Conhecimento de acadêmicos de enfermagem sobre a vacina contra o papilomavírus humano / Conocimientos de académicos de enfermería sobre la vacuna contra el virus del papiloma humano / Nursing students' knowledge on the human papillomavirus vaccine

Resumo Objetivo Avaliar o conhecimento entre acadêmicos de enfermagem sobre a vacina contra o papilomavírus humano e comparar os resultados obtidos entre estudantes do primeiro e do último ano de graduação. Métodos Estudo descritivo, transversal, quantitativo, realizado entre maio e junho de 2019. Aplicado questionário a 179 estudantes do curso de Enfermagem de uma universidade pública do estado de São Paulo, contendo dados sociodemográficos e outro sobre o conhecimento do papilomavírus humano e a vacina contra o mesmo. Dados foram analisados através do programa Statistical Packcage for Social Science. Resultados 82,4% dos estudantes do primeiro ano e 95,5% do último responderam que sabiam o que é o papilomavírus humano, e afirmaram ser um vírus sexualmente transmissível. Lacunas de conhecimento foram identificadas, quanto à finalidade do exame citopatológico, aos fatores de risco relacionados à infecção e relacionados à vacina, como número de doses e possíveis riscos e benefícios da mesma. Conclusão Apesar de os acadêmicos demonstrarem conhecimento quanto ao papilomavírus humano, sua transmissibilidade e relação direta com o câncer do colo do útero, ainda apresentaram dúvidas importantes que devem ser sanadas, quanto à finalidade do exame citopatológico, aos fatores de risco para infecção pelo vírus e em relação à vacina contra o papilomavírus humano.

Resumen Objetivo Evaluar los conocimientos de académicos de enfermería sobre la vacuna contra el virus del papiloma humano y comparar los resultados obtenidos de estudiantes del primer y del último año de carrera. Métodos Estudio descriptivo, transversal, cuantitativo realizado entre mayo y junio de 2019. Cuestionario aplicado a 179 estudiantes de la carrera de Enfermería de una universidad pública del estado de São Paulo, que contenía datos sociodemográficos, y otro sobre conocimientos del virus del papiloma humano y su vacuna. Los datos fueron analizados a través del programa Statistical Packcage for Social Science. Resultados El 82,4 % de los estudiantes de primer año y el 95,5 % del último respondieron que sabían lo que es el virus del papiloma humano y afirmaron que es un virus sexualmente transmisible. Se identificaron vacíos de conocimiento respecto a la finalidad del estudio citológico, a los factores de riesgo relacionados con la infección y con la vacuna, como número de dosis y sus posibles riesgos y beneficios. Conclusión A pesar de que los académicos demostraron conocimientos respecto al virus del papiloma humano, su transmisión y relación directa con el cáncer de cuello uterino, también presentaron dudas importantes que deben ser aclaradas sobre la finalidad del estudio citológico, los factores de riesgo de la infección por el virus y sobre la vacuna contra el virus del papiloma humano.

Abstract Objective To assess nursing students' knowledge on the human papillomavirus vaccine and compare the results obtained among students of the first and last year of graduation. Methods This is a descriptive, cross-sectional, quantitative study, conducted between May and June 2019. A questionnaire was applied to 179 nursing students from a public university in the state of São Paulo, containing sociodemographic data and another on knowledge of human papillomavirus and the vaccine against it. Data were analyzed using the Statistical Packcage for Social Science. Results 82.4% of first-year students and 95.5% of last-year students answered that they knew what human papillomavirus is, claiming to be a sexually transmitted virus. Knowledge gaps were identified regarding the purpose of cytopathological examination, risk factors related to infection and related to the vaccine, such as number of doses and possible risks and benefits of it. Conclusion Although students demonstrated knowledge on human papillomavirus, its transmissibility and direct relationship with cervical cancer, they still presented important doubts that should be answered, regarding the purpose of the cytopathological examination, the risk factors for infection by the virus and in relation to the vaccine against the human papillomavirus.

Papiloma conjuntival / Conjunctival papilloma

RESUMEN El papiloma conjuntival es un tumor de células escamosas adquirido, benigno, que se puede presentar a cualquier edad, pero más frecuentemente en la tercera y cuarta décadas de la vida. Los papilomas están asociados con la infección del virus papiloma humano, usualmente los tipos 6 y 11. Se presenta un paciente quien se encuentra en la cuarta década de la vida, fumador. Acudió al Servicio de Oculoplastia por aumento del volumen conjuntival en el ojo izquierdo. Luego del interrogatorio y de un examen ocular exhaustivo, se realizó el diagnóstico clínico de papiloma conjuntival recurrente. Se propuso exéresis, crioterapia y biopsia de las lesiones conjuntivales. Posterior a la intervención, se confirmó el diagnóstico anatomopatológico y se reajustó el tratamiento tópico ocular con interferón, con lo cual se obtuvieron resultados satisfactorios(AU)

ABSTRACT Conjunctival papilloma is a benign acquired squamous cell tumor occurring at any age, but more commonly in the third and fourth decades of life. Papillomas are associated to human papillomavirus infection, usually of types 6 and 11. A case is presented of a male smoker patient in his fourth decade of life. The patient attended the Oculoplastics Service due to conjunctival volume increase in his left eye. Interrogation and exhaustive ocular examination led to the clinical diagnosis of recurrent conjunctival papilloma. Exeresis, cryotherapy and biopsy of the conjunctival lesions were indicated. The anatomopathological diagnosis was confirmed after the intervention and a readjustment was made of the topical ocular treatment with interferon, with which satisfactory results were obtained(AU)

Vías de señalización celular implicadas en la carcinogénesis cervical / Cellular Signaling Pathways Involved in Cervical Carcinogenesis

RESUMEN Introducción: El Virus de Papiloma Humano se considera un factor clave en el desarrollo de lesiones cérvico uterinas. No obstante, la infección per se no es suficiente para desarrollar todos los eventos carcinogénicos, de manera que estos podrían estar regulados por vías de señalización celular. Las señales transmitidas hacia el interior de la célula, se producen a través de cascadas de señalización, en las que intervienen numerosas proteínas que ganan y/o pierden su actividad biológica, regulando así el metabolismo, la transcripción y traducción de genes. Objetivo: Proveer información actualizada sobre las vías de señalización TLRs, Wnt/ß-catenina y PI3K/Akt implicadas en la carcinogénesis cervical. Métodos: Se realizó una revisión de la literatura especializada mediante artículos originales y revisiones publicadas en bases de datos pertenecientes a los sitios web PubMed, Google Scholar, EBSCO y NCBI, en idiomas español e inglés. Resultados: Se constató que la vía TLR juega un rol clave en el combate a virus, bacterias y otras infecciones, además de poseer actividad inmune antitumoral. La vía Wnt/ß-catenina participa en varios procesos biológicos como la diferenciación, migración y adhesión celular, mientras que, PI3K/Akt está relacionada con el crecimiento, la motilidad y la supervivencia celular. Conclusiones: La activación o desregulación de algunos componentes de estas vías están implicadas en la proliferación incontrolada de células tumorales, evento importante en la carcinogénesis cervical(AU)

ABSTRACT Introduction: Human papillomavirus is considered a key factor in the development of uterine cervical lesions. However, infection per se is not enough to develop all carcinogenic events, so that these could be regulated by cell signaling pathways. The signals transmitted into the cell are produced through signaling cascades, which involve numerous proteins that gain and, or lose their biological activity, thus regulating the metabolism, transcription and translation of genes. Objective: To provide updated information on TLRs, Wnt / ß-catenin and PI3K / Akt signaling pathways involved in cervical carcinogenesis. Methods: A review of specialized literature was carried out through original articles and reviews published in PubMed, Google Scholar, EBSCO databases and NCBI websites, in Spanish and English languages. Results: TLR pathway was found to play a key role in the fight against viruses, bacteria and other infections, as well as having antitumor immune activity. The Wnt / ß-catenin pathway participates in several biological processes such as cell differentiation, migration and adhesion, while PI3K / Akt is related to cell growth, motility and survival. Conclusions: The activation or deregulation of some components of these pathways are involved in uncontrolled proliferation of tumor cells, an important event in cervical carcinogenesis(AU)

Elevated prevalence of high-risk HPV in healthy oral mucosa of users and nonusers of drugs in Northeastern Brazil

Abstract: Variable rates of HPV infection have been reported in healthy oral mucosa worldwide. The main objective of this study was to detect and genotype HPV infection in users and nonusers of drugs with clinically healthy mucosa from the Northeast Brazil. Samples from 105 patients were amplified using the primers MY09/MY11 and GP5+/GP6+, and genotyping was performed by multiplex-PCR for HPV-6/11, 16 and 18. A total of 81.9% samples were positive. Among drug users, 84.5% presented the virus and 20.4% showed multiple infections. Among non-drug users, 78.7% were positive and 13.5% had multiple infections. Limited information is available on oral HPV in Brazilian population, especially for drug users, and our results showed higher HPV infection rates in both users and nonusers of drugs. More studies and researches focused on drug users including factors like sexual behavior, nutrition and cultural habits are necessary to enhance the comprehension of this relationship, and develop preventive strategies.

Association between hormonal contraception and injuries induced by human papillomavirus in the uterine cervix / Associação entre a contracepção hormonal e lesões induzidas pelo vírus do papiloma humano no colo uterino

Abstract Objective To evaluate the association between hormonal contraception and the appearance of human papillomavirus HPV-induced lesions in the uterine cervix of patients assisted at a school outpatient clinic - ObGyn outpatient service of the Universidade do Sul de Santa Catarina. Methods A case-control study, with women in fertile age, performed between 2012 and 2015. A total of 101 patients with cervical lesions secondary to HPV were included in the case group, and 101 patients with normal oncotic colpocytology, in the control group. The data were analyzed through the Statistical Package for the Social Sciences (SPSS, IBM Corp. Armonk, NY, US) software, version 24.0, using the 95% confidence interval. To test the homogeneity of the proportions, the chi-square (χ2) test was used for the qualitative variables, and the Student t-test, for the quantitative variables. Results When comparing the occurrence of HPV lesions in users and non-users of combined oral contraceptives (COCs), the association with doses of 0.03 mg or higher of ethinylestradiol (EE) was observed. Thus, a higher probability of developing cervical lesions induced by HPV was identified (odds ratio [OR]: 1.9 p = 0.039); and when these cases were separated by the degree of the lesion, the probability of these patients presentingwith lowgrade squamous intraepithelial lesion was 2.1 times higher (p = 0.036), but with no impact on high-grade squamous intraepithelial lesions and the occurrence of invasive cancer. No significant differences were found in the other variables analyzed. Conclusion Although the results found in the present study suggest a higher probability of the users of combined hormonal contraceptives with a concentration higher than 0.03 mg of EE to develop low-grade intraepithelial lesions, more studies are needed to conclude causality.

Resumo Objetivo Avaliar a associação entre a contracepção hormonal e a presença de lesões induzidas pelo vírus do papiloma humano (HPV) no colo uterino de pacientes do serviço de ginecologia e obstetrícia do ambulatório de especialidade médicas da Universidadedo Sul de Santa Catarina - AME/UNISUL. Métodos Estudo observacional do tipo caso-controle, commulheres no menacme, no período compreendido entre 2012 e 2015. Foram incluídas 101 pacientes com lesões cervicais secundárias ao HPV, no grupo caso, e 101 pacientes com colpocitologia oncótica normal, no grupo controle. Os dados foram analisados por meio do programa SPSS 24.0, utilizando-se o intervalo de confiança de 95%. Para testar a homogeneidade de proporções foram utilizados o teste do qui-quadrado (χ2) para as variáveis qualitativas e o teste t de Student para as variáveis quantitativas. Resultados Ao comparar-se a ocorrência das lesões pelo HPV em usuárias de contraceptivos orais combinados (COCs) com a em não usuárias, observou-se a associação com doses de 0.03 mg ou superiores de etinilestradiol (EE), na qual se identificou 1.9 vezes mais probabilidade destas desenvolverem lesões cervicais induzidas pelo HPV (p = 0.039); ao separar-se esses casos pelo grau da lesão, a probabilidade destas pacientes apresentarem lesão cervical de baixo grau foi 2.1 vezes maior (p = 0.036), porémsemimpacto nas lesões cervicais de alto grau e na ocorrência de câncer invasor. Não foram encontradas diferenças significativas nas outras variáveis analisadas. Conclusão Embora os resultados encontrados no presente estudo sugiram maior probabilidade das usuárias de contraceptivo hormonal combinado, com concentração superior a 0.03 mg de EE, desenvolverem lesão cervical de baixo grau,mais estudos são necessários para concluir causalidade.

HPV in women assisted by the Family Health Strategy / Infecção por HPV em mulheres atendidas pela Estratégia Saúde da Família

ABSTRACT OBJECTIVE Estimate the prevalence of cervical HPV infection among women assisted by the Family Health Strategy and identify the factors related to the infection. METHODS A cross-sectional study involving 2,076 women aged 20-59 years old residing in Juiz de Fora, State of Minas Gerais, who were asked to participate in an organized screening carried out in units were the Family Health Strategy had been implemented. Participants answered the standardized questionnaire and underwent a conventional cervical cytology test and HPV test for high oncogenic risk. Estimates of HPV infection prevalence were calculated according to selected characteristics referenced in the literature and related to socioeconomic status, reproductive health and lifestyle. RESULTS The overall prevalence of HPV infection was 12.6% (95%CI 11.16-14.05). The prevalence for the pooled primer contained 12 oncogenic HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) was 8.6% (95%CI 7.3-9.77). In the multivariate analysis, it was observed that the following variables were significantly associated with a higher prevalence of HPV infection: marital status (single: adjusted PR = 1.40, 95%CI 1.07-1.8), alcohol consumption (any lifetime frequency: adjusted PR = 1.44, 95%CI 1.11-1.86) and number of lifetime sexual partners (≥ 3: adjusted PR = 1.35, 95%CI 1.04-1.74). CONCLUSIONS The prevalence of HPV infection in the study population ranges from average to particularly high among young women. The prevalence of HPV16 and HPV18 infection is similar to the worldwide prevalence. Homogeneous distribution among the pooled primer types would precede the isolated infection by HPV18 in magnitude, which may be a difference greater than the one observed. The identification of high-risk oncogenic HPV prevalence may help identify women at higher risk of developing preneoplastic lesions.

RESUMO OBJETIVO Estimar a prevalência de infecção do colo do útero pelo HPV entre mulheres assistidas pela Estratégia Saúde da Família e identificar os fatores relacionados à infecção. MÉTODOS Trata-se de estudo transversal, no qual participaram 2.076 mulheres de 20 a 59 anos, residentes em Juiz de Fora, MG, convocadas para rastreamento organizado, realizado em unidades com a Estratégia Saúde da Família implantada. As participantes responderam ao questionário padronizado, realizando exame citológico cervical convencional e teste para HPV de alto risco oncogênico. Foram calculadas estimativas de prevalência de infecção pelo HPV segundo características selecionadas, referenciadas na literatura, relacionadas ao status socioeconômico, saúde reprodutiva e estilo de vida. RESULTADOS A prevalência global de infecção pelo HPV foi 12,6% (IC95% 11,16-14,05). A prevalência para o pooled primer contendo 12 tipos de HPV oncogênicos (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 e 68) foi 8,6% (IC95% 7,3-9,77). Na análise multivariada, observou-se que as seguintes variáveis estavam significativamente associadas a uma maior prevalência de infecção por HPV: estado conjugal (solteira: RP ajustada = 1,40; IC95% 1,07-1,8), consumo de bebidas alcoólicas (qualquer frequência durante a vida: RP ajustada = 1,44; IC95% 1,11-1,86) e número de parceiros sexuais ao longo da vida (≥ 3: RP ajustada = 1,35; IC95% 1,04-1,74). CONCLUSÕES A prevalência de infecção pelo HPV na população estudada varia de média a particularmente alta entre as mulheres jovens. A prevalência de infecção por HPV16 e HPV18 se assemelha às mundiais. Uma distribuição homogênea entre os tipos do pooled primer precederia a infecção isolada pelo HPV18 em magnitude, podendo ser a diferença maior que a observada. A identificação da prevalência de HPV de alto risco oncogênico pode auxiliar na identificação de mulheres sob maior risco de evolução para lesão preneoplásica.

Expresión de E-cadherina y células de Langerhans en verruga vulgar y papiloma bucal / Expression of E-cadherin and Langerhans cells in verruca vulgaris and oral papilloma

Introducción: la verruga vulgar y el papiloma bucal son lesiones provocadas por el virus papiloma humano se pueden encontrar presentes en la mayoría de las superfi cies cutáneas y mucosas, su comportamiento biológico es benigno. Las proteínas de adhesión como la E-cadherina, se encargan de mantener la organización y morfología celular, disminuyen su expresión epitelial en ciertas lesiones potencialmente cancerizables, y favorecen la migración e invasión celular ocasionando posiblesmetástasis. Las células de Langerhans, son células presentadoras deantígeno que activan el sistema inmunológico para proteger al organismocontra patógenos o sustancias extrañas. Objetivo: Determinar el grado de expresión de E-cadherina y de células de Langerhans en verruga vulgar y papiloma bucal. Material y métodos: Se realizó un estudio descriptivo y retrospectivo, en el cual se incluyeron 16 bloques con tejido incluido en parafi na con diagnóstico de verruga vulgar, ycuatro diagnosticados como papiloma bucal, todos los casos fueron corroborados con la tinción de hematoxilina y eosina. La determinacióndel grado de expresión de las células de Langerhans y E-cadherina se realizó por medio de la técnica de inmunohistoquímica, la valoraciónse llevó a cabo de manera semicuantitativa, y se realizó estadísticadescriptiva. Resultados: La expresión de E-cadherina en verruga vulgar fue intensa tanto en cantidad como intensidad, mientras que en papiloma bucal fue moderada también en ambos casos; las células de Langerhans mostraron una inmunotinción moderada en las lesiones de verruga vulgar en intensidad y cantidad; en el caso de papiloma bucal esta inmunotinción en intensidad y cantidad fue leve. . Conclusiones:Los resultados mostraron que las proteínas de adhesión E-cadherinano pierden su expresión en la verruga vulgar y papiloma bucal, lo cualconfi rma su benignidad...

Introduction: verruca vulgaris and oral papilloma are lesions causedby the human papillomavirus. They can be found on most skin and mucosalsurfaces, and their biological behavior is benign. Adhesion proteinssuch as E-cadherins are responsible for maintaining cell morphologyand organization; they decrease the expression in certain potentiallycancerous epithelial lesions and promote cell migration and invasion,causing possible metastasis. Langerhans cells are antigen-presentingcells that activate the immune system to protect the body againstpathogens or foreign substances. Objective: To determine the degreeof expression of E-cadherin and Langerhans cells in verruca vulgarisand oral papilloma. Material and methods: We performed a descriptiveand retrospective study involving 16 paraffi n-embedded tissue blocksof diagnosed cases of verruca vulgaris and 4 paraffi n-embedded tissueblocks identifi ed as oral papilloma. The diagnosis was previouslyconfi rmed by hematoxylin and eosin staining. The degree of expressionof Langerhans cells and E-Cadherin was determined by immunohistochemistry,while the evaluation was carried out semiquantitatively,with descriptive statistics being performed. Results: The expression ofE-cadherin in verruca vulgaris was strong in terms of both quantityand intensity, whereas in the case of oral papilloma it was moderatefor both. Langerhans cells showed moderate immunostaining for bothintensity and quantity in verruca vulgaris-type lesions, while for oralpapilloma, the immunostaining was also mild in both cases. Conclusions:The results suggest that the expression of E-cadherin adhesionproteins does not diminish in verruca vulgaris and oral papilloma,which confi rms their benignity...

Virus de papiloma humano y cáncer bucal / Human papiloma virus and buccal cancer

Los virus del papiloma humano (VPH), son virus ADN de doble cadena helicoidal, epiteliotrópicos que producen lesiones verrugosas en piel y mucosas. Algunas evidencias indican que ciertos tipos específicos de estos virus son necesarios pero no totalmente suficientes para ocasionar la transformación maligna, debido a que requieren algunas acciones sinérgicas de otros eventos iniciadores. Existen más de 230 tipos de VPH, 118 tipos están bien caracterizados, más de 40 tipos anogenitales, de los cuales 15 de ellos son oncogénicos; y en humanos constituyen uno de los grupos virales más frecuentes que infectan el epitelio de piel y mucosas: conjuntivas, cavidad bucal, laringe, árbol traqueobronquial, esófago, vejiga, ano y tracto genital. El examen clínico de la boca y sus anexos, constituye el paso inicial para la detección de una infección por este virus. El examen histológico revela el cambio morfológico y patognomónico más relevante de la infección por VPH, las células coilocíticas; las técnicas moleculares, como la Reacción en Cadena de la Polimerasa, la Hibridación in situ, entre otras, están basadas en la detección del genoma del virus. El VPH puede asociarse a distintos agentes físicos y químicos que promueven el desarrollo del carcinoma bucal, siendo los tipos (16, 18, 31, 32, 33 y 35) potencialmente oncogénicos. Esta revisión se propone analizar los diferentes tipos de VPH asociados con lesiones malignas de la cavidad bucal

Human papillomaviruses (HPV) are epitheliotropic and double-helix stranded DNA viruses, which produce warty lesions in mucosae and skin. A bigger amount of evidence suggests that specific types of viruses are necessary but not enough to produce the malignant transformation, also it´s necessary the synergistic action of other indicators. There are more than 230 types of HPV, 118 types are well characterized, more than 40 types anus genital, 15 of them have an oncogenic potential; in humans constitutes one of the most frequent viral groups infecting skin epithelium and mucosae: conjunctives, oral cavity, tracheo-bronchial tree, esophagus, bladder, anus and genital tract. Clinical exam of the mouth and its annexes constitutes the initial step for the detection of an infection by this virus. Histological exam reveals morphological and pathognomonic most relevant changes of HPV infection, koilocytes; molecular techniques such as Polimerase Chain Reaction, in situ hybridization, among others, are based in the detection of virus genome. HPV can act with different types of physical and chemical agents that promote the development of oral carcinoma being (16, 18, 31, 32, 33 y 35) HPV´s potentially oncogenic. This review analyzes the different types of HPV associated with malignant lesions of oral cavity

Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women

OBJECTIVES: To evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN) among HIV-infected women. METHODS: Cross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors. RESULTS: CIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1). Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5-10.1), with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2-3.5), and with age < 34 years old (OR 1.5, 95% CI 1.0-2.4). HIV viral load and antiretroviral use were not independent risk factors for CIN. CONCLUSIONS: Severity of immunosupression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women.

Infección por virus papiloma humano en pacientes con células escamosas atípicas de un programa de pesquisa de cáncer cervical / Human papilloma virus infection in patients with atypical squamous cells of a screening program for cervical cancer

Evaluar la frecuencia de la infección por virus del papiloma humano en pacientes con células escamosas atípicas de un programa de pesquisa de cáncer de cuello uterino. Laboratorio Asistencial “Lic. Celina Sánchez Rincón y Laboratorio de Biología y Medicina Experimental LABIOMEX. Universidad de Los Andes. Mérida, Estado Mérida. Estudio prospectivo y descriptivo que incluyó las pacientes vistas entre marzo de 2006 y diciembre de 2009. Se tomaron muestras para evaluación citológica y detección del virus papiloma humano, mediante la metodología molecular PCR-RFLP a pacientes de pesquisa de cáncer cervical. Se estudiaron 2 805 pacientes seleccionándose las que presentaron informe citológico de células escamosas con atipias de significado indeterminado y con atipias que no excluyen lesión intraepitelial escamosa de alto grado. Del total de mujeres evaluadas por citología, 121 (4,31 por ciento) tenían informe de anormalidades en células epiteliales. Las células escamosas atípicas se encontraron en 58 (2,06 por ciento) citologías, 52 (1,85 por ciento) eran células escamosas con atipias de significado indeterminado y 6 (0,21 por ciento) eran células escamosas con atipias que no excluyen lesión intraepitelial de alto grado. La prevalencia general de la infección por virus del papiloma humano fue de 32/58 (53,4 por ciento). Los virus del papiloma humano de alto riesgo oncogénico se encontraron en 10/58 (17,2 por ciento) de los casos, la mayoría en el grupo etario de 21-30 años. No se pudo determinar el tipo viral en un 16/58(27,5 por ciento) de las muestras. Se observó una elevada prevalencia de virus del papiloma humano en pacientes con informe citológico de células escamosas atípicas.

To evaluate the frequency of human papillomavirus infection in patients with atypical squamous cells of a cervical cancer detection program. Between March 2006 to December 2009, specimens for cervical smears and human papillomavirus molecular detection by PCR-RFLP were taken from the patients attended at the cervical cancer clinic prevention. Facultad de Farmacia y Bioanálisis. Laboratorio Asistencial “Lic. Celina Sánchez Rincón y Facultad de Ciencias, Laboratorio de Biología y Medicina Experimental LABIOMEX. Universidad de Los Andes. Mérida, Estado Mérida, Venezuela. A total of 2 805 patients were evaluated, those with atypical squamous cells of undetermined significance and atypical squamous cells that cannot exclude a high intraepithelial lesion were chosen. Abnormalities in epithelial cells were found in 4,31 percent. Atypical squamous cells were found in 58 (2,06 percent) of the cases, 1,85 percent were atypical squamous cells of undetermined significance and 0,21 percent were atypical squamous cells that cannot exclude a high intraepithelial lesion. The overall prevalence of human papillomavirus infection was 32/58 (53,4 percent). High risk human papillomavirus was found in 10/58 (17,2 percent)of the patients, most of them between 21 and 30 years old. Human papillomavirus could not be determinedin 16/58 (27,5 percent) of the cases. It was observed a high frequency of human papillomavirus in patients with atypical squamous cells in their cervical smears.

Rastreamento de lesões precursoras do carcinoma espino-celular anal em indivíduos portadores do HIV / Tracking precursor lesions of anal squamous cell carcinoma in individuals with HIV

INTRODUÇÃO: O carcinoma espino-celular do canal anal é doença que atinge os adultos de meia idade e corresponde a 4 por cento dos cânceres do trato gastrointestinal baixo. Na população geral a incidência é de 1 em 100.000 habitantes, e entre os homens que fazem sexo com homens essa incidência atinge 35 por 100.000 habitantes, sendo que os portadores de HIV têm esse risco duplicado (70 por 100.000 habitantes). MÉTODO: Foi realizada revisão da literatura com consulta nos periódicos das bases Medline/Pubmed, Scielo e Lilacs cruzando os descritores Rastreamento, Lesões pré-cancerosas, Neoplasias do ânus e HIV. Além da revisão bibliográfica, foi adicionada a este trabalho a experiência pessoal dos autores, e a obtida no Departamento de Gastroenterologia - Divisão Cirúrgica, no ICESP - Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira, no Departamento de Moléstias Infeciosas - Casa da AIDS e no Serviço de Coloproctologia do Hospital das Clínicas da Universidade de São Paulo, SP, Brasil. CONCLUSÕES: HIV+ é um grande fator de risco no desenvolvimento de carcinoma espino-celular anal em indivíduos infectados por HPV. A avaliação desses pacientes não deve se restringir à erradicação de condilomas, mas principalmente incluir o rastreamento de lesões displásicas subclínicas potencialmente neoplásicas. Apesar dos métodos de rastreamento ainda não serem ideais, o grande benefício do rastreamento baseia-se no fato de oferecer acompanhamento rigoroso, tornando possível à prevenção ou detecção cada vez mais precoce do carcinoma espino-celular anal.

INTRODUCTION: Squamous cell carcinoma of the anal canal is a disease that affects the middle-aged adults and accounts for 4 percent of cancers of the gastrointestinal tract below. In the general population the incidence is 1 in 100,000, and among men who have sex with men the incidence is 35 per 100,000 inhabitants, those with HIV have doubled this risk (70 per 100,000 inhabitants). METHODS: Was performed literature review in consultation with periodic Medline / Pubmed, Lilacs and Scielo crossing Trackingm, Precancerous conditions, Anus neoplasms and HIV descriptors. Besides the review,was added to this work the authors'personal experiences, and obtained at the Department of Gastroenterology - Surgical Division, in ICESP - Cancer Institute of the State of São Paulo Octavio Frias de Oliveira, in Department of Diseases Infectious - House of AIDS and in the Department of Coloproctology, Hospital das Clinicas, University of São Paulo, Brazil. CONCLUSIONS: HIV + is a major risk factor in developing squamous cell carcinoma anal in individuals infected with HPV. The evaluation of these patients should not restrict itself to the eradication of warts, but mainly include the screening of subclinical dysplastic lesions potentially neoplastic. Despite the screening methods are still not ideal, the great benefit of screening is based on the fact offer closely monitored, making possible the prevention or detection of increasingly early anal squamous cell carcinoma.

Infecção pelo papilomavírus humano: etiopatogenia, biologia molecular e manifestações clínicas / Human papillomavirus infection: etiopathogenesis, molecular biology and clinical manifestations

O papilomavírus humano (HPV) é um vírus DNA que apresenta tropismo por células epiteliais, causando infecções na pele e nas mucosas. A replicação do HPV ocorre no núcleo das células escamosas e o seu ciclo de vida é diretamente relacionado ao programa de diferenciação da célula hospedeira. Até o momento, foram completamente caracterizados cerca de 100 tipos diferentes de HPVs e há um grande número adicional de tipos ainda não sequenciados. Além de ser o responsável por lesões benignas de pele e mucosas, o HPV também está envolvido no desenvolvimento de diversos tumores cutaneomucosos: doença de Bowen, cânceres de pele não melanoma e carcinomas genitais. Esta revisão aborda as características do HPV, quadros cutâneos e mucosos benignos e malignos causados por ele e os principais métodos empregados em sua detecção e tipagem.

Human papillomavirus (HPV) is a DNA virus that presents tropism for epithelial cells, causing infections of the skin and mucous membranes. Replication of HPV occurs in the nuclei of squamous cells and its life cycle is directly related to the differentiation program of the host cell. To date, nearly 100 different types of HPV have been characterized and there is a large number of other types that have not been sequenced yet. Besides being responsible for benign lesions of the skin and mucous membranes, HPV is also involved in the development of various mucocutaneous tumors: Bowen's disease, non-melanoma skin cancers and genital carcinomas. This review discusses the characteristics of HPV, malignant and benign mucous and skin manifestations caused by HPV, besides the main methods of detection and typing of the virus.

Fatores associados a persistência da infecção pelo HPV na cervice uterina / Factors associated with HPV persistent infection in uterine cervix

A infecção pelo papilomavirus humano (HPV) é o principal fator para o desenvolvimento do câncer cervical. A infecção pelo HPV de alto risco (oncogênico), contudo, é necesséria, mas não o suficiente para o desenvolvimento do câncer cervical. A infecção persistente pelo HPV oncogênico é fator de risco na progressão para a neoplasia intraepitelial cervical e para o câncer cervical invasivo. Vários fatores influenciam na persistência do HPV, tais como idade mais avançada, coinfecções por Chlamydia trachomatis, tabagismo, imunossupressão e fatores virais. A infecção pelo virus da imunodeficiência adquirida (HIV) está fortemente associada com a alta prevalência, incidência e persistência de infecção pelo HPV e, assim, influencia diretamente na persistência e progressão das lesões intraepiteliais escamosas. A persistência do HPV é maior nas mulheres com a contagem de células CD4+ abaixo de 200 células/mm3. A taxa de clearance do HPV é menor nas mulheres HIV positivas. Existe ainda a associação do clearance do HPV com a contagem de células CD4+. O melhor entendimento dos cofatores da carcinogênese cervical pode ter impacto no rastreamento e no prognóstico das lesões cervicais.

Human papillomavirus (HPV) infection is the main factor for the development of cervical cancer. However, the infection with high-risk HPV (oncogenic) is necessary but not enough for the development of cervical cancer. Persistent infection with oncogenic HPV is a risk factor for the progression to cervical intraepitelial neoplasia and cervical invasive cancer. Several factors influence HPV persistence, such as elderly, co-infections by Chlamydia trachomatis, smoking, immunosuppression and viral factors. The human immunodeficiency virus (HIV) infection is strongly associated with the high prevalence, incidence and persistence HPV infection and, thus, directly influencing persistence and progression of squamous intraepithelial lesions. HPV persistence is greater among women with CD4+ cells count below 200 cells/mm3. The clearance rate of HPV is lower in HIV positive women. There is still an association of HPV clearance and CD4+ cells count. The better understanding of cervical carcinogenesis factors might have an impact on screening and prognosis of cervical lesions.

Tipos de papilomavirus humanos más frecuentes en muestras cubanas de cáncer cervical / The more frequent types of human papillomavirus in Cuban samples of cervix cancer

El cáncer del cuello uterino (CCU) es considerada una enfermedad de transmisión sexual, debido a los factores involucrados en su aparición y desarrollo, se reconoce a la infección por el papilomavirus humano (VPH) como el principal agente etiológico de esta enfermedad. En Cuba este tumor ocupa el 2do lugar en incidencia y el 4to en mortalidad entre las enfermedades malignas que afectan al sexo femenino. El presente estudio persigue como objetivos determinar los tipos de VPH presentes en muestras de tumores de cáncer de cérvix en mujeres cubanas, así como describir el comportamiento de diferentes factores de riesgo asociados a esta enfermedad. Se analizaron 45 muestras de cáncer cérvico uterino y se determinó la presencia de 20 tipos de VPH mediante el uso de la reacción en cadena de la polimerasa con cebadores específicos, se encontró en ellas un 91,1 por ciento de positividad. El genotipo 16 fue el más prevalente, seguido por el 18, 45, 31, 39, 51, 56, 59, PAP238A. No se encontraron en ninguna de las muestras los tipos de bajo riesgo 6 y 11. La promiscuidad mostró ser el factor de mayor interés en nuestro estudio. El conocimiento de los tipos virales presentes en los tumores del cérvix uterino en nuestras pacientes es importante a la hora de plantearse el desarrollo y uso de vacunas tanto profilácticas como terapéuticas

Cervix cancer (UCC) is considered a sexually transmitted disease due to factors involved in its appearance and development and this infection is recognized as the main etiological agent of this entity. In Cuba this type of tumor is placed in 2nd category in incidence and in 4th place in mortality among the malignant disease affecting the female sex. The objective of present study is to determine the types of human virus papiloma (HVP) present in samples of cervix tumors in Cuban women, as well as to describe the behavior of different risk factors associated with this disease. Forty five samples of cervix cancer were analyzed and the presence of 20 types of HVP was determined by polymerase chain reaction with specific primers founding in them a 91,1 percent of positivity. Genotype 16 was the more prevalent, followed by the 18, 45, 31, 39, 51, 56, 59, PAP23A. The low risk type 6 and 11 weren't founded in samples. Promiscuity was the more interesting risk factor in our study. Knowledge of the viral types present in cervix cancer in our patients is very important when we approach the development and the use of prophylactic and therapeutical vaccines

Virus de papiloma humano y factores de riesgo: en el desarrollo de cáncer cérvico uterino / VPH and riks factors: in the development of cervix cancer

Se presenta una revisión sobre la relación entre el virus de papiloma humano y el cáncer cérvico uterino, haciendo énfasis en el papel etiológico de la infección viral durante el desarrollo de malignidad, los posibles factores y cofactores involucrados y la importancia clínica de este conocimiento en el diagnóstico y tratamiento de dicha patología, considerada mundialmente como un problema de salud pública.

This is a review about the relationship between human papillomavirus and the cervical cancer, with emphasis on the etiological role of the viral infection during the development of malignancy, the possible factors and the cofactors involved and the importance of this knowledge in clinical diagnosis and treatment of this kind of pathology, seen in worldwide as a public health problem.

Prevalencia de papilomavirus humano (HPV) tipo 6, 11, 16 y 18 en la ciudad de Buenos Aires: implicancias en la implementación de vacunas profilácticas / Prevalence of human papillomavirus (HPV-6-11, -16 and -18) in the city of Buenos Aires: epidemiology and vaccination

Introducción: el cáncer cervical es uno de los cáncer más comunes que afectan mujeres en países en desarrollo. Es provocado por la infección persistente del Papilomavirus Humano (HPV). En los últimos años se ha lanzado al mercado una vacuna cuadrivalente contra los HPV de bajo y alto riesgo (HPV-6, 11, 16 y 18), otra vacuna, bivalente para HPV-16 y 18, también ha sido introducida al mercado. En el presente trabajo se evaluó si los tipos de HPV cubiertos por las vacunas profilácticas son los más prevalentes en nuestro país, así como la utilidad de los métodos de detección viral por ADN como herramienta para el diagnóstico en mujeres asintomáticas. Materiales y métodos: éste protocolo se encuentra aprobado por el Comité de Docencia e Investigación (CODEI) del Hospital Gral. de Agudos "C.G. Durand" y por el consejo de Etica de la USAL. Todos los participantes dieron consentimiento escrito voluntario antes de participar del mismo. Se analizaron biopsias cervicales obtenidas en el Servicio de Tocoginecología de dicho Hospital, las cuales fueron agrupadas en 4 categorías: Grupo Control (ctrl.) n= 27, Grupo de lesiones de bajo grado (CIN I) n = 22, Grupo de lesiones de mediano y alto grado (CIN II/III) n = 30, Grupo de carcinomas cervicales (CC) n = 35. El ADN fue extraído por métodos estándar. La determinación de presencia de HPV se realizó mediante PCR específica con cebadores MY09/MY11. La tipificación de ADN específico de HPV-6, -11, -16 y -18 se realizó con PCR multiplex específica. Resultados y conclusiones: hemos observado una alta incidencia de la infección con HPV-16 en todos los grupos analizados (52% p< 0,0001), y varias muestras mostraron coinfección entre HPVs de alto riesgo, y entre HPVs de bajo y alto riesgo (6,85%, p< 0,001 vs. HPV16). Estos resultados, sumados al hecho que el 17,8 % de las muestras no mostró infección con los citados tipos de HPV, sugieren que la prevalencia de los tipos virales cubiertos por las vacunas es menor a la esperada...

Introductions: Cervical cancer is one of the most frequent cancers that affect women in developing countries. It is caused by persistent infection with Human Papillomavirus (HPV). In the last years a cuadrivalent vaccine against High-risk HPVs (HPV-6, -11, -16 and -18) has been launched into the market; another vaccine, bivalent for HPV-16 and -18, has also been introduced intro the market. In the present work we evaluated if HPV types covered by these vaccines are actually the most prevalent in our country, as well as the utility of DNA-based viral detection essays as a diagnosis tool in asymptomatic women. Materials and Methods: this protocol has been approved by the Hospital Durand's Teaching and Ethics committee (CODEI) and by the Ethics committee of USAL. All pariticipants gave voluntary informed consent before being included in the study. we analyzed cervical biopsies obtained in Gynecology Service of Hospital Durand, which were grouped into 4 categories: Control group (ctrl.) n = 27, low grade cervical lesions group (CIN I) n = 22, high grade cervical lesions group (CIN II/III) n = 30, cervical carcinomas (CC) n = 35. DNA was extracted by standard methods. Viral HPV presence was evaluated by specific PCR with MY09/MY11 primers. Viral-specific DNA determination of HPV-6, -11, -16 and -18 was evaluated by specific multiplex PCR. Results and conclusions: We observed a high incidence of and several samples showd co-infection between High-risk HPVs, and between high and low-risk HPVs (6.85%, p< 0.001 vs. HPV16). These results, plus the fact that almost 17.8% of the samples shown no expression of HPV types covered by the vaccines, suggest that the prevalence of HPV-6,-11, -16 and -18 is lower than expected in Buenos Aires city.

Análise da prevalência das displasias cervicais e da infecção pelo papilomavírus humano em mulheres com lúpus eritematoso sistêmico / Analysis of the prevalence of cervical dysplasia and human papillomavirus infection in women with systemic lupus erythematosus

O lúpus eritematoso sistêmico (LES) que é doença auto-imune com prevalância maior em mulheres, determina lesões potencialmente muito graves em diversos órgãos. Seu tratamento é feito habitualmente com corticosteróides e agentes citostáticos, sendo esses últimos responsáveis não só por um aumento na freqüência de infecções, mas também de neoplasias, principalmente as hematológicos e as relacionadas às infecções virais. Estudos realizados em mulheres com LES, evidenciaram maior incidência de displasias cervicais, principalmente as pré-malignas, contudo poucos, pesquisaram especificamente o papiloma vírus humano (HPV) e sua associação com o uso dos imunossupressores. Considerando que a infecção pelo HPV é a doença sexualmente transmissível de maior prevalência no mundo e, que esse vírus é o agente etiológico do câncer cervical (a segunda neoplasia mais prevalente em mulheres), este estudo foi desenhado com o objetivo de identficar a freqüência da infecção pelo HPV e das displasias cervicais em mulheres com LES incluindo a análise dos fatores de risco clássicos e o uso de imunossupressores. Neste estudo foram selecionadas 177 pacientes com LES e, 244 mulheres sem LES e sem queixas e/ou doenças ginecológicas conhecidas, atendidas no ambulatório de ginecologia do HUPE-UERJ ou da Policlínica Piquet Carneiro - UERJ (grupo controle). Todas as mulheres incluídas, foram previamente informadas e assinaram termo de consentimento livre e esclarecido, aprovado pelo Comitê de Ética em Pesquisa do HUPE-UERJ. A pesquisa do HPV e genotipagem foi feita por reação em cadeia da polimerase e a citpatologia, por coloração de Papanicolaou e análise por dois patologistas. As pacientes com LES apresentaram freqüência da infecção por HPV (20,2%) e de displasias cervicais (22,6%) significativamente mais elevadas que as encontradas no grupo controle (Chi quadrado, P<0,05), apesar de apresentarem em média, menos fatores de risco clássicos para essa infecção (p<0,05)...

Systemic lupus erythematosus (SLE) that is an autoimmune disease with higher prevalence among women, causes potencially severe lesions in different organs. SLE treatment commonly includes the use of steroids and cytostatic agents, being the latter partially responsable for an increased frequency of infection and neoplasia mostly hematologycal and virus-associated cancer. Studies that included women with SLE, have detected higher frequencies of cervical dysplasia, mainly the pre-malignant ones, however few were able to analyse its association with immunosuppressors. Taking into consideration that HPV infection is the most frequent sexually transmitted disease and that this virus is the etiologycal agent of cervical cancer, the second most prevalent neoplasia among women, this study was designed to detect the frequency of HPV infection and cervical dysplasis in SLE patients and to establish its association with classical risk factors and the use of immunosuppressors. We selected 177 SLE patients and 244 women without SLE and who did not present any complain of known gynecological disease who attended to the HUPE-UERJ or Policlínica Piquet Carneiro - UERJ gynecology clinics (control group). All women were previously explained the study and signed an informed consent approved by the HUPE-UERJ Ethical Committee. HPV detection and genotyping were performed by proteinase chain reaction and cytopatology by Papanicolaou technique with analysis by two pathologists. Patients with SLE presented higher frequency of HPV infection and cervical dysplasia than control group (Chi square, P<0.05), despite they presented less frequently the classical HPV associated risk factors (p<0.05). Long-term use of immunosuppressors determined among LSE patients, a three-fold increase on HPV prevalence (28.2%). Also among SLE patients, those who presented HPV, have received higher cumulative doses of cyclophosphamide and prednisone and also had a higher dose-time ratio of azathioprine...

Sexually transmitted papillomavirus infections: epidemiology pathogenesis, clinic, morphology, important differential diagnostic aspects, current diagnostic and treatment options: [review] / Infecções por papilomavírus sexualmente transmitida: epidemiologia, patogênese, clínica, morfologia, aspectos importantes do diagnóstico diferencial, diagnóstico atual e opções de tratamento: [revisão]

The family of human papilloma viruses (HPV) comprises more than 100 genotypes. Approximately 30 of the genotypes are responsible for infections in the human anogenital area. A precisely defined algorithm with the goal of diagnosing and removing HPV for a prolonged or indefinite length of time, as well as to protect the patient from any malignant ransformation, does not currently exist. The identification of HPV strains by PCR or DNA hybridization in lesional tissue provides higher security for the patients. In high-risk patients additional colposcopy, rectoscopy, and rethroscopy/cystoscopy increase the probability of proper diagnosis and the application of a reliable therapeutic strategy. Removal of lesions by means of invasive methods, such as electrodessication, cryosurgery, and/or laser therapy, may be successful and could be combined pre- and postoperatively with the local application of podophyllotoxin, Trichloroacetic acid, 5-fluorouracil epinephrine gel, imiquimod, cidofovir or interferon. The administration of vaccine to young patients prevents to a significant extent the clinical manifestation of the most frequent viral strains, being HPV-6,-11 and -18. The different therapeutic methods must be applied in accordance with the clinical picture, taking into account the patient's general status, the presence of concomitant diseases, as well as the local and systematic compatibility of the side effects of each remedy. The review focuses on the diagnosis and treatment options of sexually transmitted HPV-infections and includes synopsis of the most recent literature regarding new data of epidemiology, pathogenesis, ifferential diagnosis and morphology of HPV infections in humans.

A família de papiloma vírus humano (HPV) compreende mais de 100 genótipos. Aproximadamente 30 dos genótipos são responsáveis pelas infecções na área anogenital em humanos. Não dispomos no momento de um algoritmo precisamente definido tendo como meta o diagnóstico e a remoção de HPV por períodos de tempo prolongados ou indefinidos, nem para proteção do paciente contra transformação maligna. A identificação das cepas de HPV por PCR ou hibridização de DNA em tecido lesional oferece maior segurança para os pacientes. Em pacientes de alto risco realiza-se ainda colposcopia, rectoscopia e uretroscopia/ cistoscopia, aumentando a probabilidade do diagnóstico correto e a aplicação de estratégia terapêutica confiável. A remoção das lesões por meio de métodos invasivos, como a eletrodissecção, criocirurgia, e/ou terapia com laser, pode ser bem sucedida e combinada no pré e no pós-operatório com a aplicação local de toxina podofílica, ácido tricloroacético, gel de epinefrina 5-fluorouracil, imiquimod, cidofovir ou interferon. A administração da vacina em pacientes jovens é capaz de previnir as manifestações clínicas das cepas virais mais frequentes, que são HPV-6, -11 e -18. Os diferentes métodos terapêuticos devem ser aplicados de acordo com o quadro clínico, levando em consideração o estado de saúde geral do paciente, a presença de doenças concomitantes, assim como a compatibilidade local e sistêmica dos efeitos adversos em cada remédio. A revisão foca o diagnóstico e as opções de tratamento de infecções por HPV sexualmente transmitidas e inclui uma sinopse da literatura mais recente no que diz respeito aos dados de epidemiologia, patogênese, diagnóstico diferencial e morfologia de infecções por HPV em humanos.

Neoplasia Intraepitelial Cervical. Preámbulo del cáncer cérvicouterino / Cervical intraepithelial neoplasia. Preamble of cervicouterine cancer

La neoplasia intraepitelial cervical es una lesión que se considera la antesala del cáncer cérvicouterino. La infección por el virus del papiloma humano (VPH) en el aparato genital, sobre todo algunos subtipos llamados oncogénicos, juegan un papel relevante en la aparición de las lesiones intraepiteliales y su posible evolución al cáncer invasor en esas localizaciones. Existe además un importante grupo de factores de riesgo o cofactores que asociados a la infección por el VPH pueden producir esos cambios celulares en el cérvix. En el presente artículo se analizan esos factores de riesgo y se tienen en consideración la participación de ambos miembros de la pareja en la infección por el VPH. Se señalan algunas modalidades terapéuticas conservadoras de las NIC.

Cervical intraepithelial neoplasia is a lesion considered as the preamble of cervicouterine cancer. HPV infection in the genital apparatus, mainly some subtypes called oncogenic, plays an important role in the appearance of some intraepithelial lesions and in its possible evolution to invasive cancer in these localizations. There is a significant group of risk factors or cofactors that associated with HPV infection may produce these cellular changes in the cervix. These risk factors are analyzed in the present article, and the participation of both members of the couple in the HPV infection is taken into consideration. Some conservative therapeutic modalities used to treat CIN are stressed.