Behavioral factors associated with multiple-type HPV genital infections: data from a cross-sectional study in young women in Brazil

Abstract

Objectives To investigate the pattern of multiple human papillomavirus (HPV) infections and associated factors in young women who access the Brazilian public health care system to better understand the characteristics of multiple HPV infections, a critical issue in this era of multivalent vaccines. Methods This was a cross-sectional, multicenter study with sexually active unvaccinated women (16–25\xa0years old) from 119 primary Brazilian healthcare centers between September 2016 and November 2017. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. Results Of the 5268 women, 33.00% (95% CI 31.07–34.92) had multiple infections. At least one type of high-risk HPV was present in 85.50% of all multiple infections. All HPV types were detected more frequently in association with other types than alone. Young individuals who were single or in a casual relationship and those who had more than one sexual partner in the past year were more likely to have multiple infections. Conclusions In this work, a high rate of multiple HPV infections among unvaccinated young adults tended to increase due to certain risk factors. Such data can provide insight for decision makers in the development of public policies regarding HPV prevention. Compreender as características de infecções múltiplas é fundamental na era das vacinas multivalentes contra o HPV para a prevenção do cancer de colo de útero. Portanto, neste estudo transversal, tivemos como objetivo investigar o padrão de infecções múltiplas de HPV e fatores associados em 5.268 mulheres sexualmente ativas não vacinadas (16-25 anos) que acessam o sistema público de saúde brasileiro. Amostras cervicais foram coletadas por profissionais de saúde treinados. A detecção do HPV foi realizada em um laboratório central por Linear Array. Ao todo, 33,00% (95% IC 31,07–34,92) das participantes tiveram infecções múltiplas (60,43% entre aquelas com HPV positivo). O número de tipos de HPV em uma infecção múltipla variou de 2 a 14. Os tipos virais mais frequentemente identificados foram 16 e 52. Todos os tipos de HPV foram detectados mais frequentemente em associação com outros tipos do que isoladamente. A incidência de infecções múltiplas foi 1,29 vezes maior em participantes solteiros do que em casados. Mulheres que tiveram duas ou mais parcerias sexuais no último ano também tiveram taxas mais altas de infecções múltiplas do que aquelas que tiveram menos de duas parcerias. Em conclusão, foi observada uma alta prevalência de infecções múltiplas antes do Programa Nacional de Imunização contra o vírus, especialmente naqueles que apresentam comportamentos menos seguros. Understanding the characteristics of multiple infections is critical in the era of HPV multivalent vaccines for the prevention of cervical carcinomas. Therefore, in this cross-sectional study, we aimed to investigate the pattern of multiple HPV infections and associated factors in 5,268 sexually active unvaccinated women (16–25\xa0years old) who access the Brazilian public health care system. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. A total of 33.00% (95% CI 31.07–34.92) had multiple infections (60.43% of the HPV-positive sample). The number of HPV types in a multiple infection ranged from 2 to 14 different types. The viral types more frequently identified were HPV 16 and 52. All HPV types were detected more frequently in association with other types than alone. The incidence of multiple infections was 1.29 times higher in single than in married or cohabitating participants. Women who had two or more partners in the last year also had higher rates of multiple infections than those who had fewer than two sexual partners. In conclusion, a high prevalence of multiple infections prior to the national HPV immunization program was observed, especially with the increase in less safe behavior factors.