Original
Article
Virology
Kasmera 47(2):95-101, Julio-Diciembre,
2019. P-ISSN 0075-5222 E-ISSN 2477-9628
https://doi.org/10.5281/zenodo.3521760
Human Papilloma Virus genotypes in Type III cervical intraepithelial neoplasia. Cuenca–Ecuador, 2013-2017
Genotipos del virus del papiloma
humano en neoplasias intraepiteliales tipo III; Cuenca-Ecuador, 2013-2017
Tigre
Sinchi, Patricio Santiago . Hospital del Instituto Ecuatoriano de
Seguridad Social, Ministerio de Salud Pública del Ecuador. Cuenca. Azuay.
Ecuador. E-mail: psntiago_ts_befa@hotmail.com
Salazar
Torres, Zoila Katherine . (Corresponding Author). Cátedra de Ginecología y Obstetricia. Universidad Católica de Cuenca.
Cuenca. Azuay. Ecuador. Dirección postal: Coricancha 23 y Teotihuacan. Cuenca
010113. Azuay. Ecuador. Teléfono: 593+984047774. E-mail: zsalazart@ucacue.edu.ec
Espinosa
Martin, Lizette . Centro de Investigación de la Unidad
académica de Salud y Bienestar. Cátedra de Medicina Interna. Universidad
Católica de Cuenca. Cuenca. Azuay. Ecuador. E-mail: lespinosam@ucacue.edu.ec
Aspiazu
Hinostroza, Karla Alexandra . Departamento Investigación de la Carrera de
Medicina. Cátedra de Inmunología. Universidad Católica de Cuenca. Cuenca.
Azuay. Ecuador. E-mail: kaspiazuh@ucacue.edu.ec
Espinosa,
Hermel Medardo . Centro de Investigación de la Unidad
académica de Salud y Bienestar. Cátedra de Medicina Interna. Universidad Católica
de Cuenca. Cuenca. Azuay. Ecuador. E-mail: hespinozae@ucacue.edu.ec.
Cárdena
Heredia, Freddy Rosendo . Carrera de Medicina. Cátedra de Ginecología y
Obstetricia. Universidad Católica de Cuenca. Cuenca. Azuay. Ecuador. E-mail: fcardenash@ucacue.edu.ec
hespinozae@ucacue.edu.echespinozae@ucacue.edu.ec
Abstract
Cervical
cancer is one of the most common cancers in female population worldwide in
underdeveloped countries, and in Ecuador it stands out in second place. This
research focuses on HPV-genotype description in type III-intraepithelial
neoplasms. The study type was analytical, retrospective and cross-sectional.
The sample was 195 patients with NIC III diagnosis, from 20 to 60 years old,
who were in the data system of “Sociedad de Lucha Contra el Cancer”
Cuenca–Ecuador, 2013-2017 term. It was established that HPV-16 genotype was in
32.9% (n 51) of all cases; factors like sociodemographic variables, tobacco
use, infection, hormonal contraceptives use, more than one sexual partner, age
of start of active sex life equal or less than 20 years old, didn´t show a
relationship with HPV infection; on the other hand, IUD use and HPV-16
infection had a statically significant relationship (OR 2,75; CI 95% 1,21-6,26;
p 0,01). HPV genotype HPV-16 was the most common, and IUD use was a risk factor
to get HPV infection.
Keywords: carcinoma
in situ, uterine cervical dysplasia, papanicolaou test
Resumen
El cáncer de cuello uterino, es uno de los
cánceres más frecuentes en la población femenina a nivel mundial en países
subdesarrollados, y en Ecuador ocupa el segundo lugar. Esta investigación se
sitúa en la descripción de los genotipos del VPH en neoplasias intraepiteliales
tipo III. El tipo de estudio fue analítico, retrospectivo y transversal. La
muestra fueron 195 pacientes con diagnóstico de NIC III, de 20 hasta los 60
años de edad, que se encontraba en el sistema informático de la “Sociedad de
Lucha Contra el Cáncer”, Cuenca – Ecuador, periodo 2013 - 2017. Los datos
fueron procesados a través del software SPSS 23.00. Se determinó que el
genotipo VPH-16 estuvo en el 32,9% (n 51) de los casos; las variables
sociodemográficas, consumo de tabaco, infecciones, uso de anticonceptivos
hormonales, más de una pareja sexual, IVSA igual o menor de 20 años no
presentaron relación a la infección por VPH; pero, el uso de DIU e infección
por VPH-16 tuvo una relación estadísticamente significativa (OR 2,75; IC 95%
1,21-6,26; p 0,01). El genotipo de VPH-16 fue el más frecuente, y el uso de DIU
fue un factor de riesgo para adquirir la infección por el VPH.
Palabras clave: carcinoma in situ, displasia del cuello del útero, prueba de
papanicolaou.
Received: 04-06-2019 / Accepted: 02-07-2019 / Published on line: 03-07-2019
Introduction
Cervical cancer is one of the most prevalent cancer
types in female population worldwide, particularly in third-world countries,
there are many factors that are related to disease development, and one of them
is human papilloma virus infection (HPV), infection that stands out as one of
the most common in our field. This virus acts altering epidermis’ and mucous’
cells. Within this infection, many virus genotypes have been sorted, of which
the high-risk ones are the most commonly related to lesion evolution prevalence
(1,2).
This has led many studies to focus on virus’
infection early diagnosis, some of them finding that cytology and colposcopy,
which are the diagnostic methods in our field, have not had a big influence in
cervix cancer’s prevalence-and-death rates, since they detect cervix lesions in
advanced stages (3).
In 2008, it was estimated that 4.8% of the 12.7
million cancer cases that were diagnosed worldwide, were related to HPV
infection (4). For
this reason, many studies have aimed to show HPV virus as a big factor in the
development of premalignant and malignant lesions in cervix, esophagus, anal
region, etc (5,6). The most important relationship is with
cervical cancer, whom according to World Health Organization (WHO), in a
non-immunocompromised woman could develop cancer in 15 to 20 years, and in an
immunocompromised woman cancer could develop in 5 to 10 years (7).
As expressed above, for this research is
appropriate to recognize human papilloma viruses-infection current prevalence
in our field and contextualize these results according to world literature;
knowledge will let us detect this issue’s control and measures to take.
The objective of this study was to determine the
prevalence and risk factors for infection by the genotypes of human papilloma
virus in cervical intraepithelial neoplasia Type III, classified by the
Bethesda System, in patients 20 to 60 years of age, users of the hospital SOLCA
of Cuenca; period 2013 - 2017.
Methods
Investigation design: non-experimental analytical,
cross sectional and retrospective study was done.
Population and sampling: the universe and sample of the
study was formed by 195 female patients, with an III-intraepithelial neoplasms
diagnosis, in ages between 20 and 60 years old, who were examined in external
medical gynecology area in "Sociedad de Lucha contra el Cáncer" SOLCA
in Cuenca - Ecuador. Inclusion criteria were: patients with NIC III confirmed
results through cytology or biopsy, patients with infection evidence caused by
one or more HPV genotypes, patients with complete medical records.
Methodology: according to protocol, samples were
taken through cervical brushing, and then processed through DNA amplification
through polymerase chain reaction and hybrids capture. DNA amplification was
done in Gene-Amp DNA PCR System 9700 and hybrids capture through Hibri-Max DNA
HHM-2. For genotyping “37 HPV GenoArray Diagnostic Kit” was used, which has a
primer, “HybriMem”, which is a membrane that reacts according to different
genotypes that feature in the sample, determines 37 different HPV genotypes (15
high risk, 6 low risk and 16 probably low risk); results are interpreted
through a diaphragm which shows the exact place that must react and change its
color. Quality control is according to ISO certification, through Hybribio’s
quality management system; besides each kit has quality control methods: an
external one which controls each test lot, an internal one in each membrane
which has a biotin control to examine all hybridization process, and a
beta-globin one which shows the DNA-amplification’s efficiency due to
polymerase chain reaction.
Data collection: information was taken through forms
for both sociodemographic variables and age, place of residence, marital
status, education level and occupation, also aspects like gynecological
background, sexually-transmitted-disease background and HPV genotyping were
added.
Statistical analysis: data was entered in SPSS version
23.00 program. Recordings were made and results analysis was done with
descriptive statistic according to frequency tables and percentages for
qualitative variables and through average calculation and standard deviation
for quantitative variables. For association, Pearson's square Chi and Odds
Ratio were used with a 95% confidence interval, statistical significance was
determined with a p <0,05 value.
Bioethical aspect: in our country, physician’s duty is
to promote and ensure patient’s health, wellness and rights, including those
who take part in medical research; therefore, physician’s knowledge and
awareness must subordinate to that duty’s accomplishment. Current research is
ruled according to Helsinki’s agreement and our country’s laws, to give further
protection to this study’s participants.
All taken data will be
used solely for this study, will have absolute confidentiality and will take
respect for participants and their rights. Besides, through an ethical
commitment letter with the Committee on bioethics of the Catholic University,
the author of this study commits to use patient’s taken data in an appropriate
way.
Results
In sociodemographic parameters (Table 1), it was demonstrated that most of
them were from urban areas (146), also a bigger portion is married (106), they
predominantly had an elementary (78) and secondary (71) education level,
regarding occupation there are more patients who do only housework.
Among study group’s clinical
characteristics features that patient’s average number of sexual partners is 2,
additionally, sexual initiation’s average age was 18 years old (Table 2).
Regarding related factors (Table 3), most patients did not consume
tobacco (146); 27 women had a STD at some point in their lives, being
Candidiasis the most common (13); about used contraceptive method, hormone use
was the most common one (99); besides that, of the 195 patients with a
diagnosis of type III-intraepithelial lesions, 159 had HPV infection and 42 had
coinfection with 2 or 3 subtypes.
Table
1. Sociodemographic
characteristics of SOLCA's female patients with a diagnosis of NIC III
intracervical lesion; 2013-2017.
|
Variable |
n (%) 195 (100) |
|
|
Average age 39,4 ± 9 (DS) |
||
|
Origin |
Rural |
49 (25,1) |
|
Urban |
146 (74,9) |
|
|
Marital status |
Single |
42 (21,5) |
|
Married |
106 (54,4) |
|
|
Widow |
8 (4,1) |
|
|
Divorced |
20 (10,3) |
|
|
Consensual union |
19 (9,7) |
|
|
Education Level |
None |
16 (8,2) |
|
Elementary |
78 (40) |
|
|
Secondary |
71 (36,4) |
|
|
Postsecondary |
30 (15,4) |
|
|
Occupation |
Employed |
87 (44,6) |
|
Housework |
105 (53,8) |
|
|
None |
3 (1,5) |
|
Table
2. Clinical
characteristics of SOLCA’s patients with a diagnosis of NIC III intracervical
lesion; 2013-2017.
|
Variable |
Average |
SD |
|
Number of sexual
partners |
2 |
1,3 |
|
Age of sexual
initiation |
18 |
3 |
Table
3. Factors related to
HPV infection of SOLCA’s patients with a diagnosis of NIC III intracervical
lesion; 2013-2017.
|
Variable |
n (%) 195 (100) |
|
|
Cigarette smoking |
Yes |
47 (24,1) |
|
No |
146 (75,9) |
|
|
Sexually-transmitted
diseases |
Candidiasis |
13 (6,7) |
|
Vaginosis |
5 (2,6) |
|
|
Trichomoniasis |
3 (1,5) |
|
|
Syphilis |
3 (1,5) |
|
|
HIV |
3 (1,5) |
|
|
None |
168 (86,2) |
|
|
Contraceptive
Method |
Hormonal |
99 (50,8) |
|
IUD |
28 (14,4) |
|
|
Tubal ligation |
22 (11,3) |
|
|
Condom |
14 (7,2) |
|
|
Rhythm |
10 (5,1) |
|
|
None |
22 (11,3) |
|
|
HPV Infection |
Yes |
159 (81,5) |
|
No |
7 (3,6) |
|
|
Undone test |
29 (14,9) |
|
|
HPV Coinfection |
Yes |
42 (21,5) |
|
No |
124 (63,6) |
|
|
Undone test |
29 (14,9) |
|
Table 4 show genotype distribution in SOLCA’s patients
with a diagnosis of NIC III intracervical lesion; 155 of the 195 patients had
HPV infection, in 29 of them the test was not performed, 4 were negative for
HPV infection, and in 4 patients that were diagnosed positive for infection,
HPV subtypes could not be found because they were out of the analysis spectrum
regarding what is performed in the hospital. Of the high-risk genotypes,
genotype 16 was found in 51 patients being the most common one, without
considering the subtypes that are related to other subtypes, meanwhile low risk
ones were rarely found, being genotype 71 the main subtype.
Table
4. Detected genotypes
in SOLCA’s patients with a diagnosis of NIC III intracervical lesion;
2013-2017.
|
Variable |
n (%)
155
(100) |
|
|
Genotypes |
16 |
51
(32,9) |
|
31 |
18
(11,6) |
|
|
58 |
12 (7,7) |
|
|
33 |
5 (3,3) |
|
|
52 |
5 (3,3) |
|
|
16,52 |
4 (2,5) |
|
|
49 |
3 (1,9) |
|
|
31,58 |
3 (1,9) |
|
|
39 |
3 (1,9) |
|
|
16,45 |
3 (1,9) |
|
|
71 |
3 (1,9) |
|
|
35 |
2 (1,2) |
|
|
66 |
2 (1,2) |
|
|
16,33 |
2 (1,2) |
|
|
16,54 |
2 (1,2) |
|
|
6,1 |
1 (0,6) |
|
|
56 |
1 (0,6) |
|
|
43,31 |
1 (0,6) |
|
|
58,16 |
1 (0,6) |
|
|
31,16,6,11 |
1 (0,6) |
|
|
18 |
1 (0,6) |
|
|
42,58 |
1 (0,6) |
|
|
16,52,58 |
1 (0,6) |
|
|
16,56 |
1 (0,6) |
|
|
33,35 |
1 (0,6) |
|
|
31,33 |
1 (0,6) |
|
|
59 |
1 (0,6) |
|
|
15,35,56 |
1 (0,6) |
|
|
35,58 |
1 (0,6) |
|
|
6,31 |
1 (0,6) |
|
|
6,52 |
1 (0,6) |
|
|
51,58 |
1 (0,6) |
|
|
16,68 |
1 (0,6) |
|
|
16,51,58 |
1 (0,6) |
|
|
51 |
1 (0,6) |
|
|
59,68 |
1 (0,6) |
|
|
6,16,45,51 |
1 (0,6) |
|
|
16,18 |
1 (0,6) |
|
|
53 |
1 (0,6) |
|
|
Other |
15 (9,6) |
|
Altogether, 42 coinfection cases
with 2 or more HPV genotypes were found, the 16, 52 genotype-association was
the most common; also genotype 16 is the most correlated with another genotype,
being present in more than 10 of all possible associations (Table 5).
Risk factors like: cigarette
smoking, hormone use as a contraceptive method, 2 or more sexual partners in
the last 6 months, less-than-20-year-old age of sexual initiation,
sexually-transmitted-disease background, and a marital status of singleness or
consensual union, did not have a statistically significant relationship with
human papilloma virus’ genotype 16 infection; however, copper T type-IUD use as
a contraceptive method was a related factor to this genotype’s infection (OR
2.75; CI 95% 1,21–6,26; p 0,013) (Table 6).
Table
5. Found genotypes in
SOLCA’s patients with various-HPV subtypes’ coinfection with a diagnosis of NIC
III intracervical lesion; 2013-2017.
|
Variable |
n (%)
42
(100) |
|
|
Coinfection
Genotypes |
16, 52 |
4 (9,5) |
|
31, 58 |
3 (7,1) |
|
|
16,45 |
3 (7,1) |
|
|
16, 33 |
2 (4,7) |
|
|
16, 54 |
2 (4,7) |
|
|
6, 31 |
1 (2,4) |
|
|
43, 31 |
1 (2,4) |
|
|
58, 16 |
1 (2,4) |
|
|
31, 16,
6, 11 |
1 (2,4) |
|
|
42, 58 |
1 (2,4) |
|
|
16, 52,
58 |
1 (2,4) |
|
|
16, 56 |
1 (2,4) |
|
|
33, 35 |
1 (2,4) |
|
|
31, 33 |
1 (2,4) |
|
|
15, 35,
56 |
1 (2,4) |
|
|
35, 58 |
1 (2,4) |
|
|
6, 31 |
1 (2,4) |
|
|
6, 52 |
1 (2,4) |
|
|
51, 58 |
1 (2,4) |
|
|
16, 68 |
1 (2,4) |
|
|
16, 51,
58 |
1 (2,4) |
|
|
59, 68 |
1 (2,4) |
|
|
6, 16,
45, 51 |
1 (2,4) |
|
|
16, 18 |
1 (2,4) |
|
Table
6. Risk factors related
to genotype 16 HPV infection, in study patients, SOLCA Hospital; 2013–2017.
|
Related Factors |
Genotype 16 |
OR |
CI 95% LI - LS |
p Value |
||
|
Yes n (%) 77 (39,5) |
No n (%) 118 (60,5) |
|||||
|
Age > 29 years
old |
Yes |
72 (36,9) |
104(53,3) |
1,9 |
0,66–5,62 |
0,21 |
|
No |
5 (2,5) |
14(7,2) |
||||
|
Cigarette Smoking |
Yes |
18 (9,2) |
29(14,8) |
0,9 |
0,48–1,84 |
0,84 |
|
No |
59 (30,2) |
89(45,6) |
||||
|
Hormone Use |
Yes |
34 (17,4) |
66(33,8) |
0,6 |
0,34–1,11 |
0,10 |
|
No |
43 (22) |
52(26,6) |
||||
|
Sexual partners ≥
2 |
Yes |
44 (22,5) |
72(36,9) |
0,9 |
0,47–1,52 |
0,59 |
|
No |
33 (16,9) |
46(23,5) |
||||
|
Start of active
sex life < 20 years old |
Yes |
54 (27,6) |
94(48,2) |
0,6 |
0,39–1,16 |
0,12 |
|
No |
23 (11,7) |
24(12,3) |
||||
|
Infection |
Yes |
11 (5,6) |
26(13,3) |
0,59 |
0,72–1,27 |
0,17 |
|
No |
66 (33,8) |
92(47,1) |
||||
|
IUD Use |
Yes |
17 (8,7) |
60(30,7) |
2,75 |
1,21–6,26 |
0,013 |
|
No |
11 (5,6) |
107(54,8) |
||||
|
Single or
Consensual union |
Yes |
25 (12,8) |
36(18,4) |
1,09 |
0,59–2.03 |
0,77 |
|
No |
52 (26,6) |
82(42) |
||||
Discussion
Garcia et al., in 2017 (8), through a quantitative, observational,
descriptive, cross-sectional, retrospective study, in 190.203 25-to-64-year-old
women in Spain; determined that HPV prevalence is directly proportional to
detected cytological lesion, affecting 90% of patients with a NIC III lesion.
Likewise, Aguilar-Lemarroy et al. (9), through a 2015-Mexico-accomplished-studies
meta-analysis formed by 822 patients with ages between 18-87 years old,
demonstrated that 100% of type III-intracervical lesion patients had HPV
infection. On this side, our study’s results vary because it was determined
that 81% of all population had an HPV infection.
De la Fuente et al., in 2013 (10), through an observational, cross-sectional,
prospective and comparative analytical study where 343 Mexico City’s women were
studied, demonstrated that VPH infection’s most prevalent age was 40 years old,
which slightly differs with our study’s found data (age average 39,4 years old
± 9).
Cabrera-Gaytan et al. (11), through a descriptive retrospective study,
performed in Mexico in 2014, in a 299 women sample, demonstrated that variables
like singleness or consensual union mean a slight risk for HPV infection
regarding other marital status (RM = 1.214 CI 95% p= 0.548). It differs from
our study because we could not find an association between a marital status of
singleness or consensual union and a genotype 16-HPV infection.
Drolet et al. (12), through a meta-analysis performed in Canada
in 2013 with a 953-patient sample, demonstrated that 38,5% of VPH-infected
patients had accomplished secondary education, which differs with our study,
because most of our patients finished elementary education.
Melo et al. (13), through their retrospective descriptive study
made in Chile in 2016, in which a 151 18-to-24-year-old-university-student
sample was used, they determined that more than half of the studied population
(58,3%) with HPV infection said to having had three or more partners in the
last three years; it is important to underline that most of them had high risk
HPV genotypes (71,4%), besides that, they determined that HPV infection
prevalence increased proportionally according to the number of sexual partners:
15,1% (one partner), 33,3% (two partners) and 51,5% (three or more partners) (13). This matches with our study, because it was
proved that most women who had HPV infection had more than one sexual partner.
In their study, De la Fuente et al. (10), determined that start of active sex life
showed an age average of 19,9 years old in HPV infected patients, unlike this,
our study determined that start of active sex life is a year less, being 18
years old the average age for women with HPV infection.
Sánchez, in 2012 (14), through an observational, descriptive and
retrospective study made in Malaga in a 111-patient sample, it determined that
there was no statistically significant relationship between tobacco use and HPV
infection, however, an important percentage (52,1%) of HPV infected patients
and with a diagnosis of type II and III intracervical lesions had a tobacco-use
habit at the time of the study; what we beared out in our research, because an
association between HPV infection and tobacco use was demonstrated.
Additionally, in the same study, Sanchez (14) demonstrated that 36% of
hormonal-contraceptive using patients had type II or III intracervical lesions,
but did not show a statistically significant relationship between HPV infection
and referred contraceptives; in our study, it was demonstrated that a lesser
number of patients used hormonal contraceptive method and had HPV infection,
which represents 17% of all patients.
Rodriguez et al. (15), in their research named “Human papilloma
virus infection in middle-aged women and related factors”, a descriptive cross
sectional study made in Cuba in 2014, which includes 177 patients, demonstrated
that 31,1% of HPV infected patients did not have sexually-transmitted-disease
background, and most of the patients with STD background were related to
trichomoniasis cases (38,5%). It differs from our study, because we could
demonstrate a bigger prevalence of candidiasis in 6.7% of all cases.
Flores-Miramontes et al. (16), in their research “HPV-genotype prevalence in
Mexico and worldwide detected through Linear Array”, which is a meta-analysis
that consists of 12 studies made in Mexico, United States, Canada, Brazil,
Sweden, Tanzania, Saudi Arabia and Australia, with 5.294 patients, in 2015 they
demonstrated that infection in high-grade-intracervical lesions in homogeneous,
due to a bigger-HPV-16 incidence, followed by HPV -31, -18, -52 and -51. This
was beared out by Paredes through a cross-sectional study made in Spain in 2017
(17), with a 595-patient sample in which HPV-16 was
the most prevalent genotype, found in 30,08% of HPV-infected women, besides
that, a bigger coinfection incidence was noticed in less-than-34-year-old
women. In our study HPV-16 was found to be the most common genotype in infected
patients with a 32.9% percentage, likewise followed by HPV-31, but the
following genotypes vary, with HPV-58 and HPV-32 featuring in third and fourth
place according to their incidence.
In regard to coinfection, Aguilar-Lemarroy et
al. (17), demonstrated that HPV-16 was the most common
genotype related to other genotypes, and those other genotypes related to
HPV-16 in women with malignant lesions were 18, 39 and 70; Paredes et al.,
demonstrated that less-than-34-year-old women are more likely to have a
multiple infection. In our study it was proved that HPV-16 is the most related
genotype to other genotypes, being related to more than 10 of possible
relations to other genotypes, besides that, the most common relations of coinfection
incidence were: 16,52; 31,58; 16,45; 16,33.
Averbach et al. (18), through a prospective-type research in 2017,
in San Francisco, included 591 women who did not use IUD and 85 women that used
IUD, the study’s approach was on proving a relationship between HPV infection
and IUD use as a contraceptive method, and it could not be able to find a
statistically significant relation between IUD use and HPV infection (OR: 0.50;
CI: 95% 0.20-1.23; p = 0,13) or a decrease of HPV infection (OR: 1.44; CI: 95%
0.76–2.72; p= 0.26) . On the other side, this research demonstrated that
14,4% of studied patients used IUD as a contraceptive method, showing a
statistically significant relationship (OR: 2,75; CI: 95% 1,21-6,26; p=0,013).
Salazar (19), through an analytical cross-sectional study,
in 2016, made in indigenous women from 3 ecuatorian provinces, in which a
396-random-women sample was used, it was demonstrated a relationship
between being more than 29 years old and having intracervical lesions
without HPV, but in our study, this demonstrated relationship between
older-than-29 age and HPV infection did not have a statistically significant
value.
The prevalence of human papilloma virus
infection in patients with type III-intraepithelial-lesion diagnosis was high.
The sociodemographic profile showed by most of this study’s patients, was
32-to-42-year-old patients, from urban origin, who have accomplished an
elementary education level, married, whose occupation is housework.
Regarding gynecologic-obstetric characteristics
found in most study’s patients, were 2-or-more-sexual-partner patients, whose
start of active sex life was at 18 years old. High-risk-HPV-16 genotype was the
most common in study’s group. Besides that, it was demonstrated that most
patients have coinfection by two or more HPV genotypes, HPV-16 genotype was
also regarded as the most common in referred coinfections, being the most
related to other genotypes.
Bedoya et al., (20). In Ecuador, 166 samples were analyzed,
including 57 and 95 cases of cervical intraepithelial neoplasia type 1 (CIN 1)
and type 2/3 (CIN 2/3) respectively, and 14 cases of cancer. HPV DNA was found
in 54.4% of the CIN 1 sample, 74,7% on the CIN 2/3 sample and 78.6% of the
cancer sample. The types HPV 16 (38.9%) and HPV 58 (19.5%) were the most
frequent. The risk factors for the development of cervical lesions / cancer
were or more pregnancies (OR: 4.3) and HPV infection (OR: 3.7 for high–risk
HPV, OR: 3.5 for HPV 16) among others.
The only related factor to HPV-16 infection
that had a statistically significant value was IUD use. Variables like:
more-than-29-year-old age, cigarette smoking, hormone use as a contraceptive
method, two-or-more sexual partners, less-than-20-year-old start of active sex
life and sexually-transmitted-disease background, did not have statistically
significant values.
This research provides relevant information about the genotypes of human
papilloma virus of the south-central region of Ecuador. These results may
relate to the genotypes that cover the currently existing vaccines against HPV.
Conflict of Interest
Authors declare to have no conflict of
interest.
Acknowledgment
To distinguished members who work at Sociedad
de Lucha Contra el Cáncer (SOLCA) Hospital – Cuenca.
Study
Limitations
There were no limitations for this study,
because it is working with the total population.
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Authors
Contribution
TSPS: Information collection and bibliographic
review. STZK: methodological analysis. CDFR: content analysis. AHKA, EML: contribution of methodological
design and statistical processing, EHM: statistical and results analysis.
©2019.
The Authors. Kasmera. Published by Infectious Diseases and Tropical Medicine
Department. Medicine Faculty, Zulia´s University. Maracaibo-Venezuela. This is
an open access publication distributed under Creative Commons license
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