Infecção pelo HPV em mulheres adultas vivendo com HIV atendidas em serviço de referência em hospital universitário no Espírito Santo

• Ano de defesa: 2024
• Autor(a) principal: Rocha, Waltesia Perini
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Espírito Santo; BR; Mestrado em Saúde Coletiva; Centro de Ciências da Saúde; UFES; Programa de Pós-Graduação em Saúde Coletiva
• Palavras-chave em Português: Papillomavirus humano; Fatores de risco; Lesões intraepiteliais escamosas cervicais; Saúde Coletiva
• Link de acesso: http://repositorio.ufes.br/handle/10/18301

Introduction: human papillomavirus (HPV) has a high prevalence and persistence in women living with HIV/AIDS, increasing the risk of developing lesions on the cervix, and thus increasing the incidence of cervical cancer by up to six times compared to HIV-negative women. Understanding the clinical and epidemiological profile of these women and the diversity of HPV genotypes is essential for developing effective health policies. Objective: Our objective was to analyze the prevalence and diversity of high- and low-risk HPV genotypes, the associated risk factors and the impact of HIV immune status on cytological abnormalities. Method: a cross-sectional study was carried out with 207 HIV-positive women who underwent vaginal self-collection for HPV Real-Time Polymerase Chain Reaction (RT-PCR) analysis between May 2021 and May 2022. The study included women aged 18 to 64, with a history of sexual intercourse, without cognitive or motor deficits that prevented the study. Participants who were pregnant, hysterectomized or had cervical cancer were excluded. Prevalence was calculated and related elements were identified using adjusted analysis. Results: all samples were considered valid for HPV testing. HPV DNA was detected in 143 samples (69.1%), with a predominance of high and/or probable high risk genotypes (60.4%). Multiple HPV infections occurred in 48.8% of cases, and 94% of samples had at least one high-risk genotype. The most prevalent high-risk HPV genotypes (HPV-HR) were HPV 58 (21.7%), HPV 68 (14.5%) and HPV 52 (9.2%). In the adjusted analysis, women with detectable HIV viral load (≥20) were 1.37 (95% CI: 1.00-1.88, p=0.046) times more likely to be infected with probable high and/or high risk HPV (HPV-Pr/HPV-HR). The prevalence of cytological alterations was 8.2% (n=17) and was associated with HPV type 18, with a prevalence probability of 33.3% (PR = 5.0; 95% CI: 1.9-13.1; p=0.001), while HPV 58 was associated with a significant increase in the risk of altered cytology, with a prevalence ratio of 2.5 (95% CI: 1.0-6.3; p=0.05). Vaccination coverage with the Quadrivalent vaccine was 5.8% (n=12). In 75% of those vaccinated, other high-risk HPVs were detected, most frequently HPV 58. Conclusion: the study identified a high prevalence of HR-HPVs/PR-HPVs in women living with HIV/AIDS, especially type 58. Detectable HIV viral load was the risk factor associated with HR-HPVs/PR-HPVs infection. The results reinforce the importance of integrated health strategies, with early HIV treatment to keep viral load suppressed and reduce HPV infection. Screening with HPV genotyping and expanding vaccination coverage with the nonavalent vaccine aims to prevent pre-neoplastic and neoplastic lesions of the uterine cervix, improving the health of this vulnerable population.