title: HPV Infection and Cervical Screening in Socially Isolated Indigenous Women Inhabitants of the Amazonian Rainforest.
abstract: OBJECTIVE
  Indigenous women from the Amazon regions have some of the highest rates of cervical cancer in the world. This study evaluated cervical cytology and human papillomavirus (HPV) in native women that differ by lifestyle and interaction with western society. Yanomami women are isolated deep in the Amazon with a hunter/gatherer lifestyle. Macuxi and Wapishana women live in proximity to western society.
  
  
  METHODS
  To select a representative group of women from each district, random cluster sampling was used, considering each registered village as a cluster. Cervical samples were collected for cytology and HPV detection and typing by PCR amplification and next generation sequencing. The study was approved by the National IRB and by tribal leaders.
  
  
  RESULTS
  664 native women were enrolled from 13 indigenous villages (76% participation rate). Yanomami women had higher rates of abnormal cytology (5.1% vs. 1.8%, p = 0.04) and prevalent HR-HPV (34.1% vs. 19.2%, p<0.001). Yanomami women >35 y of age were significantly more likely to have HR-HPV, whereas women ≤ 35 y did not significantly differ between groups. Prevalence of HPV was significantly different amongst geographically clustered Yanomami women (p<0.004). The most prevalent HPV types in the entire group were HPV31 (8.7%), HPV16 (5.9%) and HPV18 (4.4%).
  
  
  CONCLUSIONS
  Isolated endogenous Yanomami women were more likely to be HPV+ and rates increased with age. Study of HPV in isolated hunter-gather peoples suggests that long-term persistence is a characteristic of prehistoric humans and patterns reflecting decreased prevalence with age in western society represents recent change. These studies have implications for cervical cancer prevention and viral-host relationships.
authors.affiliation: Postgraduate Program in Tropical Medicine, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil; Department of Health Sciences Research, Universidade Federal de Roraima, Boa Vista, Brazil.
authors.forename: Allex Jardim
authors.initials: AJ
authors.lastname: Fonseca
authors.affiliation: Department of Health Sciences Research, Universidade Federal de Roraima, Boa Vista, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Taeko
authors.affiliation: Department of Health Sciences Research, Universidade Federal de Roraima, Boa Vista, Brazil.
authors.forename: Thiciane Araújo
authors.initials: TA
authors.lastname: Chaves
authors.affiliation: Department of Health Sciences Research, Universidade Federal de Roraima, Boa Vista, Brazil.
authors.forename: Lucia Dayanny da Costa
authors.initials: LD
authors.lastname: Amorim
authors.affiliation: Department of Health Sciences Research, Universidade Federal de Roraima, Boa Vista, Brazil.
authors.forename: Raisa Saron Wanderley
authors.initials: RS
authors.lastname: Murari
authors.affiliation: Center for Infectious Diseases, Universidade Federal do Espírito Santo, Maruípe, Vitoria, Brazil.
authors.forename: Angélica Espinosa
authors.initials: AE
authors.lastname: Miranda
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, New York, United States of America.
authors.forename: Zigui
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, New York, United States of America; Department of Microbiology & Immunology, Albert Einstein College of Medicine, New York, United States of America; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, United States of America; Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine, New York, United States of America.
authors.forename: Robert David
authors.initials: RD
authors.lastname: Burk
authors.affiliation: Department of Tropical Pathology, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.
authors.forename: Luiz Carlos Lima
authors.initials: LC
authors.lastname: Ferreira
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003469:Culture; D004279:DNA, Viral / Q000032:analysis; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007199:Indians, South American / Q000706:statistics & numerical data*; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000208:ethnology*; D044382:Population Groups / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000821:virology; D015995:Prevalence; D065947:Rainforest; D012934:Social Isolation; D002583:Uterine Cervical Neoplasms / Q000208:ethnology / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult
chemical_list: D004279:DNA, Viral