Research Article: Factors associated with high-risk human papillomavirus infection and high-grade cervical neoplasia: A population-based study in Paraguay

Date Published: June 27, 2019

Publisher: Public Library of Science

Author(s): Elena Kasamatsu, María Isabel Rodríguez Riveros, Ana María Soilan, Marina Ortega, Pamela Mongelós, Malvina Páez, Amalia Castro, Carmen Cristaldo, Fátima Romina Báez, Claudia Carolina Centurión, Jaime Vester, Hernán Barrios, Griselda Villalba, María Luisa Amarilla, Graciela Giménez, Elodie Caubere, María de la Luz Hernández, Armando Baena, Maribel Almonte, Rolando Herrero, Laura Patricia Mendoza, Clement A. Adebamowo.


Cervical cancer (CC) is one of the leading causes of cancer mortality among women from Paraguay, with high incidence and mortality rates (31.2 and 16 per 100 000 women, respectively). Although the risk factors associated with high-risk human papillomavirus (hrHPV) infection and preneoplastic cervical lesions are widely studied, population-based characteristics of particular settings may influence the feasibility of HPV-based CC screening implementation. This study aimed to explore factors associated with hrHPV infection and high-grade cervical neoplasia in hrHPV-positive (hrHPV+) women from Paraguay.

A total of 5677 women aged 30–64 years from the Central Department of Paraguay were screened with HPV test (Hybrid Capture 2) and Pap smear. Sociodemographic and risk factor interviews were conducted. hrHPV+ women were referred to colposcopy and women with an abnormal colposcopy had a biopsy taken. The outcomes recorded were the hrHPV status and the presence of high-grade cervical intraepithelial neoplasia or worse (CIN2+) among hrHPV+ women. Associations were investigated using multivariate logistic regressions.

hrHPV prevalence was 13.8% (95%CI 13.0–14.8). This value decreased with the age of women (p-trend<0.001) and increased with the lifetime number of sexual partners (p-trend<0.001) and number of previous female partners of their current male partner if women had had one lifetime sexual partner (p-trend<0.001), increasing from 3.06 (95%CI 0.073–20.9) if partners had had one previous female partner to 9.19 (95%CI 2.36–61.1) if they had had eight or more. In hrHPV+ women, CIN2+ prevalence was 10.7% (95%CI 8.58–13.2) and increased with time since the last Pap smear (p-trend<0.001) and with the increasing number of pregnancies (p-trend = 0.05). In these settings, the sexual behavior of women and their male partners is associated with hrHPV infection. In hrHPV+ women, underscreening practices and multiple pregnancies are associated with CIN2+. This knowledge can contribute to public health policies for CC prevention and control in Paraguay.

Partial Text

Cervical cancer (CC) ranks globally as the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women, with an estimated 570 000 new cases and 311 000 deaths in 2018 [1] and more than 85% of the cases occurring in developing countries. In Paraguay, the burden of CC is a significant health problem with high incidence and mortality rates of 31.2 and 16 per 100 000 women, respectively [1].

This is the first population-based study of hrHPV infection and CC precursors using hrHPV testing in Paraguay, which assesses the prevalence and risk factors of hrHPV infection and CIN2+ in hrHPV+ women living in two districts of the Central Department. The results showed that the prevalence of hrHPV infection (13.8%) was consistent with that observed in Paraguayan women without cytological abnormalities in five indigenous communities of Paraguayan Chaco (16.1%) and those coming from reference health centers in the Central Department, of Paraguay (13.5%). [7,27]. The higher hrHPV prevalence observed in indigenous women could be due to the fact that the median age was lower (30) than that of women enrolled in the present study (44.5).