Prevalência e distribuição genotípica do papilomavírus humano (hvp) em mulheres brasileiras com câncer do colo do útero e neoplasia intraepitelial cervical, no período de 2000 a 2020 – revisão sistemática da literatura

Abstract

Introduction: Cervical cancer (CCU) is the third most incident cancer and the fourth in cancer mortality in the female population in Brazil. The main risk factor for the development of cervical cancer is the persistent infection with oncogenic types of Human Papillomavirus (HPV) since all cases of cervical cancer present the viral genome. In this context, HPV DNA detection and genotyping, used as a primary test, allows with greater sensitivity, the detection of pre-neoplastic lesions, and the more effective stratification of the risk for the development of cervical cancer, providing an important parameter for monitoring the vaccine program implemented in Brazil, more specifically, in each regional scenario. Objective: To determine the prevalence of HPV infection in cervical cancer and cervical intraepithelial neoplasia (CIN2 and CIN3), as well as the distribution of genotypes Brazil. Methodology: The study comprises a systematic review and meta-analysis, which used the criteria of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), conducted from the search for studies available in PUBMED, by using the terms "Uterine Cervical" AND “Human Papillomavirus” AND “Brazil”. Initially, 553 studies were identified and after reading and selection, based on the inclusion criteria, 18 studies were selected, including 13 studies related to cervical cancer and ten related to cervical intraepithelial neoplasia. The studies were published between 2000 and 2020 and the HPV prevalence and genotyping data in cervical cancer and in CIN 2 and CIN 3 were combined in a meta-analysis. Results: The population investigated in the meta-analysis comprised 2,991 Brazilian women and all included studies used the polymerase chain reaction (PCR) to detect HPV DNA. The combined prevalence of any HPV in cervical cancer was 94.0% (95% CI: 89.0 - 97.0%; I2= 86.0%). HPV16 was the most prevalent genotype in cervical cancer (62.0%), followed by HPV18 (9.0%), HPV33 (4.0%), HPV45 (3.0%), HPV31 (2, 0%), HPV58 (2.0%) and HPV52 (1.0%). In cervical intraepithelial neoplasia (CIN2 and CIN3), the combined prevalence of any HPV was 97.0% (95% CI: 85.0 - 100.0%; I2= 78.0%), and the most prevalent genotypes were HPV16 (47%), followed by HPV18 (5.0%), HPV33 (4.0%), HPV31 (4.0%), HPV45 (3.0%), HPV52 (3.0%), HPV35 (2 .0%) and HPV35 (2.0%). Conclusion: The results of this systematic review and meta-analysis confirm the high prevalence of HPV in cervical cancer and cervical intraepithelial lesions in Brazilian women over the last twenty years, and the genotypic distribution of HPV described herein is consistent with that detected in other regions in the world, with the highest prevalence of HPV16 and HPV18, followed by HPV33, HPV31, HPV35, HPV45, HPV52, and HPV58. Continuous tracking on the HPV genotypic distribution in new cases of cervical cancer and cervical intraepithelial neoplasia is crucial in determining the effectiveness of the anti-HPV vaccine in the coming years in Brazil.