Microbioma cervicovaginal e infecção persistente por papilomavírus humano (HPV) de alto risco oncogênico: revisão sistemática da literatura

Abstract

Introduction: Persistent infection with high-risk Human Papillomavirus (hrHPV) is the main etiological factor for cervical cancer, although cofactors such as the cervicovaginal microbiome also play a crucial role in viral persistence and progression of precursor lesions. Objective: To investigate the association between cervicovaginal microbiota composition and persistence of hrHPV infection. Methods: A systematic review was conducted according to the PRISMA guidelines using the PubMed database, focusing on primary studies employing molecular methodologies (16S rRNA sequencing) and Community State Types (CSTs) classification. Results: Ten studies (2020–2025) were included. Eubiosis (CST I – Lactobacillus crispatus) was associated with protection and viral clearance, whereas CST IV (high diversity and Lactobacillus depletion) was associated with hrHPV persistence and progression to high-grade lesions (CIN3). The genus Gardnerella emerged as a trigger for increased cervicovaginal polymicrobial diversity and as a potential biomarker for CIN2+ risk. The role of Lactobacillus iners (CST III) was ambiguous, acting as a transitional profile. Conclusion: The transition to highly diverse microbiais profiles and the presence of pathogenic anaerobes disrupt local defense mechanisms, favoring hrHPV persistence and cervical carcinogenesis.