration, and progressive motility both before and after semen capacitation. We observed a not significant different clinical pregnancy per cycle in the HPV - (6.8%) and HPV + (5.0%) IUI. We did not find any significant difference in fertilization, cleavage, quality of developed embryos, blastocyst formation nor in embryo utilization of ART cycles. Slightly lower cumulative pregnancy (33% vs 39%) and live-birth (25% vs 30%) rates and higher miscarriage rate (53% and 29%) were observed in HPV + with respect to HPV - cycles. Fifty-five neonatal outcomes from HPV - (n = 45) and HPV + (n = 10) cycles were available. No stillbirths as well as no malformations were recorded.

CONCLUSIONS

This study confirmed previous findings that HPV DNA is present in semen of one quarter of infertile couples. No significant association of seminal HPV presence with semen parameters was found. We observed a trend of worst clinical outcomes in the HPV + group that is worth further investigation in a large population to draw definitive conclusions.

The role of photodynamic therapy in treating LSIL in women with high-risk HPV: a literature review

Photodynamic therapy has become a promising non-invasive method for the treatment of LSIL associated with HR-HPV infections. This literature review assesses the efficacy, safety, and clinical relevance of PDT for managing HPV-related cervical lesions. PDT employs photosensitizers, such as 5-aminolevulinic acid, which selectively accumulate in abnormal cervical tissues. When subjected to particular wavelengths of light, these agents become activated and produce reactive oxygen species, leading to the target elimination of particular cells. Numerous studies have documented the effectiveness of PDT with pathological regression rate improving to 94.79%, and the HR-HPV clearance rate increased to 93.75%. Beyond facilitating lesion regression, PDT also plays a significant role in eliminating persistent HR-HPV infections, which are a crucial element in the advancement of cervical dysplasia. Furthermore, the non-invasive nature of PDT presents a compelling alternative to traditional surgical approaches, which may compromise fertility and cause cervical stenosis. PDT is generally well-tolerated; adverse reactions are typically mild and transient, including symptoms such as abdominal discomfort and increased vaginal discharge. Most notably, the fertility-preserving characteristics of PDT render it an optimal treatment choice, particularly for young women desiring to maintain their reproductive potential. While the existing data is promising, it is essential to conduct additional research to enhance treatment protocols, optimize dosages, and thoroughly assess the long-lasting impact of photodynamic therapy in the field of gynecology. By synthesizing existing evidence, this review supports the enhanced incorporation of PDT into clinical decision-making frameworks for the management of HPV-related LSIL.

High-risk human papillomavirus genotypes in previously unscreened reproductive-age women in Ethiopia: A community-based cohort study

High-risk human papillomavirus (hrHPV) genotype is needed for adequate cervical cancer screening and HPV vaccination program evaluation as recommended by different guidelines. We aimed to assess the rate of HPV infection and HPV genotype distribution using vaginal self-sampling in a cohort of unscreened reproductive-age women in Ethiopia. A community-based cohort study was conducted with women aged 23-46 living in Adama, Ethiopia. A total of 885 self-collected vaginal swabs were obtained and tested for hrHPV genotypes with the real-time polymerase chain reaction technique. The overall hrHPV prevalence was 21.1% (187/885, 95% confidence interval [CI]: 18.5-24.0). Among women living with human immunodeficiency virus, 46% (30/56) (95% CI: 33.7-59) were hrHPV positive compared with 19% (157/820) (95% CI: 16.2-22) of human immunodeficiency virus-negative women. The most frequent genotypes were HPV16 (3.1%), HPV51 (3.1%), HPV35 (2.6%), HPV56 (2.6%), HPV52 (2.4%), HPV31 (2.5%), and HPV39 (2.5%). Among the 187 HPV-positive women in self-samples, HPV 16/18 was found in 21% (39), HPV 16/18/45 was found in 24% (44), and HPV 16/18/31/33/45/52/58 was prevalent in 56% (104). Out of 116 biopsies, 7% (8) had cervical intraepithelial lesions and worse identified. Of these eight cervical intraepithelial lesions and worse patients, only 25% tested positive for HPV-16; none tested positive for HPV-18 or 45. One out of five women tested positive for hrHPV genotypes. Other HPV genotypes not covered by the quadrivalent HPV vaccine but associated with clinically significant cervical high-grade lesions or cancer were detected in 75%. It is more effective to prevent cervical cancer by switching to the nine-valent HPV vaccine.

Dynamic causal effects of gut microbiota on cervical Cancer lesion progression

Many investigations have highlighted the involvement of the intestinal microbiota in the progression of cervical cancer lesions; however, the causal link between them remains to be confirmed. We employed two-sample Mendelian randomization (MR) as a alternative to randomized controlled trials (RCTs) to explore the association between intestinal microbiota and high-risk Human Papillomavirus (HPV) infection, cervical intraepithelial neoplasia (CIN), and cervical cancer (CC). This method allowed for a detailed investigation of the underlying mechanistic interactions within the gut-cervix axis. The analysis predominantly encompassed the utilization of inverse variance weighting (IVW) and the Wald ratio test. Additionally, various sensitivity analysis methods were employed to validate the findings. We uncovered a total of 17 gut microbial taxa associated with HPV infection, 9 taxa related to CIN, and 7 taxa linked to CC. At different stages of cervical cancer lesions, various gut microbial communities play either protective or promoting roles. However, some microbial communities also act as persistent risk factors in promoting the progression of CC. Our investigation has revealed that the gut microbiota exerts a considerable impact along the entire spectrum of CC progression within the gut-cervix axis. These findings lay a foundation for prospective research focused on the utilization of gut microbiota in cervical cancer screening, prevention, and therapeutic strategies.

Targeting HPV for the prevention, diagnosis, and treatment of cervical cancer

Despite advances in screening and prevention, cervical cancer (CC) remains an unresolved public health issue and poses a significant global challenge, particularly for women in low-income regions. Human papillomavirus (HPV) infection, especially with the high-risk strains, is a primary driver of cervical carcinogenesis. Emerging evidence indicates that integrating HPV testing with existing approaches, such as cervical cytology and visual inspection, offers enhanced sensitivity and specificity in CC screening. HPV infection-associated biomarkers, including HPV E6/E7 oncogenes, p16^INK4a, DNA methylation signatures, and non-coding RNAs, offer valuable insights into disease progression and the development of personalized interventions. Preventive and therapeutic vaccination against HPV, along with tertiary prevention strategies such as the use of antiviral and immune-modulating drugs for HPV-related lesions, show great clinical potential. At the mechanistic level, single-cell RNA sequencing analysis and the development of organoid models for HPV infection provide new cellular and molecular insights into HPV-related CC pathogenesis. This review focuses on the crucial roles of HPV in the prevention, diagnosis, and treatment of CC, with particular emphasis on the latest advancements in screening and disease intervention.

Clinical Benefit of a Conservative Treatment for High-Risk Human Papillomavirus Lesions in Patients with HIV

Infection with human immunodeficiency virus (HIV) shows a higher risk of infection by human papillomavirus (HPV). We aim to provide evidence about the effect of a Coriolus versicolor-based vaginal gel (Papilocare®) for treating HPV in women with HIV. Women ≥25 years coinfected by endocervical HPV and with low-grade abnormal cervicovaginal cytology were treated for 6 months with Papilocare in this observational, prospective, noncontrolled pilot study. Cytology, colposcopy, biopsy, hybrid capture test, and 5-point Likert scale were assessed to evaluate cervical lesions repair, HPV clearance, and changes in cervical reepithelization, respectively, at 6 months. Fifteen patients (25-54 years) were included. Overall HPV clearance and cytological normalization rates were 73.3% and 80.0%, respectively, and 55.6% of the abnormal colposcopies were normalized. Reepithelialization index improved in 66.7% of cases. Papilocare may be effective for managing endocervical HPV infection in patients living with HIV.

Overcoming Barriers to Human Papillomavirus Vaccination in Guangdong Province, China

Human papillomavirus (HPV) infection remains a critical public health challenge in China, particularly in Guangdong Province, where HPV-52, 16, and 58 genotypes predominate, and male infection rates exceed 40%. Despite the successful implementation of a government-funded school-based program that has achieved 88% HPV vaccine coverage among adolescent girls, several persistent barriers, including genotype mismatch (the free HPV vaccine covers < 50% of high-risk local strains), regional disparities (80% vs. 60% for first-dose coverage), and exclusion of males, thwart progress toward herd immunity. Financial sustainability risks pose an even more significant threat to the expansion of HPV vaccination programs, especially in Guangdong province where annual expenditures exceed CNY 200 million. This review delves into Guangdong's pioneering efforts and proposes practical solutions: accelerating domestic multivalent HPV vaccine development, adopting gender-neutral vaccination policies, and leveraging mobile clinics for remote populations. These strategies not only provide a roadmap for China but also serve as valuable insight for other LMICs striving to overcome HPV-related inequalities.

Effect of HPV integration on prognosis of young women with CIN2 in China: protocol for a multicentre prospective cohort study

INTRODUCTION

Cervical cancer, a major global health concern, is primarily caused by human papillomavirus (HPV) infection. Although cervical intraepithelial neoplasia grade 2 (CIN2), a precancerous lesion, exhibits high spontaneous regression rates (50%-60%), particularly in younger women, current clinical management lacks accurate risk stratification. This study examines HPV integration status as a prognostic biomarker in women aged 18-45 diagnosed with CIN2, with the objective of developing a predictive tool for personalised therapeutic strategies and minimising overtreatment in this high-regression population.

METHOD AND ANALYSIS

This multicentre cohort study will be implemented across 20 tertiary Grade A hospitals in China, encompassing eastern, western, central and northern regions. It will recruit 240 CIN2 patients, collecting sociodemographic, lifestyle and medical history data via questionnaires. Clinical examinations will be performed at baseline and follow-up. Disease regression ((to cervical intraepithelial neoplasia grade 1 [CIN1] or lower)) and non-regression (persistent CIN2 or progression) will be evaluated. Prognostic factors will be analysed using Cox proportional hazards models, adjusting for confounders such as age, weight and socioeconomic status.

ETHICS AND DISSEMINATION

The cohort study protocol and informed consent procedures adhere to the Declaration of Helsinki and pertinent Chinese clinical research regulations. Ethical approval has been obtained from the Clinical Research Review Committee of the Fujian Maternal and Child Health Hospital (2022KYLLR01018) and from the participating hospitals. Written informed consent is secured from all participants prior to enrolment, with detailed information provided regarding study objectives, procedures, potential risks and benefits and participants' rights. Results will be published in peer-reviewed scientific journals, presented at academic meetings and conferences and released to the public through press releases.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT05282095); Pre-results.

Lineage analysis of human papillomavirus types 33 and 35 based on E6 gene in cervical samples from Tehran, Iran

Knowing the geographical distribution of lineages and sublineages of each HPV type is beneficial for the epidemiological and evolutionary studies of this virus. However, no studies have analyzed the variants of HPV 33 and 35 in Iranian women. To investigate the sequence variation of HPV 33 and 35 E6 gene, 42 and 92 samples were analyzed using nested PCR and sequencing, respectively. Sublineage analysis of HPV 33 showed that most of the samples belonged to the A2 sublineage (85.8%) and the remaining were classified to the A1 sublineage. Four mutations at positions A132C, A213C, A364C, and A480T were detected, among which two mutations A213C and A364C led to amino acid changes corresponding to positions K35N and N86H of amino acid, respectively, in 85.8% of samples. For HPV 35, two sublineages A1 and A2 were found in studied samples with a prevalence of 84.8 and 15.2%, respectively. Seven nucleotide changes were observed at positions of C127G/T, A130C, A131C, C136T, G249T, A326G, and C341T. Three of these mutations including A130C, G249T, and C341T resulted in amino acid changes at positions of E7D, C47F, and R78W in 4.4%, 3.3%, and 9.8% of samples, respectively. Concerning HPV 33 or 35 distinct lineages by histology/cytology status, no statistically significant differences were observed. Our results indicated that sublineages A2 of HPV 33 and A1 of HPV 35 were dominant in Tehran, Iran. However, more studies with larger sample sizes from different histopathological stages of cervix in various geographical regions of Iran are necessary to evaluate the pathogenicity risk of HPV 33 and 35 (sub)lineages in Iranian women with cervical cancer in the future.

Novel therapeutic strategies for targeting E6 and E7 oncoproteins in cervical cancer

Cervical cancer is the fourth most common cause of cancer-related mortality among women worldwide. The main aetiological factor for developing cervical cancer is the persistent infection of Human papillomavirus (HPV). The E6 and E7 oncoproteins produced by HPV mainly contribute to the carcinogenic process by inhibiting the function of tumour suppressor genes. The E6 protein causes degradation of p53 leading to impaired cellular stress response. In contrast, the E7 protein impairs the activity of retinoblastoma protein (pRb) resulting in continuous cell cycle propagation. Even though screening programmes and prophylactic vaccination have reduced the incidence of cervical cancer, the disease burden is still high, especially in low socioeconomic countries. Treatment of cervical cancer involves a multimodal strategy incorporating surgery, chemotherapy, and radiotherapy. Most of these management approaches use invasive techniques and are associated with adverse effects. Drug resistance is observed over time with chemotherapeutic agents. Hence there is a crucial need for developing novel targeted treatment strategies for cervical cancer. The E6 and E7 viral oncoproteins are continuously expressed in HPV infected cells making them ideal targets for developing therapies. Therapeutic DNA vaccines, gene therapy involving RNA interference technology, and CRISPR are currently under intensive study. These technologies represent a productive and promising approach for the future treatment of cervical cancer. Moreover, several new compounds demonstrate significant anti-cancer effects against cervical cancer. This review provides an updated account of therapeutic strategies currently under research targeting the E6 and E7 viral oncoproteins.

The inferred modulation of correlated vaginal microbiota and metabolome by cervical differentially expressed genes across distinct CIN grades

BACKGROUND

In vitro studies have demonstrated the modulation of vaginal microbiota (VM) by cervical peptides which levels varied with the status of HPV infection and cervical intraepithelial neoplasia (CIN) grades. However, there is a deficiency in population-based studies investigating the modulation of VM compositions and metabolome by cervical differentially expressed genes (DEGs) across different grades of CIN.

METHODS

This study included 43 HPV-positive women, classified into low-grade (CIN1, n = 23) and high-grade (CIN2 + , n = 20) groups. Vaginal swabs were collected for both microbiota and metabolome analysis. Cervical exfoliated cells were collected for RNA-Seq analysis.

RESULTS

We identified 258 differentially expressed genes (DEGs), among which 176 CIN1-enriched genes were linked to immune responses, cell chemotaxis, negative regulation of cell migration, and B cell differentiation, activation, and proliferation. Eighty-two genes upregulated in CIN2 + cohorts were associated with epidermis development and keratinization. Then, we identified 5,686 paired correlations between DEGs, VM, and metabolome, with 2,320 involving Lactobacillus. Further analysis revealed Lactobacillus as the primary determinant of metabolic profiles, followed by Gardnerella, Faecalibacterium, Aerococcus and Streptococcus, such as the notable positive correlation between Lactobacillus with D-lactic acid and DL-indole-3-lactic acid. Applying mediation analysis, we found that Lactobacillus mediated the association of 14 CIN1-enriched DEGs, such as COL4A2, CCBE1 and SPON1, with the production of 57 metabolites, including D-lactic acid, oleic acid and various amino acids. Additional analysis indicated significant mediation effects of 79 metabolites on the association of DEGs with the growth of Lactobacillus, Gardnerella, Fannyhessea and Aerococcus.

CONCLUSIONS

Our findings provide valuable population-based evidence for the inferred modulation of correlated VM and metabolome by cervical DEGs across different CIN stages.

Comparison of photodynamic therapy and LEEP in women of reproductive age with cervical squamous intraepithelial neoplasia 2 (CIN2): A prospective observational study in China

BACKGROUND

Non-invasive treatments, such as 5-Aminolevulinic acid photodynamic therapy (5-ALA-PDT), has gained increasing attention among women with cervical intraepithelial neoplasia grade 2 (CIN2) who have fertility requirements. To compare the effectiveness of 5-ALA-PDT and loop electrosurgical excision procedure (LEEP) in patients with CIN2, we conducted this prospective cohort study in Chinese patients with CIN2.

METHODS

229 patients with CIN2 were enrolled. They were divided into the PDT Group (n=94) and LEEP Group (n=135) according to the patient's willingness. Patients were evaluated at the 3-, 6-, 12- and 18-month follow-up periods, using cytology, HPV testing, and colposcopy examination.

RESULTS

At the 3-month follow-up, the rates of disease regression to normal or CIN1 in the PDT group were 76.6% (72/94) and 13.8% (13/94), respectively, whereas in the LEEP group, they were 80.7% (109/135) and 11.1% (15/135), respectively. Logistic regression analysis revealed that the transformation zone type 3 was the only risk factor for both the PDT (OR=3.68; 95% CI, 2.43-5.26; P=0.008) and LEEP groups (OR=2.34; 95% CI, 1.84-4.53; P=0.02). The treatment efficacy in the PDT group increased gradually and peaked at the 18-month follow-up point with disease disappearance and regression rates of 90.4% and 8.5%, respectively. The disease disappearance and regression rates in the LEEP group were highest at the first half year posttreatment, with disease disappearance and regression rates of 87.4% and 12.6%, respectively. The hrHPV-negative rates in the PDT group and LEEP group were the highest at the 18-month follow-up (78.7% and 74.8%). There was no significant difference in the disappearance or regression rates between the two groups at the follow-up points (P > 0.05).

CONCLUSIONS

Our study revealed that both 5-ALA PDT therapy and LEEP were highly effective at treating CIN2. 5-ALA-PDT, as a non-invasive treatment, could be an effective option for CIN2 patients with fertility preservation needs.

Oral HPV incidence and risk factors for acquisition

BACKGROUND

We evaluated incidence of oral HPV infection, which precedes HPV-related oropharynx cancer.

METHODS

In this prospective multicenter cohort of participants with HIV and demographically similar participants without HIV, oral rinse and gargle samples were collected every 6-12 months and tested for 35 HPV types (anyHPV), 13 of which were oncogenic (oncHPV). Kaplan Meier and Cox regression were used for incidence curves and clustered risk factor hazard ratios. Logistic regression was used to determine relative odds of same infection at next visit.

RESULTS

The 1587 participants had a median follow-up of 3.67 years, 422 had 708 incident type-specific oral HPV detected. The most common oncHPV was HPV16 [incidence rate = 7.8 per 1000 person-years (95 %CI 5.8-10.6)]. At 5 years, the cumulative incidence of anyHPV, oncHPV and HPV16 was 34.9 % (95 %CI = 31.9 %, 38.3 %), 17.1% (95 %CI = 14.8 %, 19.8 %) and 4.0 % (95 %CI = 2.9, 5.6 %), respectively. Risk of incident oral HPV infection was independently associated with a higher number of oral sex partners, current smoking, younger age, prevalent oral anyHPV, living with HIV and lower CD4 counts. Prevalent oncHPV at baseline had greater odds of being re-detected at subsequent visits than an incident oncHPV detected for the first-time at a later visit. Detection of oral HPV type at one visit was associated with highly elevated odds of detecting that same type-specific infection at the next visit (OR > 100).

CONCLUSION

Cumulative incidence of oral HPV is increased among PLWH and with prevalent oral HPV, represents a mix of new and intermittently detected infections, and is higher among those with repeated detection of oral HPV.

The Relationship Between Metal Exposure and HPV Infection: Evidence from Explainable Machine Learning Methods

HPV is a ubiquitous pathogen implicated in cervical and other cancers. Although vaccines are available, they do not encompass all subtypes. Meanwhile, metal exposure may elevate the risk of HPV infection and amplify its carcinogenic potential, but studies to further elucidate this relationship are insufficient. This study entailed a cross-sectional analysis utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2007-2016. The study sample comprised 2765 women. Multivariate logistic regression was employed to examine the association between single metal exposure and HPV infection, weighted quantile sum (WQS) regression was utilized for assessing the mixed metal exposure effect, and the XGBoost + SHapley Additive exPlanations (SHAP) to evaluate the contribution of metal exposure in HPV infection. Multivariate logistic regression analysis indicated that elevated Co concentration was inversely associated with HPV infection (OR 0.891; 95% CI 0.814-0.975), while elevated Pb concentration correlated with an increased HPV infection (OR 1.176; 95% CI 1.074-1.287). Regression analysis of the WQS for mixed metal exposure suggested that the WQS index was potentially linked to an increased likelihood of HPV infection in the positive direction (OR 1.249; 95% CI 1.052-1.482), with no significant association observed in the negative direction (OR 0.852; 95% CI 0.713-1.017). SHAP analysis prioritized the importance of characteristics: number of sexual partners, marital status, poverty-to-income ratio (PIR), Co, Pb, and alcohol consumption. Exposure to Pb was associated with an increase in the incidence of HPV infection, whereas Co exposure demonstrated an inverse relationship. The composite exposure to multiple metals showed a positive association with the prevalence of HPV infection. These findings indicate that exposure to metals could potentially escalate the prevalence of HPV infection.

Structural Virology: The Key Determinants in Development of Antiviral Therapeutics

Structural virology has emerged as the foundation for the development of effective antiviral therapeutics. It is pivotal in providing crucial insights into the three-dimensional frame of viruses and viral proteins at atomic-level or near-atomic-level resolution. Structure-based assessment of viral components, including capsids, envelope proteins, replication machinery, and host interaction interfaces, is instrumental in unraveling the multiplex mechanisms of viral infection, replication, and pathogenesis. The structural elucidation of viral enzymes, including proteases, polymerases, and integrases, has been essential in combating viruses like HIV-1 and HIV-2, SARS-CoV-2, and influenza. Techniques including X-ray crystallography, Nuclear Magnetic Resonance spectroscopy, Cryo-electron Microscopy, and Cryo-electron Tomography have revolutionized the field of virology and significantly aided in the discovery of antiviral therapeutics. The ubiquity of chronic viral infections, along with the emergence and reemergence of new viral threats necessitate the development of novel antiviral strategies and agents, while the extensive structural diversity of viruses and their high mutation rates further underscore the critical need for structural analysis of viral proteins to aid antiviral development. This review highlights the significance of structure-based investigations for bridging the gap between structure and function, thus facilitating the development of effective antiviral therapeutics, vaccines, and antibodies for tackling emerging viral threats.

Human papillomavirus carriage in the semen of men consulting for infertility: prevalence and correlations with sperm characteristics

ABSTRACT

We aim to study the semen carriage of human papillomavirus (HPV) and evaluate its association with patient characteristics. We conduct a single-center cohort study at Amiens University Hospital Center (Amiens, France). From May 1 to October 31, 2021, 461 men consulting for infertility and with semen analysis data were included. Each participant gave his written informed consent for the use of laboratory, demographic, clinical, and lifestyle data. A proportion of the semen samples were sent to a virology laboratory for HPV screening in a polymerase chain reaction (PCR) assay. In univariate and multivariate analyses with a logistic regression model, HPV + and HPV - groups were compared with regard to semen characteristics (including the DNA fragmentation index and the sperm decondensation index) and demographic, clinical, and lifestyle variables. Semen HPV carriage was detected in 22.3% of the patients. High-oncogenic-risk HPV genotypes were predominant (57.6%). Multivariate analysis showed that HPV carriage was significantly associated with the presence of at least one abnormal spermogram dinging (according to the 6 th World Health Organization criteria), with an adjusted odds ratio (OR) of 4.10 (95% confidence interval [CI]: 2.32-7.25, P < 0.001). A statistically significant association was also found for the type of infertility (OR: 1.61, 95% CI: 1.00-2.57, P = 0.05), the presence of varicocele (OR: 3.99, 95% CI: 1.48-10.71, P = 0.01), and a history of cryptorchidism, testicular ectopia, or monorchidism (OR: 3.54, 95% CI: 1.07-11.66, P = 0.04). Infection with a single HPV genotype or multiple HPV genotypes was significantly associated with at least one abnormal spermogram finding for all HPV oncogenic risk groups (OR: 3.93, 95% CI: 2.08-7.41, P < 0.001; and OR: 4.11, 95% CI: 1.58-10.68, P = 0.01, respectively). The association between sperm HPV carriage and the risk of infertility was statistically significant in a multivariate analysis (OR: 5.63, 95% CI: 3.16-10.01, P < 0.001) and after adjustment for the propensity score (OR: 6.10, 95% CI: 3.33-11.21, P < 0.001). Our results suggest that semen HPV carriage has an impact on male fertility. Sperm screening for HPV might be a useful addition to the work-up for male infertility.

Intratype variants and high genotypic diversity of human papillomavirus with polymorphisms in the antigenic hypervariable loops of the L1 protein from women living with human immunodeficiency virus in Northeastern Brazil

Introduction. The human papillomavirus (HPV) is one of the main oncogenic viruses. High-risk HPV types are associated with the development of cervical cancers. In addition, it is known that some mutations in HPV genes, or variant viral lineages, have been associated with greater oncogenic risk.Gap statement. The L1 protein is the major component of the viral capsid and is therefore used in currently available vaccines. However, the characterization of mutations in the L1 gene, which is relevant to increasing the knowledge of the immune escape mechanisms used by the virus, is still incipient.Aim. This study aimed to characterize mutations associated with antigenic domains in the L1 protein of HPVs isolated from cervical samples of women living with HIV in Northeastern Brazil.Methodology. L1 gene sequences were obtained from the samples, and the mutations and the viral variants were characterized. Phylogenetic and functional analyses of the structure of the L1 protein were carried out.Results. A total of 41 HPV variant isolates were obtained, distributed among 16 different viral types. Of this, 25 non-synonymous mutations were evaluated regarding the stability of the L1 protein. It was observed that 10 of these mutations were predicted to increase, and 14 to decrease, the stability of the L1 protein and that most of them occurred in the FG hypervariable antigenic loop.Conclusion. These results add useful knowledge to understanding the biological and immunological aspects of HPV variants and the impact of these mutations on the development of vaccine strategies.

Infection and Persistent Infection of Human Papillomavirus Among HIV-Negative Men Who Have Sex with Men in Xinjiang, China: A Prospective Cohort Study

Anal HPV infection is particularly prevalent among men who have sex with men (MSM). The purpose of this study was to understand the status and influencing factors of HPV infection in MSM in Urumqi, Xinjiang, in order to provide suggestions for policy formulation. A prospective cohort study was conducted among HIV-negative MSM in Urumqi Xinjiang between April 2016 and June 2023. 824 MSM were recruited. Data were collected anal swab results from self-administered questionnaires and laboratory tests. A Cox regression model was employed to analyze factors associated with HPV infection. The prevalence rates of high-risk HPV and low-risk HPV were 37.99% and 25.97%. Receptive anal intercourse is a well-established risk factor for both incident and persistent HPV infections among MSM. For new high-risk HPV infections, the adjusted hazard ratio is 1.55 (95% CI: 1.28-1.89), and for persistent high-risk HPV infections, the aHR is 1.95 (95% CI: 1.48-2.57). Similarly, for low-risk HPV, receptive anal intercourse increases the risk of incidence (aHR = 1.34, 95% CI: 1.07-1.67) and persistent infection (aHR = 1.64, 95% CI: 1.18-2.29). Seeking sexual partners in bathhouses raised the risk of low-risk HPV infections (aHR = 1.36, 95% CI: 1.05-1.76). Young MSM may face a higher risk of HPV infection. Implementing targeted HPV vaccination catch-up programs for the MSM population in Urumqi could offer significant societal benefits.

Human papillomavirus infection is associated with increased risk of new-onset hidradenitis suppurativa: A population-based cohort study

BACKGROUND

The exact cause of hidradenitis suppurativa (HS) remains unclear, although emerging research suggests a link between infectious agents and inflammatory skin diseases. The association between human papillomavirus (HPV) infection and HS development, however, has not been studied.

OBJECTIVE

The objective of this study was to evaluate the risk of incident HS in patients with HPV infection.

METHODS

Using the TriNetX research network, we conducted a retrospective cohort study of patients diagnosed with HPV and matched controls. Propensity score matching adjusted for variables like age, sex (male/female), race, body mass index, comorbidities, and lifestyle factors. The primary outcome was new-onset HS, analyzed across demographic and clinical factors. Hazard ratios with 95% confidence intervals were calculated to assess the risk.

RESULTS

After matching, both the HPV and control cohorts included 582,007 patients. HPV-infected individuals had a significantly higher risk of developing HS (hazard ratio: 1.356, 95% confidence interva: 1.290-1.427). This increased risk was consistent across various demographic and clinical groups. Sensitivity analyses confirmed the robustness of these findings.

LIMITATIONS

Retrospective cohort design.

CONCLUSIONS

HPV infection is linked to a higher risk of HS, suggesting a potential association. Further research is required to validate these results and assess their impact in different populations and clinical settings, as well as also elucidate the potential impact of other infections involved in the pathogenesis of HS.

L-shaped association between dietary iron intake and HPV infection: a cross-sectional analysis based on national health and nutrition examination survey 2005-2016

Background

Human Papillomavirus (HPV) infection is a ubiquitous sexually transmitted infection globally, frequently associated with sexual behaviors characterized by increased frequency and multiple partnerships. The relationship between varying levels of dietary iron intake and the occurrence of Human Papillomavirus (HPV) infection remains an unresolved question in the scientific community. The objective of our study was to investigate the potential relationship between the consumption of dietary iron and HPV infection.

Methods

Our investigation drew upon comprehensive datasets from 7,819 participants enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016. Employing a cross-sectional analytical framework, we delved into the potential correlation between dietary iron consumption and Human Papillomavirus infection. To statistically assess this relationship, we utilized weighted multivariate logistic regression models. Additionally, we implemented smooth curve fitting and threshold effect analysis, to delineate the complex, nonlinear association between iron intake and HPV infection. Furthermore, we conducted subgroup analyses.

Results

After adjusting for multiple confounding variables, our results demonstrated a statistically significant inverse association between iron intake and HPV infection (OR = 0.988, 95% CI: 0.979-0.998, p = 0.018). It's worth noting that, in comparison to individuals in the quartile with the lowest iron intake, those in the highest quartile exhibited a 23.2% reduction in the odds of HPV infection for each incremental unit of iron intake (OR = 0.768, 95% CI: 0.634 to 0.930, p = 0.009). A refined analysis employing smoothing curve fitting techniques unveiled an L-shaped correlation, delineating a specific relationship between dietary iron intake and the incidence rate of Human Papillomavirus infection. When iron intake was <16.99 mg, a higher incidence of HPV infection was associated with lower levels of iron intake. (OR = 0.968, 95% CI: 0.956-0.980, p < 0.001).

Conclusion

The presence of an L-shaped association between iron intake and HPV infection underscores and emphasizes the possible beneficial effect of sufficient iron intake in reducing the likelihood of HPV infection.

Antiviral properties of essential oil mixture: Modulation of E7 and E2 protein pathways in human papillomavirus (HPV) infection

ETHNOPHARMACOLOGICAL RELEVANCE

Clove is used in Indian and Chinese traditional medicine for viral diseases. Palmarosa essential oils have been traditionally used in India and Southeast Asia since ancient times and have made considerable use of them. In New Caledonia, niaouli oil is used in aromatherapy and pharmaceutical formulations to treat pain and viral diseases. Since ancient times, the South Pacific region has used tamanu oil as a traditional medicine to treat a wide range of skin conditions.

AIM OF THE STUDY

This study investigates the antiviral properties of essential oils (EOs) from Eugenia aromaticum (clove oil, CL-R030424005 (CL)), Cymbopogon martinii (palmarosa oil, PA-R040923008 (PA)), Melaleuca viridiflora (niaouli oil, NI-R290124038 (NI)), and Calophyllum inophyllum (tamanu oil, TA-F140224029 (TA)), and their mixture against human papillomavirus (HPV) infection.

MATERIALS AND METHODS

A D-optimal mixture design is used to determine the most effective EO combinations and evaluate their antiviral efficacy through IC50 values. The EOs were tested for their ability to inhibit HPV-related oncogenes (L1, L2, E1, E2, E6, and E7) in HPV-infected cells with ELISA, qPCR, and Western blot analyses.

RESULTS AND DISCUSSION

The optimal mixture (31.5% CL, 31.5% PA, and 37% NI) demonstrated significant antiviral activity, reducing viral replication and protein expression in HPV-infected cells. Ex-vivo permeation studies showed higher permeation rates in healthy tissues compared to infected ones, indicating the oils' potential in targeted drug delivery. Additionally, cytotoxicity assessments confirmed the safety of the EOs at effective concentrations in HPVCs, DoTc2, and HEKa cells. Molecular docking studies further elucidated the interactions between EO components and HPV proteins, supporting their antiviral mechanisms.

CONCLUSION

These findings suggest that EOs, particularly in optimized combinations, offer a promising natural supportive treatment for managing HPV infections, warranting further in vivo animal tests and clinical trials.

Retrospective Analysis of Human Papillomavirus Genotyping and Cytology (Pap Smears) in Cervical Cancer Screening: An Institutional Experience in the State of Oregon, USA

Background/Objectives: The 2020 American Cancer Society guidelines endorse human papillomavirus (HPV) testing as the preferred method for cervical cancer screening. This study aims to evaluate the concordance of HPV and cytology findings for cervical intraepithelial neoplasia (CIN) at a population level. Methods: A retrospective cohort review of cervical cytology, HPV testing, and biopsies for all patients at a single Oregon-based medical center was performed over 21 months. The performance of HPV and cytology in detecting high-grade CIN lesions was compared. Results: A total of 22,488 tests were evaluated, showing 7.5% abnormal cytology and 7.4% positive HPV. Among 574 patients who underwent co-testing and a subsequent biopsy, 345 had abnormal cytology, with 212 having abnormal biopsy results. HPV was positive in 455 cases, with 266 having abnormal biopsy results. Among 455 HPV-positive cases, there were 283, 104 and 33 cases of non-16/18, 16, and 18 types, respectively. Additionally, 35 cases had co-infection with multiple HPV types. Among the cases diagnosed as CIN3 on biopsy, 90.6% had positive HPV testing (N = 96), and 82.9% had abnormal cytology (N = 94). HPV testing demonstrated a slightly higher sensitivity (88.8% vs. 78.3%, p = 0.128) and lower specificity (27.1% vs. 48.9%, p < 0.01) compared to cytology for CIN2 and CIN3 diagnosis. Conclusions: HPV testing showed a similar sensitivity but lower specificity compared to cytology for detecting high-grade lesions.

The relationship between the recurrence rate of genital warts and administration of quadrivalent human papilloma virus vaccine in women

In this cohort study a total of 203 women with genital warts, who were referred to gynecology clinic of Shahid Muftah in Yasuj city between 2019 and 2022, were examined and treated by a gynecologist and trained for injection of three doses of Gardasil vaccine after treatment. Of these, 138 women completed the study. Half of them who received three doses of the Gardasil vaccine, aligned in vaccinated group and the other half served as the unvaccinated group. In the vaccinated group, 8 individuals (11.6 %) experienced recurrence, compared to 15 individuals (21.7 %) in the unvaccinated group (p = 0.11). The overall number of recurrence among all participants was 23 (16.7 %). The average duration of treatment until recurrence was 43.6 ± 24.7 weeks in the vaccinated group and 16.4 ± 16.5 weeks in the unvaccinated group (P ≤ 0.017), underscoring the vaccine's preventive role in the recurrence of genital warts.

Temporal Trends in Knowledge of Human Papillomavirus and Associated Oropharyngeal Cancer Following Expanded Vaccination Eligibility

OBJECTIVE

Human papillomavirus (HPV) is a significant driver of elevated risk for oropharyngeal squamous cell carcinoma (OPSCC). In 2018, HPV vaccination eligibility was expanded to men and women aged 27 to 45. We evaluated changes in awareness of HPV, its association with OPSCC, and HPV vaccination among all US adults between 2018 and 2020, focusing on those aged 27 to 45.

STUDY DESIGN

Cross-sectional survey cycles.

SETTING

The Health Information National Trends Survey (HINTS).

METHODS

The HINTS, a nationally representative survey of US adults, was queried. A total of 3504 adults in 2018 and 3865 adults in 2020 were assessed for knowledge of HPV, its vaccine, its association with OPSCC, and changes in awareness between 2018 and 2020. Statistical significance was set at P < .05.

RESULTS

Most respondents were aware of HPV (2018: 60.8%; 2020: 64.8%) and its vaccine (2018: 60.8%; 2020: 61.6%). A significant decrease in awareness of the association between HPV and cervical cancer was seen between 2018 and 2020 (75.0% vs 70.2%, P = .028). Knowledge of HPV+ OPSCC was poor and did not change over time (2018: 27.0%, 2020: 29.5%). Statistically significant increases in HPV awareness between 2018 and 2020 were found for individuals who reported completing high school as their highest level of education (P = .009), Caucasians (P = .013), males (P = .024), and those making more than $200,000 annually (P = .022).

CONCLUSION

Knowledge of the association between HPV and OPSCC remained poor despite expanded vaccine eligibility. Public health education on the association may increase awareness for groups likely to benefit from vaccination.

Vaccines for cancer prevention: exploring opportunities and navigating challenges

Improved understanding of cancer immunology has gradually brought increasing attention towards cancer-preventive vaccines as an important tool in the fight against cancer. The aim of this approach is to reduce cancer occurrence by inducing a specific immune response targeting tumours at an early stage before they can fully develop. The great advantage of preventive cancer vaccines lies in the potential to harness a less-compromised immune system in vaccine recipients before their immune responses become affected by the advanced status of the disease itself or by aggressive treatments such as chemotherapy. Successful implementation of immunoprevention against oncogenic viruses such as hepatitis B and papillomavirus has led to a dramatic decrease in virally induced cancers. Extending this approach to other cancers holds great promise but remains a major challenge. Here, we provide a comprehensive review of preclinical evidence supporting this approach, encouraging results from pioneering clinical studies as well as a discussion on the key aspects and open questions to address in order to design potent prophylactic cancer vaccines in the near future.

Impact of HIV on HPV-related cancers in men who have sex with men: a review

Co-infection with human immunodeficiency virus (HIV) significantly increases the incidence of human papillomavirus (HPV) infection and HPV-related cancers among men who have sex with men (MSM). Conversely, HPV infection can also influence HIV acquisition rates. HIV-induced immune suppression may affect chromosomal stability, gene expression, protein function and other molecular components in MSM with HPV-related cancers. Additionally, HIV infection also alters cellular mechanisms by compromising immune responses and epithelial integrity. In this review, we reviewed the influence of HIV on specific HPV-related cancers in MSM, including oropharyngeal squamous cell carcinoma, penile cancer, and anal cancer. We integrated epidemiological data from the past five years and discussed diagnosis and treatment strategies. Overall, our review offers crucial insights into the underlying molecular and cellular mechanisms of these co-infection MSM patients. Our review aims to assist future research in developing effective treatment strategies for MSM with HIV/HPV co-infection.

Augmented immunogenicity of the HPV16 DNA vaccine via dual adjuvant approach: integration of CpG ODN into plasmid backbone and co-administration with IL-28B gene adjuvant

Therapeutic human papillomavirus (HPV) DNA vaccine is an attractive option to control existed HPV infection and related lesions. The two early viral oncoproteins, E6 and E7, are continuously expressed in most HPV-related pre- and cancerous cells, and are ideal targets for therapeutic vaccines. We have previously developed an HPV 16 DNA vaccine encoding a modified E7/HSP70 (mE7/HSP70) fusion protein, which demonstrated significant antitumor effects in murine models. In this study, we employed multifaceted approach to enhance the potency of the HPV16 DNA vaccine. Strategies including inserting CpG oligodeoxynucleotide (CpG ODNs) into the vaccine vector backbone, selecting cytokine gene adjuvants, combining plasmids encoding mE6/HSP70 and mE7/HSP70, and utilizing electroporation for vaccination. Our findings revealed that mice immunized with CpG-modified vaccines, coupled with an IL-28B gene adjuvant exhibited heightened antigen-specific CD8+ T cell responses. Additionally, the combination of mE6/HSP70 and mE7/HSP70 plasmids synergistically enhanced the specific CD8+ T cell response. Furthermore, vaccination with CpG-modified mE7/HSP70 and mE6/HSP70 plasmids, alongside the Interleukin-28B (IL-28B) gene adjuvant, generated substantial preventive and therapeutic antitumor effects against HPV E6- and E7-expressing tumors in C57BL/6 mice. These results suggested that integrating these multiple strategies into an HPV DNA vaccine holds promise for effectively controlling HPV infection and related diseases.

Adenosinergic Signalling in Cervical Cancer Microenvironment

Despite the emergence of the first human papillomavirus vaccine, the incidence of cervical cancer is still responsible for more than 350,000 deaths yearly. Over the past decade, ecto-5'-nucleotidase (CD73/5'-NT) and extracellular adenosine (ADO) signalling has been the subject of many investigations to target cancer progression. In general, the adenosinergic axis has been linked to tumourigenic effects. However, CD73 can play contradictory effects, probably dependent on the tumour type, tumour microenvironment and tumour stage, thus being in some circumstances, inversely related to tumour progression. We herein reviewed the pathophysiological function of CD73 in cervical cancer and performed in silico analysis of the main components of the adenosinergic signalling in human tissues of cervical cancer compared to non-tumour cervix tissue. Our data showed that the NT5E gene, that encoded CD73, is hypermethylated, leading to a decreased CD73 expression in cervical cancer cells compared to normal cells. Consequently, the high availability of ADO cytoplasmatic/extracellular leads to its conversion to AMP by ADK, culminating in global hypermethylation. Therefore, epigenetic modulation may reveal a new role for CD73 in cervical cancer.

Retrospective analysis of HPV infection: Cotesting and HPV genotyping in cervical cancer screening within a large academic health care system

BACKGROUND

In 2019, the American Society for Colposcopy and Cervical Pathology introduced fundamental shifts toward "risk-based" guidelines, with human papillomavirus (HPV) genotyping as a principal test for investigating squamous intraepithelial lesions. This study aims to provide practice-based evidence and supplement the updated guidelines by investigating HPV demographic distribution and uncovering the pathological features of high-grade squamous intraepithelial lesions (HSILs) caused by high-risk HPV (hrHPV) subtypes.

METHODS

Patients who underwent Papanicolaou screening and HPV testing in two hospital systems over the course of 4 years were recruited. The cytology results were categorized on the basis of the 2014 Bethesda classification. DNA sequences of 14 types of hrHPV were detected by Aptima test. The histological features of HSILs caused by different subtypes were compared between biopsies and excisions.

RESULTS

A total of 63,709 cases were included. The HPV prevalence was 14.70%, predominantly in the 30 to 39-year-old age group, with slightly higher rates observed in African Americans. There was no significant racial distribution difference between HPV 16/18/45 and other types. HPV 16/18/45 infection was directly correlated with the severity of abnormal cytology, although the other subtypes were the major causes of cytological abnormalities. The trend for HPV prevalence was consistent across calendar years, and was associated with 8.77% negative for intraepithelial lesion or malignancy, 30.46% atypical squamous cell of undetermined significance, 64.62% low-grade squamous intraepithelial lesion, 66.75% atypical squamous cell-cannot exclude a high-grade squamous intraepithelial lesion, and 91.80% HSIL. Furthermore, 29.09% of HSILs associated with other subtypes were not detectable on subsequent resections.

CONCLUSIONS

Given the HPV demographic distribution and the histological features of HSILs caused by different subtypes, cotesting with reflex HPV genotyping in specific populations, or expanding the subtypes in the primary HPV screening test, should be considered.

Transcriptionally Active Human Papillomavirus in Male Genital Lichen Sclerosus, Penile Intraepithelial Neoplasia, and Penile Squamous Cell Carcinoma

Penile intraepithelial neoplasia (PeIN) and penile squamous cell carcinoma (PeSCC) are both thought to be associated with male genital lichen sclerosus and human papillomavirus (HPV) infection through dichotomous pathways: (i) undifferentiated PeIN and warty/basaloid PeSCC are thought to be HPV related, whereas (ii) differentiated PeIN and usual PeSCC are considered HPV independent. Tissue arrays were constructed from male genital lichen sclerosus, undifferentiated and differentiated PeIN, usual-type PeSCC, and unaffected tissues. Staining for p16 and for high-risk and low-risk HPV subtypes through RNAscope was performed. The expression of HPV RNA and p16 were quantified, and appropriate statistical comparisons were undertaken. High-risk HPV was prevalent in undifferentiated PeIN (77%) and less so in PeSCC (46%) and was exiguous or absent in all other tissues. LR HPV was only observed in 2 tissue cores. Strong p16 staining exhibited 96.15% sensitivity and 100% specificity for high-risk HPV. Transcriptionally active HPV is unlikely to be implicated in male genital lichen sclerosus and differentiated PeIN, although it is clearly important in undifferentiated PeIN. The high prevalence of high-risk HPV in usual PeSCC challenges the existing paradigm. Strong p16 positivity was a reliable surrogate marker for the detection of transcriptionally active high-risk HPV.

Global prevalence of cervical human papillomavirus in women aged 50 years and older with normal cytology: a systematic review and meta-analysis

BACKGROUND

Given the paucity of up-to-date empirical data on human papillomavirus (HPV) among older women, we aimed to estimate the global HPV prevalence in women aged 50 years and older with normal cytology.

METHODS

In this systematic review and meta-analysis, we searched for quantitative studies (cross-sectional, longitudinal, case-control, randomised control trials) reporting HPV prevalence among women aged 50 years and older with normal cytology published until May 31, 2022, in PubMed, Scopus, and Web of Science. The risk of bias was assessed using a modified Newcastle-Ottawa scale. The pooled prevalence and 95% CIs of any-HPV and high-risk (HR)-HPV were estimated using random-effects models. Geographical differences were assessed in stratified meta-analyses and multiple meta-regression models. The prevalence by 5-year age groups and genotypes was estimated when reported using mixed-effects models. The study protocol was registered with PROSPERO (CRD42021241365).

FINDINGS

From 9099 identified articles, 132 were included in the qualitative synthesis. 91 (68·9%) studies were deemed to have a low risk of bias and 41 (31·1%) a high risk of bias. We estimated a worldwide pooled any-HPV prevalence of 11·70% (95% CI 9·68-13·87) from 73 studies including 41 745 women and an HR-HPV prevalence of 6·45% (5·45-7·53) from 102 studies including 437 228 women. The pooled prevalence varied geographically, with the highest estimates in western Africa (any-HPV: 32·26% [4·53-70·22]; HR-HPV: 16·20% [0·70-45·95]) and central America (any-HPV: 24·50% [9·97-42·93]; HR-HPV: 13·52% [9·48-18·14]), and the lowest in western Europe (any-HPV: 5·98% [3·08-9·77]; HR-HPV: 4·09% [2·37-6·25]) and western Asia (for HR-HPV only: 3·27% [0·00-20·91]). Worldwide, any-HPV prevalence generally decreased with age, from 10·74% (5·84-18·95) at 50-54 years to 3·56% (2·33-5·40) after age 75 years. HR-HPV prevalence decreased from 6·04% (4·33-8·38) at age 50-54 years to 4·61% (3·25-6·51) at 60-64 years, increased again to 6·33% (4·03-9·79) at 65-69 years, and then decreased to 5·28% (2·83-9·63) after age 75 years. HPV types 16 (1·17% [0·67-2·03]) and 53 (0·90% [0·43-1·90]) were the most prevalent globally.

INTERPRETATION

HPV prevalence in women aged 50 years and older with normal cytology varies globally and mostly correlates with the cervical cancer burden. Research on HPV persistence, progression, and cost-effectiveness of HPV testing among older women should be conducted to fully inform future cervical cancer screening policies.

FUNDING

None.

Distribution of HPV Types in Cervical Cancer in Pakistan: Implications for Screening and Vaccination Programs

BACKGROUND

HPV plays a key role in the development of cervical cancer. This study aims to investigate the prevalence of HPV genotypes in patients with Squamous cell carcinoma (SSC) and Adenocarcinoma (ADC) at NORI cancer Hospital Pakistan, with the aim of improving screening and prevention strategies.

METHOD

Cervical scrapings were collected from 129 diagnosed cervical cancer patients. HPV typing was performed using a real-time PCR assay and sequencing.

RESULT

Among the patients, 73.6% (90/129) were HPV positive. Proportion of HPV positivity was observed within each group. The highest incidence of HPV was observed in the 50-60 years age group (80.9%), followed by the 40-to-50-year group (75.8%). The positivity rate declined in the 60-to-70-year-old (63.6%) and further in the 70-80 years (62.5%). Eight different HPV subtypes were identified, with HPV 16 being the most prevalent (80.0%), followed by HPV 18 (9.5%), HPV 45 in 2 (2.1%), HPV 31 in 1 (1.1%), HPV 35 in 1 (1.1%), HPV 59 in 1 (1.1%), HPV 66 in 1 (1.1%), and HPV 89 in 1 (1.15). Histologically, 89.2% of the cases were Squamous cell carcinoma (SCC) and 10.8% were Adenocarcinomas. In SCC patients, HPV 16 was found in 80.9% of cases, while in Adenocarcinoma patients, HPV 16 was detected in 66.7% of cases.

CONCLUSION

The prevalence of high-risk HPV types, both vaccine and non-vaccine, targeted in Pakistan highlights the urgent need for widespread screening and vaccination programs. Tailored public health strategies are essential to effectively reduce cervical cancer rates and mortality.

Cost-Effectiveness of Extending Human Papillomavirus Vaccination to Population Subgroups Older Than 26 Years Who Are at Higher Risk for Human Papillomavirus Infection in the United States

BACKGROUND

In June 2019, the U.S. Advisory Committee on Immunization Practices recommended shared clinical decision making regarding potential human papillomavirus (HPV) vaccination of men and women aged 27 to 45 years ("mid-adults").

OBJECTIVE

To examine the incremental cost-effectiveness ratios (ICERs) and number needed to vaccinate (NNV) to prevent 1 HPV-related cancer case of expanding HPV vaccination to subgroups of mid-adults at increased risk for HPV-related diseases in the United States.

DESIGN

Individual-based transmission dynamic modeling of HPV transmission and associated diseases using HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation).

DATA SOURCES

Published data.

TARGET POPULATION

All U.S. mid-adults and higher-risk subgroups within this population.

TIME HORIZON

100 years.

PERSPECTIVE

Health care sector.

INTERVENTION

Expanding 9-valent HPV vaccination to mid-adults and higher-risk subgroups.

OUTCOME MEASURES

ICERs and NNVs.

RESULTS OF BASE-CASE ANALYSIS

Expanding 9-valent HPV vaccination to all mid-adults, those with more lifetime partners, and those who have just separated was projected to cost an additional $2 005 000, $763 000, and $1 164 000 per quality-adjusted life-year (QALY) gained, respectively. The NNVs to prevent 1 additional HPV-related cancer case were 7670, 3190, and 5150, respectively, compared with 223 for vaccination of persons aged 9 to 26 years (vs. no vaccination).

RESULTS OF SENSITIVITY ANALYSIS

The mid-adult strategy with the lowest ICER and NNV was vaccinating infrequently screened mid-adult women who have just separated and have a higher number of lifetime sex partners (ICER, $86 000 per QALY gained; NNV, 470).

LIMITATION

Uncertainty about rate of new sex partners and natural history of HPV among mid-adults.

CONCLUSION

Vaccination of mid-adults against HPV is substantially less cost-effective and produces higher NNVs than vaccination of persons younger than 26 years under all scenarios investigated. However, cost-effectiveness and NNV are projected to improve when higher-risk mid-adult subgroups are vaccinated, such as mid-adults with more sex partners and who have recently separated, and women who are underscreened.

PRIMARY FUNDING SOURCE

Centers for Disease Control and Prevention.

Transcriptomic Analysis of HPV-Positive Oesophageal Tissue Reveals Upregulation of Genes Linked to Cell Cycle and DNA Replication

Human papillomavirus (HPV) is a prevalent sexually transmitted infection, implicated in various cancers, yet its influence in non-cancerous oesophageal tissue remains unclear. This study aims to investigate the gene expression changes associated with high-risk HPV (HR-HPV) in non-cancerous oesophageal tissue to elucidate potential early oncogenic mechanisms. Using RNA sequencing, we compared transcriptomic profiles of HPV-positive and HPV-negative non-cancerous oesophageal tissues. Differential gene expression analysis revealed significant upregulation of cell cycle and DNA replication pathways in HPV-positive samples, specifically involving key genes such as CCNA2, DSN1, and MCM10, which are known to regulate cellular proliferation and genomic stability. Additionally, kinase and transcription factor enrichment analyses highlighted HR-HPV-associated regulatory molecules, including E2F4 and CSNK2A1, suggesting HPV's role in modulating host cell cycle control. These findings support the hypothesis that HPV infection may initiate cellular alterations in oesophageal tissue, potentially predisposing it to malignancy. This study contributes to understanding HPV's impact in non-cancerous tissues and identifies possible biomarkers for early HPV-related cellular changes, offering insights into HPV-driven cancer development beyond traditionally associated sites.

Potential Interactions Between Soil-Transmitted Helminths and Herpes Simplex Virus Type II: Implications for Sexual and Reproductive Health in Sub-Saharan African

Sub-Saharan Africa (SSA) bears a disproportionate and overlapping burden of soil-transmitted helminths (STHs) and sexually transmitted viral infections. An estimated 232 million pre-school and school-aged children in SSA are vulnerable to STH infections. Together with this, SSA has a high prevalence of herpes simplex virus type II (HSV-2), the primary cause of genital herpes. Studies have examined the immunological interactions between STHs and human immunodeficiency virus and human papillomavirus during co-infections. However, epidemiological and immunological studies on STH-HSV-2 co-infections are lacking, therefore their impact on sexual and reproductive health is not fully understood. STH-driven Th2 immune responses are known to downregulate Th1/Th17 immune responses. Therefore, during STH-HSV-2 co-infections, STH-driven immune responses may alter host immunity to HSV-2 and HSV-2 pathology. Herein, we provide an overview of the burden of STH and HSV-2 infections in SSA, and host immune responses to STH and HSV-2 infections. Further, we emphasize the relevance and urgent need for (i) focused research into the interactions between these important pathogens, and (ii) integrated approaches to improve the clinical detection and management of STH-HSV-2 co-infections in SSA.

Herpes simplex virus type 2 in sub-Saharan Africa and the potential impact of helminth immune modulation

Herpes simplex virus type 2 (HSV-2) and helminth infections are among the most widespread infectious diseases in sub-Saharan Africa (SSA). Helminths are known to modulate host immune responses and consequently impact the severity and outcomes of unrelated diseases, including allergies, autoimmune conditions, and infectious diseases. In this way, helminths may modulate essential immune responses against HSV-2 during co-infection and may alter susceptibility to and pathology of HSV-2. However, the epidemiology of STH/HSV-2 co-infections is understudied, and whether helminths influence the host immune response to HSV-2 is not well understood. In this perspective piece, we briefly examine the current knowledge on helminth immune modulation of important pathogens that are endemic to SSA, arguing that it is important to explore HSV-2 and helminth co-infections to elucidate potential interactions between HSV-2 and helminths. This is particularly relevant in SSA, where both pathogens are highly prevalent.

Recent advances in HPV biotechnology: understanding host-virus interactions and cancer progression - a review

Cervical cancer ranks as the fourth most common cancer among women globally, posing a significant mortality risk. Persistent infection with high-risk human papillomavirus (HPV) is the primary instigator of cervical cancer development, often alongside coinfection with other viruses, precipitating various malignancies. This study aimed to explore recent biotechnological advances in understanding HPV infection dynamics, host interactions, and its role in oncogenesis. The gathered data shed light on HPV biology, host-virus interplay, viral coinfections, and cellular transformations leading to HPV-associated cancers. Recent years have seen the introduction of diverse vaccination strategies, including live attenuated, subunit, and DNA-based vaccines, complemented by innovative nanotechnology and plant-based products. Despite rich data addressing research inquiries, urgent calls echo for the implementation of contemporary screening and therapeutic modalities at clinical levels. Moreover, extensive public awareness campaigns are imperative to alleviate the burden of HPV-related diseases, emphasizing the necessity for proactive intervention strategies in combating this global health challenge.

Genome-Wide Association Study of Persistent Anal Human Papillomavirus Infection Among HIV-Positive Males in Taizhou, China: A Cohort Study

The determinants of persistent human papillomavirus (HPV) infection remain largely unknown, and existing studies have predominantly focused on the female population. Individual genetic background may influence the persistence of HPV infection, we the evidence overall and among human immunodeficiency virus (HIV)-positive males are very limited. We conducted a genome-wide association study (GWAS) to identify single nucleotide polymorphisms (SNPs) associated with anal HPV persistence, based on a cohort designed to study the natural history of anal HPV infection among HIV-positive males in Taizhou, China from 2016 to 2022. A total of 322 HIV-positive males with anal HPV infection, with a mean age of 43.0 (standard deviation [SD]: 13.8) years, were included in this GWAS. The median follow-up time was 1.8 (interquartile range [IQR]: 1.5-2.0) years. The persistence of any type of HPV infection was 53.4%. After adjusting for age and sexual orientation, there were 2 SNPs with p < 1 × 10-5 and 24 SNPs with p < 1 × 10-4. The most closely associated with HPV persistence in additive models were rs7359031 (LOC105370461, odds ratio [OR]T/C = 0.36, 95% confidence interval [CI]: 0.24-0.56; p = 6.67 × 10-6) located at 14q21.1, and rs11046048 (PYROXD1, ORC/A = 0.41, 95% CI: 0.28-0.60; p = 7.80 × 10-6) located at 12p12.1. Other SNPs were mainly located at 6q23.3 (HBS1L-MYB) and 6p21.33 (CCHCR1, PSORS1C3). LOC105370461, PYROXD1, HBS1L-MYB, CCHCR1, and PSORS1C3 may be susceptible genes for HPV persistence. We appeal further studies to validate these associations and examine the underlying mechanisms.

Human Papillomavirus-Related Cancer Vaccine Strategies

BACKGROUND

Human papillomavirus (HPV) persistent infection is a major pathogenic factor for HPV-related cancers, such as cervical cancer (CC), vaginal cancer, vulvar cancer, anal cancer, penile cancer, and head and neck cancer (HNC). Since the introduction of the world's first prophylactic HPV vaccine, there has been a decline in the incidence of HPV infections and associated cancers. This article reviews the latest literature on the research progress, efficacy, and safety of HPV vaccines for these cancers, providing a reference for HPV vaccination strategy.

METHODS

By utilizing databases such as PubMed, Google Scholar, CNKI, and Wanfang, we conducted a literature search on research papers related to HPV vaccines from 2014 to 2024, employing keywords such as "HPV", "HPV vaccine", "CC", "vaginal cancer", "vulvar cancer", "anal cancer", "penile cancer" and "HNC". Additionally, we reviewed the latest information available on official websites, including the World Health Organization (WHO). Based on the quality and relevance of the papers, we selected over 100 of the most representative articles for further summarization and analysis.

RESULTS

Vaccination against HPV can effectively block the transmission of the virus and prevent HPV-related cancers. Current studies have confirmed the efficacy and safety of prophylactic HPV vaccination. However, numerous challenges remain. The global vaccination rate for preventive vaccines remains low, particularly in low- and middle-income countries. Nonetheless, in the future, we can enhance the accessibility, affordability, and coverage of HPV vaccines by expanding the indications of already licensed vaccines, continuously developing new vaccines.

CONCLUSIONS

The HPV vaccine is an extremely effective measure for the prevention and treatment of HPV-related cancers. Although there are many challenges in expanding the coverage of the HPV vaccine. It is believed that in the not-too-distant future, both prophylactic and therapeutic HPV vaccines will achieve commendable results.

Comparing visual inspection with acetic acid, with and without Lugol's Iodine for triage of HPV self-sample positive women in Ethiopia: a randomized controlled trial

BACKGROUND

Most women who are high-risk human papilloma virus (hrHPV) positive in a cervical cancer screening test will spontaneously heal from their infection. Visual inspection with acetic acid (VIA) is recommended by the World Health Organization as a triage test for cervical screening, however its accuracy as a triage test has been questioned. In this study, we aimed to examine the sensitivity and specificity of VIA with and without Lugol's iodine as a triage test to detect cervical intraepithelial neoplasia (CIN2+) among women who tested positive for hrHPV after self-sampling.

METHOD

This two-armed randomized controlled trial (RCT) took place in Adama, Ethiopia. The women who tested positive for vaginal hrHPV (Anyplex ΙΙ, Seegene) after self-sampling were randomized to VIA with or without iodine and appointed to a midwife-led clinic. The result of the triage test was categorized as positive, negative, suspicion of cancer or inconclusive, and treated accordingly. Cervical biopsies were collected from women who were hrHPV positive to serve as a gold standard.

RESULTS

22.4% (197/878) of women tested hrHPV positive. Sensitivity and specificity for VIA to detect CIN2+was 25.0% (95% CI 0.6 to 80.0) and 82.7% (95% CI 69.7 to 91.8), respectively. For VIA with iodine, the sensitivity was 50.0% (95% CI 0.7 to 93.2) and the specificity 86.3% (95% CI 71.4 to 93.0). The difference between the two methods was not statistically significant, p=0.5. The odds of detecting CIN2+ was 5.4 times higher if positive for VIA with iodine compared with a negative result. For VIA without iodine, the odds of detecting CIN2+ was 1.6 compared with a negative result. The odds of detecting CIN2+ was 6.4 times higher if the women were HIV positive than for those who were HIV negative.

CONCLUSION

VIA with iodine improved detection of CIN2+ in women who were hrHPV DNA positive but was not significantly better than VIA alone.

TRIAL REGISTRATION NUMBER

NCT05125380.

Alternatives to surveillance for persistent human papillomavirus after a positive cervical screen: A systematic review and meta-analysis

OBJECTIVES

In 2021, the World Health Organisation (WHO) updated its guidelines for cervical screening from cytology testing to primary high-risk human papillomavirus (HR-HPV) testing. This change in testing has effectively led to a 'new disease' as women are now aware of having a virus that induces changes that can cause cancer, which they would have been unaware of previously. While current management involves a 'watch and wait' approach and no active treatment, the anxiety associated with having HR-HPV may prompt some women to seek 'treatments' outside the screening programme. ● to identify potential treatment options available for women with persistent HR-HPV and/or low-grade cervical intraepithelial neoplasia (CIN), i.e. ≤CIN 1. ● to determine the clinical effectiveness of these treatments, namely by: ◦ HR-HPV clearance rate, and/or: ◦ CIN regression.

METHODS

We searched MEDLINE, PubMed, EMBASE, Web of Science and the Cochrane Library. We included cohort studies and randomised controlled trials (RCTs) only. Records (n = 2135) were screened in Rayyan by two independent reviewers. Quality assessment was conducted using the ROBINS-I tool and the ROB-2 tool.

RESULTS

12 studies (four cohort studies and eight RCTs) were included: six oral medications, two topical medications, one vaccination, and three non-surgical device treatments. Meta-analysis revealed that some therapeutic interventions, including vaginal gels, photodynamic therapy, and some oral medications, may lead to earlier resolution of persistent HR-HPV and regression of low-grade CIN when compared with natural clearance.

CONCLUSION

This review can better inform discussions with HR-HPV+ women and answer their questions about alternatives to surveillance.

The dietary inflammatory index (DII®) and human papillomavirus infection: a cross-sectional study of US women

BACKGROUND

Diet may influence susceptibility of human papillomavirus (HPV) infection by affecting inflammation and immunity. However, the association between HPV infection and the inflammatory potential of diet has not been investigated. The research aimed to examine the correlation between HPV status and the dietary inflammatory index (DII®).

METHODS

We utilized data from the National Health and Nutrition Examination Survey (NHANES) 2003-2016 to investigate the correlation between DII and HPV status among 9,256 women aged 18-59 years. DII scores were calculated based on 24-hour dietary recall interviews. The association between HPV status and DII was analyzed using weighted logistic regression and restricted cubic spline (RCS).

RESULTS

Women with HPV infection exhibited higher DII scores than those without HPV infection. An increased likelihood of HPV infection was found to be significantly associated with higher DII scores (OR = 1.05, 95% CI: 1.01-1.09, P = 0.021), after full multivariate adjustment. Compared with the lowest tertile of DII scores, the ORs (95% CIs) for HPV infection were 1.20 (1.01, 1.42) and 1.27 (1.07, 1.51) for the second and third tertiles, respectively (P for trend = 0.006). RCS analysis showed a U-shaped relationship between DII and HPV infection, with a breakpoint identified at 0.13.

CONCLUSIONS

Our findings suggest that a pro-inflammatory diet is associated with an increased likelihood of HPV infection among women in the United States. Dietary interventions to reduce inflammation may help prevent HPV infection and related diseases.

Human papillomavirus infection among adolescents living with HIV: a focus on prevention

PURPOSE OF REVIEW

To highlight recent data on HPV infection and cervical precancerous lesions in adolescents with HIV, and priorities for primary and secondary HPV prevention.

RECENT FINDINGS

Incident and persistent high-risk HPV infections and cervical abnormalities are higher among young women with perinatally acquired HIV compared to their HIV-negative peers; data on HPV among males with perinatally acquired HIV are scarce. HPV vaccination is highly effective in preventing HPV-related disease, but antibody titers may decline in people with HIV. It remains unclear if emerging recommendations to reduce vaccine schedules from three doses to two or one dose are appropriate for children and adolescents with perinatally acquired HIV. Due to higher risks of HPV-related cancers, screening guidelines for cervical cancer differ in their frequency and age at initiation for women with HIV, but there are no recommendations for women with perinatally acquired HIV; nor for anal cancer screening for men with perinatally acquired HIV.

SUMMARY

Data on the effectiveness of reduced HPV vaccine schedules in children and adolescents with HIV are needed. Implementation research to guide strategies for vaccination, screening, and treatment should include children, adolescents, and young adults with perinatally acquired HIV to ensure they are not left behind.

Prevalence and economic burden of male anogenital wart in Korea: A population-based big data analysis from 2007 to 2018

PURPOSE

To investigate the prevalence of anogenital warts (AGW) caused by human papillomavirus in men and the characteristics and changes of the disease in Korea.

MATERIALS AND METHODS

From 2007 to 2018, male AGW corresponding to the International Classification of Disease-10 A63.0 were targeted. Through a big data analysis of the Health Insurance Review & Assessment Service, data of patients diagnosed with AGW as either the main or secondary diagnosis were extracted. The overall prevalence and prevalence by age were calculated through the population by year and the population by 5-year-old unit of the National Statistical Office. Additionally, the amount accrued through the disease code was confirmed and compared as AGW-related medical expenses.

RESULTS

The annual number of patients increased by 3.5 times from 32,709 in 2007 to 114,734 in 2018. Additionally, the annual prevalence increased by 3.34 times from 132.83 per 100,000 to 443.57. The age-specific prevalence was the highest among the 25- to 29-year age group. The highest prevalence was observed in the 25- to 29-year age group in 2018 (1,492.15 per 100,000), and the lowest was noted in the 10- to 14-year age group in 2014 (7.28 per 100,000). AGW-related medical expenses increased by approximately 9.76 times from US$ 2,789,215.1 in 2007 to US$ 27,227,254.9 in 2018.

CONCLUSIONS

In Korea, cases of male AGW are increasing yearly, with the 25- to 29-year age group having the highest prevalence. Medical costs related to AGW are also increasing tenfold. For male AGW, further studies and national interventions are needed.

Multinational epidemiological analysis of oral human papillomavirus incidence in 3,137 men

Oral human papillomavirus (HPV) is associated with oropharyngeal cancer (OPC). Although OPC incidence is increasing globally, knowledge of oral HPV infection rates is limited. Here we carried out an observational epidemiological analysis of oral HPV incidence in 3,137 men enrolled from the United States, Mexico and Brazil between 2005 and 2009. Individuals were followed for new HPV infection for a median of 57 months. Cumulative incidence and factors associated with acquisition were also assessed. The incidence rate of oral oncogenic HPV was 2.4 per 1,000 person-months, did not vary with age and was constant throughout the study period. Risk of oral HPV acquisition was significantly associated with alcohol consumption, having male sexual partners, more lifetime female sexual partners, more oral sex given and higher educational attainment. These data indicate that men are at risk of acquiring oral HPV throughout their lifetime, suggesting that catch-up vaccination may reduce new infection incidence.

Effectiveness of bivalent HPV vaccination against genital HPV DNA-positivity of a catch-up campaign at age 13-16 years compared to routine vaccination at age 12 years: a biennial repeated cross-sectional study

BACKGROUND

The Netherlands is one of few countries worldwide which has used the bivalent HPV vaccine for girls-only for over a decade. This allows assessment of vaccine effectiveness (VE) against female genital HPV DNA-positivity of this vaccine in an observational post-licencing real-world setting. Additionally, it is unclear whether catch-up vaccination campaigns result in similar VE as routine vaccination. Therefore, type-specific and grouped VE were assessed and compared for women who had been eligible for catch-up vaccination at 13-16 years with those who had been eligible for routine vaccination at 12 years.

METHODS

PASSYON is a Dutch biennial repeated cross-sectional (2011-2021) study among sexual health clinic clients aged 16-24 years old. Women provided self-collected vaginal samples, questionnaires on demographics and sexual behaviour were administered, and women self-reported HPV vaccination status. Samples were analysed using a PCR-based assay (SPF10-LiPA25). Type-specific and grouped VE estimates, adjusted with propensity score stratification, were assessed against genital positivity for 14 HPV types. VE for targeted and non-targeted genotypes were compared between women who had been eligible for the catch-up and those who had been eligible for routine vaccination.

RESULTS

The study included 4488 female participants who had been eligible for HPV vaccination and provided genital swabs (1561 eligible for catch-up, 2927 for routine vaccination). Very high VE against genital HPV-16 and HPV-18 was observed (resp. 93.5% and 89.5%) and significant cross-protection against six other genotypes (HPV-31/33/35/45/52/58), varying from 18.0% (HPV-52) to 79.6% (HPV-45). VE estimates were comparable between women who had been eligible for the catch-up campaign and those eligible for routine vaccination: VE HPV-16/HPV-18: 92.2% (95%CI: 87.9-94.9) vs. 91.8% (95%CI: 86.0-95.2).

CONCLUSIONS

In real-world settings, the VE of bivalent vaccine is high against targeted genotypes, with cross-protection against 6 other genotypes. Catch-up campaigns up to age 16 years can be as effective as routine vaccination at age 12, although it is recommendable to provide HPV vaccination at an age at which most are likely not sexually active yet. This may inform countries considering catch-up campaigns when introducing or extending the use of HPV vaccination within their national immunisation programmes.

Distribution of 14 High-Risk HPV Types and p16/Ki67 Dual-Stain Status in Post-Colposcopy Histology Results: Negative, Low- and High-Grade Cervical Squamous Intraepithelial Lesions

BACKGROUND

Determining the distribution of high-risk human papillomavirus (HR-HPV) types in histologic low-(LSIL) and high-grade (HSIL/CIN2+) squamous intraepithelial lesions through a diagnostic process in a cervical cancer prevention provides one of the key etiological factors behind further progression and persistence. Incorporating novel high-grade cervical lesion biomarkers such as p16/Ki67 dual staining (DS) alongside HPV typing has become important in detecting cervical precancers.

METHODS

Among 28,525 screening tests and 602 histology results, 559 cases with HR-HPV and histology results obtained from colposcopic biopsy were retrospectively analyzed, together with DS status. The χ2 test with Bonferroni correction evaluated the differences in HR-HPV type prevalence and DS positivity across three histologic study groups.

RESULTS

A statistically significant difference in the prevalence of HPV 16 was observed between negative and HSIL/CIN2+ (p = 0.00027) groups, as well as between the LSIL/CIN1 and HSIL/CIN2+ groups (p = 0.00041). However, no significant difference was found between the negative and LSIL/CIN1 groups. Similarly, the DS positivity difference was significant between the negative and HSIL/CIN2+ (p < 0.0001) and between the LSIL/CIN1 and HSIL/CIN2+ groups (p < 0.0001), but there was no significant difference between the negative and LSIL/CIN1 groups.

CONCLUSIONS

The study highlights the heterogeneous nature of HPV-related cervical pathologies, and the distinct risks associated with different cervical lesion grades, emphasizing the importance of HR-HPV type distribution and DS status.

Effect of Clinicopathological Characteristics on the Outcomes of Topical 5-Aminolevulinic Acid Photodynamic Therapy in Patients with Cervical High-Grade Squamous Intraepithelial Lesions (HSIL/CIN2): A Retrospective Cohort Study

BACKGROUND

Minimally-invasive 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is used for treating cervical high-grade squamous intraepithelial lesions (HSIL/CIN2). The purpose of this study was to analyze the factors affecting the efficacy of ALA-PDT in the treatment of cervical HSIL/CIN2 in order to guide physicians in making appropriate treatment decisions.

METHODS

A retrospective study including 69 female patients with pathologically diagnosed HSIL/CIN2 was conducted. Patients were given six doses of 20% ALA-PDT at 7-14-day intervals. Cytology, HPV testing, colposcopy, and pathology were performed before treatment and at 6-month follow-up after treatment to assess efficacy. The main outcome of this study was the regression of HSIL/CIN2 and the clearance of high-risk HPV (hrHPV) infection after ALA-PDT treatment. Clinicopathological characteristics were collected to analyze the factors affecting the effectiveness of ALA-PDT treatment for HSIL/CIN2.

RESULTS

Between the successful and failed lesion regression group, there was a significant difference in sleeping disorders (p < 0.05). Between the successful and failed hrHPV clearance group, no statistically significant factors were found. With sensitivity values of 0.556 and 0.778, respectively, multivariate analysis showed that current smoking and sleeping disorders were independent prognostics of failure in lesion regression after ALA-PDT treatment.

CONCLUSIONS

Smoking and sleep disorders were independent risk factors for failure in HSIL/CIN2 regression following ALA-PDT, suggesting the need for careful consideration of ALA-PDT for patients with these conditions.