title: A portrait of single and multiple HPV type infections in Brazilian women of different age strata with squamous or glandular cervical lesions.
abstract: BACKGROUND
  Cervical cancer ranks third in prevalence and fourth as cause of death in women worldwide. In Brazil, 17,540 women were diagnosed in 2012 with the disease. Persistent infection with high-risk HPV types is a necessary condition for the development of pre-invasive and invasive cervical neoplasia. Currently, over 100 HPV types have been identified, but HPV16 and 18 are recognized as the mayor culprits in cervical carcinogenesis. Our objective was to assess the relationships between single- (ST) and multiple-type (MT) HPV infections with patients' age and lesion pathological status.
  
  
  METHODS
  328 patients with either squamous or glandular intraepithelial or invasive cervical lesion were selected. All subjects were tested for HPV genotypes with reverse hybridization for 21 high- (hr-HPV) and 16 low-risk (lr-HPV) probes. Prevalence of ST and MT HPV infections was compared across histological types and age strata.
  
  
  RESULTS
  287 (87%) women had at least one HPV type detected and 149 (52%) had MT infections. The most prevalent HPV type was HPV16, present in 142 cases (49% of all HPV-positive cases), followed by HPV58, 52, 31, 35 and 33. HPV18, in single or multiple infections, occurred in 23 cases (8% of hr-HPV cases). Almost all glandular lesions were associated with HPV16 and 18 alone. Multiple infections were significantly more prevalent in squamous than in glandular lesion for HPV16 and 18 (P = 0.04 and 0.03 respectively). The prevalence of MT infections followed a bimodal distribution; peaking in women younger 29 years and in those aged 50 to 59.
  
  
  CONCLUSIONS
  Our data indicate that prevention strategies for pre-invasive and invasive squamous lesions should be focused on HPV16 and a few alpha-9 HPV types. It is clear to us that in young women, prophylaxis must cover a large amalgam of HPV types beyond classic HPV16 and 18.
authors.forename: Leandro Santos de Araújo
authors.initials: LS
authors.lastname: Resende
authors.forename: Sílvia Helena
authors.initials: SH
authors.lastname: Rabelo-Santos
authors.forename: Luís Otávio
authors.initials: LO
authors.lastname: Sarian
authors.forename: Rosane Ribeiro
authors.initials: RR
authors.lastname: Figueiredo Alves
authors.forename: Andréa Alves
authors.initials: AA
authors.lastname: Ribeiro
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Zeferino
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil. derchain@fcm.unicamp.br.
authors.forename: Sophie
authors.initials: S
authors.lastname: Derchain
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D060085:Coinfection / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology*
chemical_list: D004279:DNA, Viral
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