High-risk oncogenic HPV genotypes in vulnerable women from the Amazon: a cross-sectional retrospective study.

Abstract

Introduction: Human papillomavirus (HPV) is widely acknowledged as the primary etiological agent of cervical cancer, with more than 14 high-risk oncogenic genotypes identified to date. Women residing in remote and underserved regions of the Amazon face significant barriers to accessing quality healthcare services, including geographic isolation, socioeconomic disparities, and limited infrastructure. These challenges contribute to the disproportionate burden of cervical cancer observed in this population, where women from interior regions represent the highest percentage of cases in Brazil.

Objective: This study aims to elucidate the prevalence, distribution of HPV genotypes, and associated risk factors among women from remote communities in the Brazilian Amazon, providing critical insights into regional public health challenges.

Methods: Endocervical smears were systematically collected from women across 18 municipalities. HPV detection was performed using Hybrid Capture II, a highly sensitive molecular assay, while genotyping was conducted using the Linear Array HPV system, which enables comprehensive identification of multiple HPV genotypes. Statistical analyses included chi-square tests, odds ratios (OR), and Cramér's V, with a significance threshold set at p ≤ 0.05 and a 95% confidence interval.

Results: The overall prevalence of HPV infection was 13.84% (182/1315), with notable variation across municipalities. Irituia exhibited the highest prevalence at 21.25% (p = 0.0664). Key factors associated with HPV acquisition included age ≤ 25 years (p < 0.0001), unmarried status (p < 0.0001), and non-use of condoms (p = 0.0032). Fifteen different genotypes of HPV were found. Of the total positive samples, only 58.8% (n = 107) samples were genotyped. High-risk oncogenic HPV was detected in 63 genotyped samples (58.9%), the most frequent high-risk oncogenic HPV genotypes were HPV16 (n = 15, 14%), HPV59 (n = 10, 9.3%), and HPV58 (n = 9, 8.4%). Co-infections involving both high- and low-risk genotypes were observed in 14% (8/57) of the samples, while mixed infections accounted for 22.8% (13/57).

Conclusion: Our findings highlight the significant burden of HPV infection among young, unmarried women who do not use condoms, emphasizing the urgent need for targeted interventions. The low quality of the DNA obtained prevented us from genotyping all samples. The high diversity of high-risk HPV genotypes, particularly the predominance of HPV16 in all municipalities studied, reveals a potential critical vulnerability in this population. These results emphasize the importance of strengthening screening programs, promoting condom use, and implementing vaccination campaigns to mitigate the spread of HPV and reduce the incidence of cervical cancer in the Brazilian Amazon.