title: Human papillomavirus 16 non-European variants are preferentially associated with high-grade cervical lesions.
abstract: HPV16 accounts for 50-70% of cervical cancer cases worldwide. Characterization of HPV16 variants previously indicated that they differ in risks for viral persistence, progression to cervical precancer and malignant cancer. The aim of this study was to examine the association of severity of disease with HPV16 variants identified in specimens (n = 281) obtained from a Cervical Pathology and Colposcopy outpatient clinic in the University Hospital of Espírito Santo State, Southeastern Brazil, from April 2010 to November 2011. All cytologic and histologic diagnoses were determined prior to definitive treatment. The DNA was isolated using QIAamp DNA Mini Kit and HPV was detected by amplification with PGMY09/11 primers and positive samples were genotyped by RFLP analyses and reverse line blot. The genomes of the HPV16 positive samples were sequenced, from which variant lineages were determined. Chi2 statistics was performed to test the association of HPV16 variants between case and control groups. The prevalence of HR-HPV types in <CIN1, CIN2 and CIN3+ were 33.7%, 84.4% and 91.6%, respectively. Thirty-eight of 49 (78%) HPV16 positive samples yielded HPV16 sequence information; of which, 32 complete genomes were sequenced and an additional 6 samples were partially sequenced. Phylogenetic analysis and patterns of variations identified 65.8% (n = 25) as HPV16 European (E) and 34.2% (n = 13) as non-European (NE) variants. Classification of disease into CIN3+ vs. <CIN3 indicated that NE types were associated with high-grade disease with an OR = 4.6 (1.07-20.2, p = 0.05). The association of HPV16 NE variants with an increased risk of CIN3+ is consistent with an HPV16 genetically determined enhanced oncogenicity. The prevalence of genetic variants of HPV16 is distributed across different geographical areas and with recent population admixture, only empiric data will provide information on the highest risk HPV16 variants within a given population.
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil.
authors.forename: Luciana Bueno
authors.initials: LB
authors.lastname: Freitas
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, United States of America.
authors.forename: Zigui
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Pathology, Center of Health Sciences, Federal University of Espírito Santo, Vitória, Brazil.
authors.forename: Elaine Freire
authors.initials: EF
authors.lastname: Muqui
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil.
authors.forename: Neide Aparecida Tosato
authors.initials: NA
authors.lastname: Boldrini
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil.
authors.forename: Angélica Espinosa
authors.initials: AE
authors.lastname: Miranda
authors.affiliation: Post-Graduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil; Department of Pathology, Center of Health Sciences, Federal University of Espírito Santo, Vitória, Brazil.
authors.forename: Liliana Cruz
authors.initials: LC
authors.lastname: Spano
authors.affiliation: Departments of Pediatrics, Microbiology and Addresses Immunology, Epidemiology and Population Health, and Obstetrics, Gynecology and Woman's Health, Albert Einstein College of Medicine, Bronx, New York, United States of America.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
mesh_terms: D001938:Brazil; D005260:Female; D016679:Genome, Viral; D052162:Human papillomavirus 16 / Q000235:genetics*; D006801:Humans; D030361:Papillomavirus Infections / Q000235:genetics*; D010802:Phylogeny; D002583:Uterine Cervical Neoplasms / Q000235:genetics* / Q000821:virology