Asociación del Virus del Papiloma Humano con la presencia de dos infecciones de transmisión sexual en mujeres colombianas

Abstract

Sexually Transmitted Infections (STIs) are an important cause of morbidity, generating a great impact on public health due to the consequences to which they entail. Their persistence has been associated with progressive and continuous damage to the cervical architecture, which leads to the development of lesions that can progress to cervical neoplasia. The Human Papilloma Virus (HPV) is the most widely distributed sexually transmitted infection and associate with the development of Cervical Cancer (CC) being widely demonstrated. It has been described that additional factors, such as the sexual behavior of the host, intrinsic factors of HPV and the coexistence of other STIs, could be playing a relevant role in the development of cervical disease. In this study, the coexistence between HPV and two widely distributed STIs, Chlamydia trachomatis (Ct) and Human Immunodeficiency Virus (HIV), was analyzed. This research project was designed in two components; The first, was a longitudinal study, to determine the incidence of infection of C. trachomatis and its relationship with the presence and viral load of 6 types of high-risk HPV (HPV-AR-16, -18, -31, -33, -45 and -58), in women from three cities in Colombia. The results showed that HPV-18 and -31 were the most persistent types, while HPV-16 and -33 were eliminated in less time. Regarding viral load (VL), it was found that a VL-Low of HPV-16 and -31 was associated with a higher frequency of Squamous Intraepithelial Lesion (LEI). A quarter of the women in the study began with Ct infection, increasing its frequency throughout the follow-ups; women with factors such as the presence of multiple types of HPV, a greater number of sexual partners, and a history of abortion, had a higher risk of acquiring the bacterial infection. Regarding the effect of VL in the Ct infection, the results showed that variations in the number of viral copies influence the outcome of bacterial infections; additionally, the results showed that variations in VL affected bacterial infection outcome and depended on the viral type involved in such infection. The second component, was a cross-sectional study to establish the frequency of HPV infection in a group of Colombian women with and without HIV infection. The results showed in HIV-positive women had higher HPV prevalence and were more commonly infected with multiple HPV types. HPV detection and coinfection were associated with CD4 cell count and HIV viral load, while antiretroviral treatment was associated only with HPV infections. These results indicate that HPV infection and coinfection are influenced by a cervical microenvironment, in which host factors (such as sexual behavior) and the presence of other pathogens that share the same transmission route, coexist and they interact favoring the permanence, replication and integration of HPV in the host, and favouring the appearance of abnormality at the cervical level. The association between HPV and CC has been clearly established and considerable progress has been made in understanding it; however, it remains to be resolved why only a few HPV-infected women develop cervical lesions and the influence that additional factors have on this process. Considering coexistence with other pathogens will contribute towards knowledge regarding interactions at different levels and STI dynamics, posing new challenges concerning the approach to and carrying out control strategies.