Abstract
Background: Human papillomavirus (HPV) family of viruses is the leading cause of cervical cancer in women worldwide. More than 67 types of HPV are known to infect humans, and their distribution varies from region to region. HPV prevalence studies in Brazil have focused on cervical cancer; however, a detailed understanding of HPV type prevalence in women with normal cervix is absent in the literature. Our primary aim is to systematically review the literature and summarize the prevalence and distribution of HPV types in Brazilian women with HPV positive but normal cervical cytology and lack observed abnormal cells on their cervix's surface upon cytology analysis. Methods: This protocol was designed following the PRISMA-P guidelines. We conducted this systematic review with an active search in PubMed, Web of Science, and CINAHL databases and supplemented by a secondary screening of all included articles' reference lists. The search terms "Brazil", "HPV", "Human Papillomavirus", "prevalence", "distribution", "Human Papillomavirus types", and "normal cervical cytology" were used for screening the databases. Of 1048 articles retrieved and subjected to duplicates assessment, title and abstract assessment, and full-text assessment of eligibility, 11 articles were included in the review. We excluded articles from the male population, known cervical cancer cases, and studies with a sample size of <15. Qualitative assembly of the data and analysis was performed using GraphPad Prism 5.0 Results: The articles included in the study reported the prevalence of HPV types in women with normal cytology and HPV positive from ten Brazilian states. The total sample size ranged from 80 to 432, and the sample size for the HPV positive and normal cervical cytology group ranged from 28 to 209. HPV prevalence ranged from 0 to 89.4%, and a total of 43 HPV types were identified in the study population. There was variation between studies on the distribution of HPV types because of the detection and genotyping technique used and geographical location. HPV66 was the only HPV type detected in every study reviewed, regardless of geographical region and methods. Conclusions: Due to variation in genotyping techniques used in these studies, HPV type prevalence and geographical distribution may be misestimated or underestimated. But results of these studies give a clear view of the total prevalence of HPV types in Brazil. It is also essential to consider the HPV types present in women with normal cervical cytology before the HPV-mediated progression to abnormal cervical lesions.Systematic Review Registration: Prospective Register for Systematic Reviews (PROSPERO) registration CRD42020151655
A Systematic Review of Human Papillomavirus Genotypes in Women With Normal Cervical Cytology: The Brazilian Paradigm