Current concepts of HPV as a multifactorial predictor for squamous intraepithelial lesions of the cervix
Human papillomavirus (HPV)-related cervical diseases are currently one of the urgent global health challenges. Due to its high diagnostic efficiency, HPV testing is one of the cervical cancer screening methods. To date, close attention is paid to the identification of the genotype of HPV. It is generally accepted to classify HPV into high and low carcinogenic genotypes, while it is widely believed in clinical practice that HPV genotypes 16 and 18 have the highest risk for developing and progressing precancerous diseases of the cervix. However, recent observations in many countries have shown that this position needs to be revised, as other HPV genotypes, such as 31, 33, or 51, occur in more cases than HPV genotype 18, and are more commonly associated with squamous intraepithelial lesions (SIL). Nevertheless, a more detailed study of the factors of HPV infection is a promising direction, since many aspects, such as the determination of a HPV viral load and the geographical distribution of various genotypes, are still little studied. In addition, the international community has not come to a consensus as to the detection of several HPV genotypes in one sample. The results of many recent studies on this issue often lead to diametrically opposite conclusions. The HPV test result has a great influence on the choice of further tactics for the behavior of patients with cervical lesions, as well as the correct interpretation of test results and their subsequent extrapolation to each clinical case are extremely important.Andreev A.O., Bairamova G.R., Zaretsky A.R., Rebrikov D.V.
Conclusion: Thus, HPV is a multifactorial predictor for cervical lesion; the correct interpretation, and the subsequent extrapolation of HPV test results to each specific clinical case are possible only through a comprehensive assessment of the factors of human papillomavirus infection.
Keywords
squamous intraepithelial lesions
human papillomavirus
HPV viral load
genotyping
diagnostic test systems
References
- Каприн А.Д., Старинский В.В., Шахзадова А.О., ред. Злокачественные новообразования в России в 2020 году (заболеваемость и смертность). М.: МНИОИ им. П.А. Герцена − филиал ФГБУ «НМИЦ радиологии» Минздрава России; 2021. 252с. [Kaprin A.D., Starinsky V.V., Shakhzadova A.O., ed. Malignant neoplasms in Russia in 2020 (morbidity and mortality). M.; 2021. 252 p. (in Russian)].
- WHO. WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. 2nd ed. 2021.
- Zhang J., Cheng K., Wang Z. Prevalence and distribution of human papillomavirus genotypes in cervical intraepithelial neoplasia in China: a meta-analysis. Arch. Gynecol. Obstet. 2020; 302(6): 1329-37. https://dx.doi.org/10.1007/s00404-020-05787-w.
- Министерство здравоохранения Российской Федерации. Клинические рекомендации «Цервикальная интраэпителиальная неоплазия, эрозия и эктропион шейки матки». 2020. [Ministry of Health of the Russian Federation. Clinical guidelines “Cervical intraepithelial neoplasia, erosion and ectropion of the cervix”. 2020. (in Russian)].
- Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 2021: 71(3):209-49. https://dx.doi.org/10.3322/caac.21660.
- Inturrisi F., Bogaards J.A., Heideman D.A.M., Meijer C.J.L.M., Berkhof J. Risk of cervical intraepithelial neoplasia grade 3 or worse in HPV-positive women with normal cytology and five-year type concordance: a randomized comparison. Cancer Epidemiol. Biomarkers Prev. 2021; 30(3): 485-91.https://dx.doi.org/10.1158/1055-9965.
- Campos R.G., Malacara Rosas A., Gutiérrez Santillán E., Delgado Gutiérrez M., Torres Orozco R.E., García Martínez E.D. et al. Unusual prevalence of high-risk genotypes of human papillomavirus in a group of women with neoplastic lesions and cervical cancer from Central Mexico. PLoS One. 2019; 14(4): e0215222. https://dx.doi.org/10.1371/journal.pone.0215222.
- Farahmand M., Moghoofei M., Dorost A., Abbasi S., Monavari S.H., Kiani S.J., Tavakoli A. Prevalence and genotype distribution of genital human papillomavirus infection in female sex workers in the world: a systematic review and meta-analysis. BMC Public Health. 2020; 20(1): 1455. https://dx.doi.org/10.1186/s12889-020-09570-z.
- Seyoum A., Assefa N., Gure T., Seyoum B., Mulu A., Mihret A. Prevalence and genotype distribution of high-risk human papillomavirus infection among sub-saharan african women: a systematic review and meta-analysis. Front. Public Health. 2022; 10: 890880. https://dx.doi.org/10.3389/fpubh.2022.890880.
- Faber M.T., Sand F.L., Albieri V., Norrild B., Kjaer S.K., Verdoodt F. Prevalence and type distribution of human papillomavirus in squamous cell carcinoma and intraepithelial neoplasia of the vulva. Int. J. Cancer. 2017; 141(6): 1161-9. https://dx.doi.org/10.1002/ijc.30821.
- Wang X., Zeng Y., Huang X., Zhang Y. Prevalence and genotype distribution of human papillomavirus in invasive cervical cancer, cervical intraepithelial neoplasia, and asymptomatic women in Southeast China. Biomed. Res. Int. 2018; 2018: 2897937. https://dx.doi.org/10.1155/2018/2897937.
- Yang-Chun F., Yuan Z., Cheng-Ming L., Yan-Chun H., Xiu-Min M. Increased HPV L1 gene methylation and multiple infection status lead to the difference of cervical epithelial cell lesion in different ethnic women of Xinjiang, China. Medicine (Baltimore). 2017; 96(12): e6409. https://dx.doi.org/10.1097/MD.0000000000006409.
- Trottier H., Mahmud S., Costa M.C., Sobrinho J.P., Duarte-Franco E., Rohan T.E.et al. Human papillomavirus infections with multiple types and risk of cervical neoplasia. Cancer Epidemiol. Biomarkers Prev. 2006; 15(7): 1274-80.https://dx.doi.org/10.1158/1055-9965.
- Campos N.G., Rodriguez A.C., Castle P.E., Herrero R., Hildesheim A., Katki H. et al. Persistence of concurrent infections with multiple human papillomavirus types: a population-based cohort study. J. Infect. Dis. 2011; 203(6): 823-7. https://dx.doi.org/10.1093/infdis/jiq131.
- Plummer M., Schiffman M., Castle P.E., Maucort-Boulch D., Wheeler C.M.; ALTS Group. A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion. J. Infect. Dis. 2007; 195(11): 1582-9.
- Bruno M.T., Scalia G., Cassaro N., Boemi S. Multiple HPV 16 infection with two strains: a possible marker of neoplastic progression. BMC Cancer. 2020; 20(1): 444. https://dx.doi.org/10.1186/s12885-020-06946-7.
- Kyrgiou M., Arbyn M., Bergeron C., Bosch F.X., Dillner J., Jit M. et al. Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC). Br. J. Cancer. 2020; 123(4): 510-7. https://dx.doi.org/10.1038/s41416-020-0920-9.
- Прилепская В.Н., Сухих Г.Т., ред. Диагностика, лечение и профилактика цервикальных интраэпителиальных неоплазий. М.: МЕДпресс-информ; 2020. 80с. [Prilepskaya V.N., Sukhikh G.T., ed. Diagnosis, treatment and prevention of cervical intraepithelial neoplasia. M.: MEDpress-inform; 2020. 80p. (in Russian)].
- Shrestha A.D., Neupane D., Vedsted P., Kallestrup P. Cervical cancer prevalence, incidence and mortality in low and middle income countries: a systematic review. Asian Pac. J. Cancer Prev. 2018; 19(2): 319-24. https://dx.doi.org/10.22034/APJCP.2018.19.2.319.
- Xia C., Li S., Long T., Chen Z., Chan P.K.S., Boon S.S. Current updates on cancer-causing types of human papillomaviruses (HPVs) in East, Southeast, and South Asia. Cancers (Basel). 2021; 13(11): 2691. https://dx.doi.org/10.3390/cancers13112691.
- Байрамова Г.Р., Прилепская В.Н., Смольникова В.Ю., Юренева С.В. и др. ВПЧ-ассоциированный цервицит: диагностика, лечение и профилактика. Учебное пособие. М: «ИД Третьяковъ»; 2022. 90с. [Bayramova G.R., Prilepskaya V.N., Smolnikova V.Yu., Yureneva S.V. et al. HPV-associated cervicitis: diagnosis, treatment and prevention. Study guide. M: Tretyakov Publishing House LLC; 2022. 90 p. (in Russian)].
- Прилепская В.Н., Байрамова Г.Р., Асатурова А.В., Андреев А.О., Перемыкина А.В., Пронина В.А. Современные представления о предикторах и методах профилактики рецидивов цервикальной интраэпителиальной неоплазии после петлевой электроэксцизии. Акушерство и гинекология. 2020; 12: 81-8. https://dx.doi.org/10.18565/aig.2020.12.81-88. [Prilepskaya V.N., Bairamova G.R., Asaturova A.V., Andreev A.O., Peremykina A.V., Pronina V.A. Modern ideas about predictors and methods for preventing recurrence of cervical intraepithelial neoplasia after loop electroexcision. Obstetrics and Gynecology. 2020; 12: 81-8. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.12.81-88.
- Adcock R., Cuzick J., Hunt W.C., McDonald R.M., Wheeler C.M.; New Mexico HPV Pap Registry Steering Committee. Role of HPV genotype, multiple infections, and viral load on the risk of high-grade cervical neoplasia. Cancer Epidemiol. Biomarkers Prev. 2019; 28(11): 1816-24.https://dx.doi.org/10.1158/1055-9965.
- Lee S.J., Kim W.Y., Shim S.H., Cho S.H., Oh I.K., Hwang T.S. et al. Semi-quantitative HPV viral load in patients with ASC-US cytology: viral load correlates strongly with the presence of CIN but only weakly with its severity. Cytopathology. 2015; 26(1): 19-25. https://dx.doi.org/10.1111/cyt.12146.
- Quint W., Jenkins D., Molijn A., Struijk L., van de Sandt M., Doorbar J. et al. One virus, one lesion--individual components of CIN lesions contain a specific HPV type. J. Pathol. 2012; 227(1): 62-71. https://dx.doi.org/10.1002/path.3970..
Received 05.10.2022
Accepted 22.11.2022
About the Authors
Alexander O. Andreev, post-graduate student (specialty obstetrics and gynecology), Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,+7(903)613-00-26, sasha.grash2010@yandex.ru, 117997, Russia, Moscow, Academician Oparin str., 4.
Guldana R. Bairamova, Dr. Med. Sci., Honored Doctor of the Russian Federation, Professor at the Department of Obstetrics and Gynecology,
Department of Vocational Education; Head of Clinical Work, Scientific and Polyclinic Department, Academician V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia,
+7(926)660-48-77, bayramova@mail.ru, https://orcid.org/0000-0003-4826-661X, 117997, Russia, Moscow, Academician Oparin str., 4.
Andrey R. Zaretsky, Senior Researcher at the Department of Molecular Technologies of Research Institute of Translational Medicine, Pirogov RNRMU, Ministry of Health of Russia, +7(916)815-95-56, a-zaretsky@yandex.ru, https://orcid.org/0000-0002-7778-6617, 117997, Russia, Moscow, Ostrovityanova str., 1.
Denis V. Rebrikov, Dr. Bio. Sci., Professor of the RAS, Pirogov RNRMU, Ministry of Health of Russia, +7(495)434-12-83, rebrikov_dv@rsmu.ru,
https://orcid.org/0000-0002-1884-1807, 117997, Russia, Moscow, Ostrovityanova str., 1.
Authors' contributions: Andreev A.O., Bairamova G.R. – material collection and processing, writing the text; Bairamova G.R., Rebrikov D.V., Zaretsky A.R. – editing the text of the article.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
For citation: Andreev A.O., Bairamova G.R., Zaretsky A.R., Rebrikov D.V. Current concepts
of HPV as a multifactorial predictor for squamous intraepithelial lesions of the cervix.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 11: 60-66 (in Russian)
https://dx.doi.org/10.18565/aig.2022.11.60-66
Similar Articles
