Prevalencia y factores asociados a la infección por el virus del papiloma humano (VPH) y las lesiones causadas por el mismo en mujeres de 20 a 59 años en el municipio de Sucre, Bolivia

Zusammenfassung

Objective: To determine the global and type-specific prevalence of HR-HPV infection and cytological lesions, and identify its association with socio-demographic factors, sexual and reproductive practices, smoking, body mass index (BMI) and self-perceived health status in women between 20 and 59 from general population residents of the municipality of Sucre, Bolivia in 2012. Methods: We developed a population-based cross-sectional study in women aged 20-59 years residing in Sucre 2012, with random probability sampling by districts (urban central, peripheral urban and rural). Interviews were conducted with a structured questionnaire designed for this purpose and the interviewer accompanied the women to the health center for the collection of cervical specimens. The detection and identification of HR-HPV was performed at the National Center of Microbiology, Instituto de Salud Carlos III (Madrid, Spain) by RealTime High Risk HPV (Abbott Molecular) that individually identifies HPV16 and 18 types and together 12 HRHPV types (HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). In samples in which reactivity was detected at 12 HR-HPV types, identification was performed by the technique specific type Linear Array ® HPV Genotyping Test (Roche Molecular Systems). Identifying intraepithelial lesions were performed at the Institute of Pathology of the Universidad San Francisco Xavier de Chuquisaca (USFX) in Sucre, Bolivia) and the results were reported according to the Bethesda 2001 system.We performed multiple logistic regression with robust estimators, with an estimative model, confusion and interactions were tested with Stata v12. (Stata Corp LP, Collage Station, Texas, USA). Results: We recruited 868 women: 101 (11,6%) at central urban districts , 687 ( 79,1%) in peripheral urban districts and 80 ( 9,2%) in rural districts. The prevalence of HR-HPV infection was 18,1% (95%CI 15,6-20,9), and in downtown urban districts, peripheral urban and rural it was 23,8 % , 18,0 % and 11,2% respectively. The HR-HPV 16 type was the most common followed by 31, 52 and 51. The prevalence of HR-HPV 16 was 3.7% (95%CI 2,5-5.2 ) and the prevalence of intraepithelial lesions was 0,46 % (95%CI 0,12-1.17). The risk factors identified were the highest educational level [OR: 1,9 (95%CI: 1,2-3,0)] and having had two or more sexual partners in life [OR: 2.5 (95% CI: 1,6 to 4,0 )] . And women older than 34 years showed 50% lower risk than younger [OR:0,5 (95%CI: 0.4-0,7)], and women with a BMI >30 kg/m2 with 50% lower risk than thinner [OR: 0,5 (95% CI: 0,3-0,8)]. Conclusion: The prevalence of HR-HPV infection in women from 2o to 59 years from Sucre´s general population is high and the intraepithelial lesions very low. HPV-16 is the most common type, followed by other types of the species α 9. The risk factors identified are related to a pattern of sexual behavior of young women, better educated and with more sexual partners. The results of this study are useful for interventions to strengthen primary and secondary prevention against CC in Bolivia.