Different HPV Genotypes Related to Heck's Disease in an Indigenous Population of Roraima: a cross- sectional study

Different HPV Genotypes Related to Heck's Disease in an Indigenous Population of Roraima: a cross- sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Different HPV Genotypes Related to Heck's Disease in an Indigenous Population of Roraima: a cross- sectional study Debora Pallos, Richardson Mondego Boaventura, Sergio Takashi Kussaba, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4850572/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Heck's disease (HD) is a virus-induced proliferation, normally benign and rare disease affecting the oral mucosa of children and young adults from different regions of the world and ethnic groups. Objective determine the prevalence of HD and the detection of 30 different genotypes of HPV in the oral cavity of an indigenous population. Materials and Methods 81 saliva samples were collected from indigenous people of the Yanomami ethnic group, including their family members, with a clinically history of HD. DNA was extracted and a commercial assay, which includes 28 types of human papillomavirus (HPV), was used for analysis, and RT-PCR to identify HPV-13 and HPV-32. Results from 81 saliva samples analysed, 33 (40.7%) clinically had HD. In the initial HPV genotyping analysis, 39 (48.2%) were positive for at least one genotype. All individuals who clinically had the lesion were positive for HPV-13 or HPV-32. The majority of the 13 families (46.2%) were positive for HPV-13, whereas HPV-32 was found in 38.5%, and only 15.4% had both genotypes. Of the other genotypes of HPV, only 10 individuals were positive, eight were positive for high-risk HPV group (HPV-16, 18, 58, 59, 69 and 82) and two were positive for low-risk HPV-40, 43. Conclusion Our study confirms the presence of HPV-13 and HPV-32, which are associated with Heck's disease. Additionally, there seems to be a familial segregation of these viruses. Clinical Relevance: Understanding the nature of this type of lesion and its characterization within families can inform preventive measures through public health policies. Human Papillomavirus Viruses Focal Epithelial Hyperplasia Indigenous Peoples Polymerase Chain Reaction Saliva 1. INTRODUCTION Focal epithelial hyperplasia or Heck's disease is a rare, benign disease affecting the oral mucosa of children and young adults from different regions of the world and ethnic groups, such as indigenous people and Eskimos. Heck's disease (HD) is a virus-induced proliferation located in the oral squamous epithelium and was first described (1894) in Greenland Eskimos. The sites most prone to the development of this lesion are keratinized and non-keratinized surfaces [ 3 , 5 , 7 ]. HD has been reported with the presence of two genotypes of human papillomavirus: HPV-32, which tends to cause the disease in older individuals, whereas HPV-13, which appears to be equally involved in the development of the disease in both young and older individuals [ 1 , 14 , 18 ]. The association with type 13 was reported in 1983 by a report on a Turkish patient and in 1987 the disease was associated with type 32. More recent studies have also identified the lesion in other populations and ethnic groups in South Africa, Mexico and Central America, and European countries. The ethnic predilection of this condition may be related to genetic factors as they increase the individual's vulnerability to viral infection [4, 9, 11, 20, 23, 28]. The disease is characterized by well-defined lesions ranging in size from 0.1 to 1 cm in diameter, involving single or multiple sites, and occurring preferentially on the buccal, labial, gingival and lingual mucosa. HD is generally painless and has characteristics of a benign lesion. Spontaneous regression of focal epithelial hyperplasia has been reported after months or years, being confirmed by the rarity of the disease in adults. Conservative surgical excision can be performed for diagnostic purposes or aesthetic and functional reasons. Condyloma acuminatum, squamous papilloma, Cowden's syndrome, and verruca vulgaris are differential diagnosis of HD [ 4 ]. Therefore, this study had the general objective of detecting human papillomavirus (HPV) in the saliva of indigenous people of the Yanomami ethnic group by comparing these findings with clinical characteristics of HD. Additionally, this study also sought to evaluate the prevalence of different types of human papillomavirus (HPV) in their saliva and relate them to HD. 2. MATERIALS AND METHODS 2.1. Population, Design and Ethical Assessment of the Study This study was submitted for approval by the Coordination of the Yanomami Indigenous Special Health District (DSEIY), presidency of the District Indigenous Health Councils (CONDISI) and the leadership of the Indigenous Health House (CASAI). It was also submitted to the National Research Ethics Council (CONEP) according to protocol number #1998028. For inclusion in this study, all the participants gave their authorization through a free and informed consent form (ICF) with the presence of a translator (when necessary). 2.2. Saliva Collection Saliva samples were collected from indigenous people, including their family members, who had the clinical diagnosis of HD. During sample collection, it was asked whether the individual had already had the lesion (for this question, the answer could be yes, no and I don't know). The saliva samples were frozen in the indigenous village, as described below, before being sent to the Laboratory of Virology of the Institute of Tropical Medicine of the School of Medicine University of São Paulo and stored at -80º C A disposable cup with 0.12% alcohol-free chlorhexidine solution was given to the individuals included in the study. They were instructed to rinse the mouth for 1 minute and then spit back into the cup. By using a disposable pipette, 0.12% chlorhexidine solution containing the saliva was removed and a volume of 1 mL was transferred to a properly identified Eppendorf tube, which was then frozen at -20ºC. Saliva sample was collected from each individual. 2.3. Laboratory Procedures DNA Extraction from Saliva DNA extraction from saliva samples was performed by using the QIAamp ® DNA Blood Mini kit (QIAGEN Group, Valencia, California, USA), according to the manufacturer's instructions. The technique is based on DNA purification through filters arranged in column and successive washing and centrifugation. The PCR reaction for β-globin with PCO3/4 primers was performed in all samples to ensure the presence of sufficient cells for detection of human DNA. Saliva samples positive for β-globin were included for data analysis. HPV Detection and Genotyping The presence of HPV DNA was detected by using PCR reaction with the primer sets PGMY09 and PGMY11 (13). An equimolar mixture of each primer was added to 2.5µL of 10x PCR buffer (Invitrogen® - minus MgCl2), 2µL of dNTPs (2.5 mM) (Invitrogen®), 1.5µL of MgCl2 (50mM) (Invitrogen®), 0.5µL of PGMY09 primers (0.5 µM), 0.4 µL of platinum Taq DNA polymerase (Invitrogen®), 2.5µL of glycerol (57%) (Invitrogen®), 2.5 µL of cresol red (2.5µg/µL), 8.1µL of deionized H 2 O and 5µL of DNA. Amplifications were carried out in a thermocycler (Mastercycler Gradient, Eppendorf, Germany) at 95°C for 9 minutes, 40 cycles of 95°C for 1 minute, 55°C for 1 minute and 72°C for 1 minute, followed by a final extension at 72°C for 5 minutes. After PCR, amplified products were observed on a 1.5% agarose gel (Agarose Ultrapure ™ - Invitrogen Life Technologies) in 1X TAE buffer [DNA Typing Grade TAE Buffer, GIBCO - Invitrogen Corporation (2mM Tris-Acetate and 50mM ethylenediaminetetraacetic acid - EDTA)] stained with SYBR Safe™ 1X (Invitrogen, USA). Detection of Human Papillomavirus Genotypes 13 and 32 End-point PCR reactions were performed with amplicon visualization by electrophoresis in 1.5% agarose gel, according to protocols adapted from previously published studies [ 6 , 16 ]. For HPV genotype 13, the primer pair (sense primer 5'-AAATCCCAGCAGAATTATAT-3' and antisense primer 5'-AAAGAGATGATGTAGTGGC-3') was used, with an expected target fragment size of 240bp. For genotype 32, the primer pair (sense primer GTGGCCGCCTAGTGACAAC and antisense primer GATGCCCAACAGCCAAAAG) was used, with a fragment size of 134bp. The two pairs of primers target the L1 region of the virus. Both reactions have a final volume of 25 µl, containing a final concentration of 1x GoTaq ® Flexi Buffer, 1.5 mM MgC12, 200 uM of each dNTP, 500 nM of each primer, 1.25 U of GoTaq ® G2 for hot-start polymerase and nuclease-free ultrapure water to supplement the final volume. Temperature cycling has an initial denaturation step at 95°C for 2 minutes, followed by 40 cycles of 95°C for 50 seconds, 50°C for 30 seconds and 72°C for 50 seconds. A final extension step at 72°C for 5 minutes was also added to the reaction. As a control for PCR and qPCR reactions, already known genotyped samples from the IMT biobank were used. Human Papillomavirus Genotyping Human Papillomavirus (HPV) was detected in the saliva samples by using the commercial Anyplex™ II HPV 28 detection assay (Seegene Brazil), according to the manufacturer's instructions. This assay is capable of detecting and distinguishing 28 distinct HPV genotypes, in which 19 are high risk (HPV-16, -18, -26, -31, -33, -35, -39, -45, -51, -52, -53, -56, -58, -59, -66, -68, -69, -73, -82) and nine are low risk (HPV-11, -40, -42, -43, -44, -54, -6, -61, -70). The reactions were carried out by using real-time PCR system equipment (CFX96, Bio-Rad Laboratories). Each reaction was carried out in a final volume of 20µL containing 10µL of purified DNA and 10µL of the reagent mixture for PCR assay. Thermocycling conditions followed an initial step of 4 minutes at 50°C, denaturation at 95°C for 15 minutes, followed by 50 cycles at 95°C for 30 seconds (denaturation), 60°C for 1 minute (annealing) and 72°C for 30 seconds (extension). After cycling was completed, the results were exported from the CFX Manager software (Bio-Rad Laboratories) and analysed by using the real-time visualization software (Seegene Brazil). 2.4. Methodology for Data Analysis After collecting demographic, clinical and laboratory data of the individuals included in this study, a database was built by using the Microsoft Word for Windows (XP version) and Microsoft Excel for Windows (XP version). Initially, a descriptive analysis of all study variables was carried out. Next, the values obtained from oral viral excretion were analysed and compared to the clinical manifestation of the disease. The resulting data on gender, age group and virus prevalence were tabulated, compared and submitted to statistical treatment (p < 0.05). Two Proportions Z test was used to assess the relative frequency distribution (percentages or prevalence) of qualitative factors. 3. RESULTS Samples were collected from 81 Yanomami individuals aged between 2 and 56 years old (mean age = 17.19 ±12.84), of whom 35 were female and 46 were male. Clinically, 33 individuals had lesions compatible with HD. Of the other 48 individuals without lesions, 33 said that they had already had the disease and 15 were unable to say whether or not they had the lesion. The age of those with clinical presence of the lesion ranged from 4 to 43 years old (mean age = 14.27 ± 10.52) (Table 1 ). DNA from all samples was validated by positive β-globin. In the initial analysis of the presence or absence of HPV, 39 (48.2%) individuals were positive for HPV and 42 (51.8%) were negative. All the 34 samples shown to have HD were positive for HPV-13 or 32. Of these, 15 were from females and 19 from males with ages ranging from 4 to 43 years old (14.3 ± 10.3). In the analysis of HPV-13 and 32, 14 individuals (seven females and seven males) were found to have HPV-13, with ages ranging from 5 to 35 years old (14.8 ± 10.2), and 20 had HPV-32 (eight females and 12 males) with ages ranging from 4 to 43 years old (13.9 ± 10.7). Only one individual without lesion was positive for HPV-32. Of the 14 individuals who did not know whether they had had the lesion, only one was positive for HPV-32 (Table 2 ). Table 1 Distribution of qualitative factors (i.e. age group, gender, generic HPV, presence or absence of HD ) N % P-value Age Range Adult 25 30.9% < 0.001 Child/Teen 56 69.1% Gender Female 35 43.2% 0.084 Male 46 56.8% Generic HPV Negative 42 51.9% 0.637 Positive 39 48.1% Presence of lesion No 48 59.3% 0.018 Yes 33 40.7% Clinical history of the lesion No 33 66.7% Do not know 15 31.3% < 0.001 Yes 1 2.1% < 0.001 Analysis of the prevalence calculation with a 95% confidence interval for HPV types was carried out in five segments, namely: adult, child/adolescent, female, male and all (here the entire sample was considered). Prevalence was divided into two forms: Total: when the total N of cases is the entire sample HPV+: when the total N of cases is only the positive response for generic HPV Total analysis showed that HPV-13 and HPV-32 had prevalence rates of 17.3% and 24.7%, respectively, whereas HPV-positive analysis showed prevalence rates of 35.9% and 51.3%, respectively (Table 2 ). Table 2 Prevalence of HPV - 13 and HPV - 32 by s egment. HPV-13 HPV-32 N Prev.% IC P-value N Prev.% IC P-value Total Adult 3 12.0% 12.7% 0.074 3 12.0% 12.7% 0.074 Child/Teen 11 19.6% 10.4% < 0.001 17 30.4% 12.0% < 0.001 Female 7 20.0% 13.3% 0.005 8 22.9% 13.9% 0.003 Male 7 15.2% 10.4% 0.006 12 26.1% 12.7% < 0.001 All 14 17.3% 8.2% < 0.001 20 24.7% 9.4% < 0.001 HPV+ Adult 3 30.0% 28.4% 0.060 3 30.0% 28.4% 0.060 Child/Teen 11 37.9% 17.7% < 0.001 17 58.6% 17.9% < 0.001 Female 7 38.9% 22.5% 0.003 8 44.4% 23.0% 0.001 Male 7 33.3% 20.2% 0.004 12 57.1% 21.2% < 0.001 All 14 35.9% 15.1% < 0.001 20 51.3% 15.7% < 0.001 With regard to the analysis of family nuclei, samples were collected from 13 family nuclei and three isolated samples. One can observe that there was a tendency for circulation of the same HPV type in 11 of the 13 family nuclei, whereas both HPV types were found in only two ones. The majority were positive (46.2%) for HPV-13, 38.5% were positive for HPV-32 and only 15.4% were positive for both (Table 3 ). However, no statistically significant difference was found between these indices by using the Two Proportions Z test. Table 3 Distribution of f amily n uclei for HPV-13 and 32 N % P-value Both two 15.4% 0.089 HPV-13 6 46.2% HPV-32 5 38.5% 0.691 In addition to these findings, Table 4 shows the prevalence of HPV (high and low risk) by segment. One can observe that eight individuals had high-risk HPV, one for HPV-16, one for HPV-18, two for HPV-58, one for HPV-59, two for HPV-69 and one for HPV-82. Only two individuals had low-risk HPV, one for HPV-40 and one for HPV-43. Five samples showed two different types of HPV. Table 4 Prevalence of high-risk HPV and low-risk HPV by segment. High-risk HPV Low-risk HPV N PR % CI P-value N PR % CI P-value Total Adult 5 20.0% 15.7% 0.018 2 8.0% 10.6% 0.149 Child/Teen 3 5.4% 5.9% 0.079 0 0.0% 0.0% 1,000 Female 6 17.1% 12.5% 0.010 1 2.9% 5.5% 0.314 Male 2 4.3% 5.9% 0.153 1 2.2% 4.2% 0.315 All 8 9.9% 6.5% 0.004 2 2.5% 3.4% 0.155 HPV+ Adult 5 50.0% 31.0% 0.010 2 20.0% 24.8% 0.136 Child/Teen 3 10.3% 11.1% 0.075 0 0.0% 0.0% 1,000 Female 6 33.3% 21.8% 0.007 1 5.6% 10.6% 0.310 Male 2 9.5% 12.6% 0.147 1 4.8% 9.1% 0.311 All 8 20.5% 12.7% 0.003 2 5.1% 6.9% 0.152 PR = prevalence rate; CI = confidence interval 4. DISCUSSION To our knowledge, this is the first study evaluating the presence of HPV genotypes in families of Yanomamis indigenous people from Roraima. Of the saliva samples collected from 81 individuals, 39 were HPV positive, with only 10 samples showing HPV other than type 13 or 32. The prevalence of HPV-13 and − 32 in children and young individuals showed a significant difference compared to adults, which is in line with some studies. [ 6 , 22 , 25 ] A very interesting fact observed in this study is that of the 13 family nuclei, in which 11 had the same genotype of HPV and only two families had both genotypes (Table 3 ). This demonstrates that there may be a trend towards viral circulation within family members. One can observe many reports of isolated cases and a few data on families in the literature. According to the literature, the incidence of HD in the same family is probably due to the sharing of the same food, utensils and toothbrushes [ 26 ]. A possible mode of transmission could be via saliva, which might spread the virus from one individual to others. However, a limitation of this study is the lack of assessment of virus circulation in individuals without lesions. This could be addressed by collecting serial samples over time, similarly to a study on a population of Aboriginal people from South Australia, in which three samples were collected over a two-year period. Unlike the present study, the South Australian study evaluated the prevalence of various HPV types but did not report the presence of active lesions [ 17 ]. One can verify that all individuals had the lesion, with HPV-13 or -32 being present in their oral viral excretion. In this sense, it seems that viral circulation is reduced in the absence of lesion. A strong correlation of the presence of HPV-13 and − 32 with nutritional deficiency, poverty, lack of hygiene and genetic predisposition has been associated with HD Deficient leukocyte adhesion, as well as mutations in channel-like transmembrane proteins related to TMC6 and TMC8 genes located on chromosome 17q25, have also been related to HFE [ 10 ]. In the literature, most studies are case reports and a few with a large number of patients [ 12 ]. Because of this, prevalence was only reported in some geographic regions as most reports are from South America, which has great ethnic diversity [ 26 ]. Certain ethnic groups have specific viruses in the oral cavity, such as HHV-8 [ 8 ], and we found no data on the Yanomami ethnic group. A study carried out in 2011 described the epidemiology and clinical characteristics of patients with HD living a rural community in the Mayan area of Mexico, with 53 cases and 54 controls. Clinical and epidemiological data were collected through direct interviews. Saliva and cheek swab samples were tested for HPV-13 and − 32 by using PCR. The evolution of the lesions ranged from two months to 17 years. The lesions affected lips, buccal mucosa and tongue, with 96% of the individuals having multiple lesions. From the 53 patients, 50 oral swab samples and 31 saliva samples from 31 were analysed. HPV-13 was detected in 100% of the oral and saliva samples, and 16 individuals without lesions were positive for HPV-13. A highly significant association between HPV-13 infection and HEM was found. According to the authors, household transmission of HPV-13 can occur through saliva and shared use of contaminated objects [ 2 , 21 ] It is worth noting that even if the prognosis of the lesions is good, as most regress spontaneously, monitoring is necessary because when they do not regress they can cause aesthetic and functional problems, which requires their removal. Techniques for removal are varied, such as surgery, cryotherapy, electrocoagulation, laser, chemical agents (e.g. retinoic acid) or immuno-stimulants (e.g. interferon) [ 26 , 27 ]. When investigating other types of HPV, we found eight individuals with high-risk HPV, one for HPV-16 and one for HPV-18. It is known that these two types of HPV are responsible for cervical cancers and pre-cancerous cervical lesions. In addition to these, two had HPV-58, one had HPV-59, two had HPV-69 and one had HPV-82. Only two individuals had low-risk HPV, one for HPV-40 and the other for HPV-43. Five samples showed two different types of HPV, which could determine a co-infection. Our findings were different from the results found by Jiménez Aguilar et al. (19), who analysed biopsies of HD in Mexican children, reporting a wide variety of HPV oncogenes: high-risk HPV-16, 18, 31, 39, 51, 52, 58 and 68; medium-risk HPV-66; and low-risk HPV-11, 13, 40, 62, and 69/71. In this same study, HPV-13 was found in 71% of the cases, whereas no finding was reported regarding HPV- 32. Prabhat et al. [ 24 ] reported a case of multifocal epithelial hyperplasia (MEH) involving multiple sites of the oral cavity, accompanied by skin lesions, in a 65-year-old woman. They discussed the likely multifactorial etiology and clinical presentation variations, including evidence of expression of HPV-16. This report underscores the importance of careful examination and prompt diagnosis of the disease, as it may be associated with high-risk genotypes such as HPV 16 and 18. There is a lack of information on this indigenous population of the Yanomami ethnic group due to its location and regional policies, meaning that it is extremely difficult to obtain any type of biological sample. In recent years, the Yanomami humanitarian crisis resulting from the disruption of indigenous health care and the mining invasion caused health, environmental, sociocultural and economic impacts on the communities. Understanding this type of lesion and how it is characterized by the families can lead to a preventive action through public health policies. Declarations Acknowledgments Fundação de Amparo à Pesquisa do Estado de São Paulo # 2020/15533-8 and 2021/07490-0 Pró-Reitoria de Pesquisa e Inovação da Universidade de São Paulo # 2021.1.10424.1.9 Conflict of interest The authors declare that they have no conflict of interest. Ethical approval This study was approved by the Coordination of the Yanomami Indigenous Special Health District (DSEIY), the presidency of the District Indigenous Health Councils (CONDISI) and the leadership of the Indigenous Health House (CASAI). It was also submitted to the National Research Ethics Council (CONEP Protocol ID-60086116.2.0000.0081) and was conducted in accordance with the Helsinki Declaration. For inclusion in this study, the participants gave their permission through an informed consent form. 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Ozden B, Gunduz K, Gunhan O, Ozden FO (2011) A Case Report of Focal Epithelial Hyperplasia (Heck's disease) with PCR Detection of Human Papillomavirus. J Maxillofac Oral Surg 10(4):357-60. doi: 10.1007/s12663-011-0184-2. Prabhat MP, Raja Lakshmi C, Sai Madhavi N, Bhavana SM, Sarat G, Ramamohan K (2013) Multifocal Epithelial Hyperplasia of Oral Cavity Expressing HPV 16 Gene: A Rare Entity. Case Rep Dent. 2013:871306. doi: 10.1155/2013/871306. Santos PPA, Vasconcelos MG, Pereira KMA, de Souza LB; Freitas RA, Costa ALL, Costa de Medeiros AM (2007) Hiperplasia epitelial focal (doença de Heck) em descendente de índios brasileiros: relato de caso. J Bras Patol Med Lab 43(6):431-434. Sethi S, Ali A, Ju X, Antonsson A, Logan R, Jamieson L. (2022). An update on Heck's disease-a systematic review. J Public Health (Oxf). 44(2), 269–285. https://doi.org/10.1093/pubmed/fdaa256 Wang Q, Xu L, Li X, Yu M, Chen Q. (2023). Multifocal epithelial hyperplasia confined to the interdental papilla of an adult Chinese man: a rare case report and literature review. BMC Oral Health, 23(1), 699. https://doi.org/10.1186/s12903-023-03282-7 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4850572","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":344192577,"identity":"6db35dcb-4580-47c8-a55f-7857934475fc","order_by":0,"name":"Debora Pallos","email":"","orcid":"","institution":"Universidade de Santo Amaro","correspondingAuthor":false,"prefix":"","firstName":"Debora","middleName":"","lastName":"Pallos","suffix":""},{"id":344192578,"identity":"33474685-2fab-4e15-983e-9e7730945258","order_by":1,"name":"Richardson Mondego Boaventura","email":"","orcid":"","institution":"Universidade de Santo Amaro","correspondingAuthor":false,"prefix":"","firstName":"Richardson","middleName":"Mondego","lastName":"Boaventura","suffix":""},{"id":344192579,"identity":"59494542-e3ef-4c80-a06f-6334a00836ce","order_by":2,"name":"Sergio Takashi Kussaba","email":"","orcid":"","institution":"Universidade de Santo Amaro","correspondingAuthor":false,"prefix":"","firstName":"Sergio","middleName":"Takashi","lastName":"Kussaba","suffix":""},{"id":344192580,"identity":"c8f44aa0-9015-4007-b5b6-520b79b22d7a","order_by":3,"name":"Caio Vinicius G Roman-Torres","email":"","orcid":"","institution":"Universidade de Santo Amaro","correspondingAuthor":false,"prefix":"","firstName":"Caio","middleName":"Vinicius G","lastName":"Roman-Torres","suffix":""},{"id":344192581,"identity":"2c8480b2-2b66-4fcf-a5ce-5b8f36c8c4f1","order_by":4,"name":"Amanda Passatore Cabral","email":"","orcid":"","institution":"Universidade de Santo Amaro","correspondingAuthor":false,"prefix":"","firstName":"Amanda","middleName":"Passatore","lastName":"Cabral","suffix":""},{"id":344192582,"identity":"c42eceb8-62af-4e10-9051-0667462184b4","order_by":5,"name":"Yeon Jung Kim","email":"","orcid":"","institution":"Universidade de Santo Amaro","correspondingAuthor":false,"prefix":"","firstName":"Yeon","middleName":"Jung","lastName":"Kim","suffix":""},{"id":344192583,"identity":"512adedd-e552-4bbb-8e0f-1620c0f09bde","order_by":6,"name":"Rodrigo Merlin Zerbinati","email":"","orcid":"","institution":"Institute of Medicine Tropical","correspondingAuthor":false,"prefix":"","firstName":"Rodrigo","middleName":"Merlin","lastName":"Zerbinati","suffix":""},{"id":344192584,"identity":"b1a22a70-daa7-47f0-b87e-a39026e8ed4f","order_by":7,"name":"Andre Luis Lacerda Bachi","email":"","orcid":"","institution":"Universidade de Santo Amaro","correspondingAuthor":false,"prefix":"","firstName":"Andre","middleName":"Luis Lacerda","lastName":"Bachi","suffix":""},{"id":344192585,"identity":"0acf8dc5-8df1-4d7e-8349-8053f38581bd","order_by":8,"name":"Paulo Henrique Braz-Silva","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAmUlEQVRIiWNgGAWjYDACCRBRASJ4SNJyhmQtjG2kaDGX7n348ee8w/bmDLzHPhClxXLOcWMJyW2HE3c28CXPIEqLwY00BgnDbYcTDA7wGBPnMKAW5h+Jcw7bk6SFTeJgw2HGDURrsZxzjM2y4Vh64s5mvmTitJhLtzHf/FFjbW/O3nuYSIfBGczEaUDWQqyOUTAKRsEoGHkAAF26KrbQaAktAAAAAElFTkSuQmCC","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":true,"prefix":"","firstName":"Paulo","middleName":"Henrique","lastName":"Braz-Silva","suffix":""}],"badges":[],"createdAt":"2024-08-02 21:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4850572/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4850572/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68295196,"identity":"4b82eefc-6276-434b-bcc1-36f78068e877","added_by":"auto","created_at":"2024-11-05 18:31:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":537790,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4850572/v1/43ad9531-676f-4be1-a23e-03eb4849da93.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Different HPV Genotypes Related to Heck's Disease in an Indigenous Population of Roraima: a cross- sectional study","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eFocal epithelial hyperplasia or Heck's disease is a rare, benign disease affecting the oral mucosa of children and young adults from different regions of the world and ethnic groups, such as indigenous people and Eskimos. Heck's disease (HD) is a virus-induced proliferation located in the oral squamous epithelium and was first described (1894) in Greenland Eskimos. The sites most prone to the development of this lesion are keratinized and non-keratinized surfaces [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHD has been reported with the presence of two genotypes of human papillomavirus: HPV-32, which tends to cause the disease in older individuals, whereas HPV-13, which appears to be equally involved in the development of the disease in both young and older individuals [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The association with type 13 was reported in 1983 by a report on a Turkish patient and in 1987 the disease was associated with type 32.\u003c/p\u003e \u003cp\u003eMore recent studies have also identified the lesion in other populations and ethnic groups in South Africa, Mexico and Central America, and European countries. The ethnic predilection of this condition may be related to genetic factors as they increase the individual's vulnerability to viral infection [4, 9, 11, 20, 23, 28].\u003c/p\u003e \u003cp\u003eThe disease is characterized by well-defined lesions ranging in size from 0.1 to 1 cm in diameter, involving single or multiple sites, and occurring preferentially on the buccal, labial, gingival and lingual mucosa. HD is generally painless and has characteristics of a benign lesion. Spontaneous regression of focal epithelial hyperplasia has been reported after months or years, being confirmed by the rarity of the disease in adults. Conservative surgical excision can be performed for diagnostic purposes or aesthetic and functional reasons. Condyloma acuminatum, squamous papilloma, Cowden's syndrome, and verruca vulgaris are differential diagnosis of HD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, this study had the general objective of detecting human papillomavirus (HPV) in the saliva of indigenous people of the Yanomami ethnic group by comparing these findings with clinical characteristics of HD. Additionally, this study also sought to evaluate the prevalence of different types of human papillomavirus (HPV) in their saliva and relate them to HD.\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Population, Design and Ethical Assessment of the Study\u003c/h2\u003e \u003cp\u003e This study was submitted for approval by the Coordination of the Yanomami Indigenous Special Health District (DSEIY), presidency of the District Indigenous Health Councils (CONDISI) and the leadership of the Indigenous Health House (CASAI). It was also submitted to the National Research Ethics Council (CONEP) according to protocol number #1998028. For inclusion in this study, all the participants gave their authorization through a free and informed consent form (ICF) with the presence of a translator (when necessary).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Saliva Collection\u003c/h2\u003e \u003cp\u003eSaliva samples were collected from indigenous people, including their family members, who had the clinical diagnosis of HD. During sample collection, it was asked whether the individual had already had the lesion (for this question, the answer could be yes, no and I don't know). The saliva samples were frozen in the indigenous village, as described below, before being sent to the Laboratory of Virology of the Institute of Tropical Medicine of the School of Medicine University of S\u0026atilde;o Paulo and stored at -80\u0026ordm; C\u003c/p\u003e \u003cp\u003eA disposable cup with 0.12% alcohol-free chlorhexidine solution was given to the individuals included in the study. They were instructed to rinse the mouth for 1 minute and then spit back into the cup. By using a disposable pipette, 0.12% chlorhexidine solution containing the saliva was removed and a volume of 1 mL was transferred to a properly identified Eppendorf tube, which was then frozen at -20\u0026ordm;C. Saliva sample was collected from each individual.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Laboratory Procedures\u003c/h2\u003e \u003cp\u003e \u003cem\u003eDNA Extraction from Saliva\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDNA extraction from saliva samples was performed by using the QIAamp \u0026reg; DNA Blood Mini kit (QIAGEN Group, Valencia, California, USA), according to the manufacturer's instructions. The technique is based on DNA purification through filters arranged in column and successive washing and centrifugation. The PCR reaction for β-globin with PCO3/4 primers was performed in all samples to ensure the presence of sufficient cells for detection of human DNA. Saliva samples positive for β-globin were included for data analysis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eHPV Detection and Genotyping\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe presence of HPV DNA was detected by using PCR reaction with the primer sets PGMY09 and PGMY11 (13). An equimolar mixture of each primer was added to 2.5\u0026micro;L of 10x PCR buffer (Invitrogen\u0026reg; - minus MgCl2), 2\u0026micro;L of dNTPs (2.5 mM) (Invitrogen\u0026reg;), 1.5\u0026micro;L of MgCl2 (50mM) (Invitrogen\u0026reg;), 0.5\u0026micro;L of PGMY09 primers (0.5 \u0026micro;M), 0.4 \u0026micro;L of platinum Taq DNA polymerase (Invitrogen\u0026reg;), 2.5\u0026micro;L of glycerol (57%) (Invitrogen\u0026reg;), 2.5 \u0026micro;L of cresol red (2.5\u0026micro;g/\u0026micro;L), 8.1\u0026micro;L of deionized H\u003csub\u003e2\u003c/sub\u003eO and 5\u0026micro;L of DNA. Amplifications were carried out in a thermocycler (Mastercycler Gradient, Eppendorf, Germany) at 95\u0026deg;C for 9 minutes, 40 cycles of 95\u0026deg;C for 1 minute, 55\u0026deg;C for 1 minute and 72\u0026deg;C for 1 minute, followed by a final extension at 72\u0026deg;C for 5 minutes. After PCR, amplified products were observed on a 1.5% agarose gel (Agarose Ultrapure \u0026trade; - Invitrogen Life Technologies) in 1X TAE buffer [DNA Typing Grade TAE Buffer, GIBCO - Invitrogen Corporation (2mM Tris-Acetate and 50mM ethylenediaminetetraacetic acid - EDTA)] stained with SYBR Safe\u0026trade; 1X (Invitrogen, USA).\u003c/p\u003e \u003cp\u003e \u003cb\u003eDetection of Human Papillomavirus Genotypes 13 and 32\u003c/b\u003e \u003c/p\u003e \u003cp\u003eEnd-point PCR reactions were performed with amplicon visualization by electrophoresis in 1.5% agarose gel, according to protocols adapted from previously published studies [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor HPV genotype 13, the primer pair (sense primer 5'-AAATCCCAGCAGAATTATAT-3' and antisense primer 5'-AAAGAGATGATGTAGTGGC-3') was used, with an expected target fragment size of 240bp. For genotype 32, the primer pair (sense primer GTGGCCGCCTAGTGACAAC and antisense primer GATGCCCAACAGCCAAAAG) was used, with a fragment size of 134bp. The two pairs of primers target the L1 region of the virus. Both reactions have a final volume of 25 \u0026micro;l, containing a final concentration of 1x GoTaq \u0026reg; Flexi Buffer, 1.5 mM MgC12, 200 uM of each dNTP, 500 nM of each primer, 1.25 U of GoTaq \u0026reg; G2 for hot-start polymerase and nuclease-free ultrapure water to supplement the final volume. Temperature cycling has an initial denaturation step at 95\u0026deg;C for 2 minutes, followed by 40 cycles of 95\u0026deg;C for 50 seconds, 50\u0026deg;C for 30 seconds and 72\u0026deg;C for 50 seconds. A final extension step at 72\u0026deg;C for 5 minutes was also added to the reaction. As a control for PCR and qPCR reactions, already known genotyped samples from the IMT biobank were used.\u003c/p\u003e \u003cp\u003e \u003cem\u003eHuman Papillomavirus Genotyping\u003c/em\u003e \u003c/p\u003e \u003cp\u003eHuman Papillomavirus (HPV) was detected in the saliva samples by using the commercial Anyplex\u0026trade; II HPV 28 detection assay (Seegene Brazil), according to the manufacturer's instructions. This assay is capable of detecting and distinguishing 28 distinct HPV genotypes, in which 19 are high risk (HPV-16, -18, -26, -31, -33, -35, -39, -45, -51, -52, -53, -56, -58, -59, -66, -68, -69, -73, -82) and nine are low risk (HPV-11, -40, -42, -43, -44, -54, -6, -61, -70). The reactions were carried out by using real-time PCR system equipment (CFX96, Bio-Rad Laboratories). Each reaction was carried out in a final volume of 20\u0026micro;L containing 10\u0026micro;L of purified DNA and 10\u0026micro;L of the reagent mixture for PCR assay. Thermocycling conditions followed an initial step of 4 minutes at 50\u0026deg;C, denaturation at 95\u0026deg;C for 15 minutes, followed by 50 cycles at 95\u0026deg;C for 30 seconds (denaturation), 60\u0026deg;C for 1 minute (annealing) and 72\u0026deg;C for 30 seconds (extension). After cycling was completed, the results were exported from the CFX Manager software (Bio-Rad Laboratories) and analysed by using the real-time visualization software (Seegene Brazil).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Methodology for Data Analysis\u003c/h2\u003e \u003cp\u003eAfter collecting demographic, clinical and laboratory data of the individuals included in this study, a database was built by using the Microsoft Word for Windows (XP version) and Microsoft Excel for Windows (XP version).\u003c/p\u003e \u003cp\u003eInitially, a descriptive analysis of all study variables was carried out. Next, the values obtained from oral viral excretion were analysed and compared to the clinical manifestation of the disease. The resulting data on gender, age group and virus prevalence were tabulated, compared and submitted to statistical treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Two Proportions Z test was used to assess the relative frequency distribution (percentages or prevalence) of qualitative factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eSamples were collected from 81 Yanomami individuals aged between 2 and 56 years old (mean age\u0026thinsp;=\u0026thinsp;17.19 \u0026plusmn;12.84), of whom 35 were female and 46 were male.\u003c/p\u003e \u003cp\u003eClinically, 33 individuals had lesions compatible with HD. Of the other 48 individuals without lesions, 33 said that they had already had the disease and 15 were unable to say whether or not they had the lesion. The age of those with clinical presence of the lesion ranged from 4 to 43 years old (mean age\u0026thinsp;=\u0026thinsp;14.27 \u0026plusmn; 10.52) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDNA from all samples was validated by positive β-globin. In the initial analysis of the presence or absence of HPV, 39 (48.2%) individuals were positive for HPV and 42 (51.8%) were negative.\u003c/p\u003e \u003cp\u003eAll the 34 samples shown to have HD were positive for HPV-13 or 32. Of these, 15 were from females and 19 from males with ages ranging from 4 to 43 years old (14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3). In the analysis of HPV-13 and 32, 14 individuals (seven females and seven males) were found to have HPV-13, with ages ranging from 5 to 35 years old (14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2), and 20 had HPV-32 (eight females and 12 males) with ages ranging from 4 to 43 years old (13.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7). Only one individual without lesion was positive for HPV-32. Of the 14 individuals who did not know whether they had had the lesion, only one was positive for HPV-32 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of qualitative factors \u003cb\u003e(i.e.\u003c/b\u003e age group, gender, generic HPV, presence or absence of HD\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge Range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild/Teen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGeneric HPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePresence of lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eClinical history of the lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDo not know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAnalysis of the prevalence calculation with a 95% confidence interval for HPV types was carried out in five segments, namely: adult, child/adolescent, female, male and all (here the entire sample was considered). Prevalence was divided into two forms:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTotal: when the total N of cases is the entire sample\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHPV+: when the total N of cases is only the positive response for generic HPV\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eTotal analysis showed that HPV-13 and HPV-32 had prevalence rates of 17.3% and 24.7%, respectively, whereas HPV-positive analysis showed prevalence rates of 35.9% and 51.3%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of HPV\u003cb\u003e-\u003c/b\u003e13 and HPV\u003cb\u003e-\u003c/b\u003e32 by \u003cb\u003es\u003c/b\u003eegment.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"17\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c10\" namest=\"c3\"\u003e \u003cp\u003eHPV-13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c17\" namest=\"c11\"\u003e \u003cp\u003eHPV-32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePrev.%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003ePrev.%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003eIC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e12.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e12.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e12.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e12.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eChild/Teen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e19.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e10.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e30.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e12.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e20.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e13.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e22.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e13.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e15.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e10.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e26.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e12.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e17.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e8.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e24.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e9.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHPV+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e30.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e28.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e30.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e28.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eChild/Teen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e37.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e17.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e58.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e17.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e38.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e22.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e44.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e23.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e20.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e57.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e21.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e35.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e15.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003e51.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003e15.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c17\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWith regard to the analysis of family nuclei, samples were collected from 13 family nuclei and three isolated samples. One can observe that there was a tendency for circulation of the same HPV type in 11 of the 13 family nuclei, whereas both HPV types were found in only two ones. The majority were positive (46.2%) for HPV-13, 38.5% were positive for HPV-32 and only 15.4% were positive for both (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). However, no statistically significant difference was found between these indices by using the Two Proportions Z test.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of \u003cb\u003ef\u003c/b\u003eamily \u003cb\u003en\u003c/b\u003euclei for HPV-13 and 32\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etwo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHPV-13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHPV-32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn addition to these findings, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the prevalence of HPV (high and low risk) by segment. One can observe that eight individuals had high-risk HPV, one for HPV-16, one for HPV-18, two for HPV-58, one for HPV-59, two for HPV-69 and one for HPV-82. Only two individuals had low-risk HPV, one for HPV-40 and one for HPV-43. Five samples showed two different types of HPV.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of high-risk HPV and low-risk HPV by segment.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"20\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c17\" colnum=\"17\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c18\" colnum=\"18\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c19\" colnum=\"19\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c20\" colnum=\"20\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c11\" namest=\"c3\"\u003e \u003cp\u003eHigh-risk HPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c18\" namest=\"c12\"\u003e \u003cp\u003eLow-risk HPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c20\" namest=\"c19\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003ePR %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e \u003cp\u003ePR %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c16\" namest=\"c15\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c19\" namest=\"c17\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c20\" namest=\"c20\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e20.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e15.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e8.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e10.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eChild/Teen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e5.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e1,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e17.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e12.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e2.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e5.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e4.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e2.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e9.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e2.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eHPV+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAdult\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e31.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e20.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e24.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eChild/Teen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e10.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e1,000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e33.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e21.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e5.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e10.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e0.310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e9.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e12.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e4.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e9.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e20.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e12.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c15\" namest=\"c14\"\u003e \u003cp\u003e5.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c17\" namest=\"c16\"\u003e \u003cp\u003e6.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c20\" namest=\"c18\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"20\"\u003ePR\u0026thinsp;=\u0026thinsp;prevalence rate; CI\u0026thinsp;=\u0026thinsp;confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eTo our knowledge, this is the first study evaluating the presence of HPV genotypes in families of Yanomamis indigenous people from Roraima. Of the saliva samples collected from 81 individuals, 39 were HPV positive, with only 10 samples showing HPV other than type 13 or 32.\u003c/p\u003e \u003cp\u003eThe prevalence of HPV-13 and \u0026minus;\u0026thinsp;32 in children and young individuals showed a significant difference compared to adults, which is in line with some studies. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eA very interesting fact observed in this study is that of the 13 family nuclei, in which 11 had the same genotype of HPV and only two families had both genotypes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This demonstrates that there may be a trend towards viral circulation within family members. One can observe many reports of isolated cases and a few data on families in the literature. According to the literature, the incidence of HD in the same family is probably due to the sharing of the same food, utensils and toothbrushes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. A possible mode of transmission could be via saliva, which might spread the virus from one individual to others. However, a limitation of this study is the lack of assessment of virus circulation in individuals without lesions. This could be addressed by collecting serial samples over time, similarly to a study on a population of Aboriginal people from South Australia, in which three samples were collected over a two-year period. Unlike the present study, the South Australian study evaluated the prevalence of various HPV types but did not report the presence of active lesions [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne can verify that all individuals had the lesion, with HPV-13 or -32 being present in their oral viral excretion. In this sense, it seems that viral circulation is reduced in the absence of lesion. A strong correlation of the presence of HPV-13 and \u0026minus;\u0026thinsp;32 with nutritional deficiency, poverty, lack of hygiene and genetic predisposition has been associated with HD Deficient leukocyte adhesion, as well as mutations in channel-like transmembrane proteins related to TMC6 and TMC8 genes located on chromosome 17q25, have also been related to HFE [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the literature, most studies are case reports and a few with a large number of patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Because of this, prevalence was only reported in some geographic regions as most reports are from South America, which has great ethnic diversity [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Certain ethnic groups have specific viruses in the oral cavity, such as HHV-8 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and we found no data on the Yanomami ethnic group.\u003c/p\u003e \u003cp\u003eA study carried out in 2011 described the epidemiology and clinical characteristics of patients with HD living a rural community in the Mayan area of Mexico, with 53 cases and 54 controls. Clinical and epidemiological data were collected through direct interviews. Saliva and cheek swab samples were tested for HPV-13 and \u0026minus;\u0026thinsp;32 by using PCR. The evolution of the lesions ranged from two months to 17 years. The lesions affected lips, buccal mucosa and tongue, with 96% of the individuals having multiple lesions. From the 53 patients, 50 oral swab samples and 31 saliva samples from 31 were analysed. HPV-13 was detected in 100% of the oral and saliva samples, and 16 individuals without lesions were positive for HPV-13. A highly significant association between HPV-13 infection and HEM was found. According to the authors, household transmission of HPV-13 can occur through saliva and shared use of contaminated objects [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIt is worth noting that even if the prognosis of the lesions is good, as most regress spontaneously, monitoring is necessary because when they do not regress they can cause aesthetic and functional problems, which requires their removal. Techniques for removal are varied, such as surgery, cryotherapy, electrocoagulation, laser, chemical agents (e.g. retinoic acid) or immuno-stimulants (e.g. interferon) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen investigating other types of HPV, we found eight individuals with high-risk HPV, one for HPV-16 and one for HPV-18. It is known that these two types of HPV are responsible for cervical cancers and pre-cancerous cervical lesions. In addition to these, two had HPV-58, one had HPV-59, two had HPV-69 and one had HPV-82. Only two individuals had low-risk HPV, one for HPV-40 and the other for HPV-43. Five samples showed two different types of HPV, which could determine a co-infection. Our findings were different from the results found by Jim\u0026eacute;nez Aguilar et al. (19), who analysed biopsies of HD in Mexican children, reporting a wide variety of HPV oncogenes: high-risk HPV-16, 18, 31, 39, 51, 52, 58 and 68; medium-risk HPV-66; and low-risk HPV-11, 13, 40, 62, and 69/71. In this same study, HPV-13 was found in 71% of the cases, whereas no finding was reported regarding HPV- 32.\u003c/p\u003e \u003cp\u003ePrabhat et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] reported a case of multifocal epithelial hyperplasia (MEH) involving multiple sites of the oral cavity, accompanied by skin lesions, in a 65-year-old woman. They discussed the likely multifactorial etiology and clinical presentation variations, including evidence of expression of HPV-16. This report underscores the importance of careful examination and prompt diagnosis of the disease, as it may be associated with high-risk genotypes such as HPV 16 and 18.\u003c/p\u003e \u003cp\u003eThere is a lack of information on this indigenous population of the Yanomami ethnic group due to its location and regional policies, meaning that it is extremely difficult to obtain any type of biological sample. In recent years, the Yanomami humanitarian crisis resulting from the disruption of indigenous health care and the mining invasion caused health, environmental, sociocultural and economic impacts on the communities. Understanding this type of lesion and how it is characterized by the families can lead to a preventive action through public health policies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunda\u0026ccedil;\u0026atilde;o de Amparo \u0026agrave; Pesquisa do Estado de S\u0026atilde;o Paulo # 2020/15533-8 and 2021/07490-0\u003c/p\u003e\n\u003cp\u003ePr\u0026oacute;-Reitoria de Pesquisa e Inova\u0026ccedil;\u0026atilde;o da Universidade de S\u0026atilde;o Paulo # 2021.1.10424.1.9\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003eEthical approval\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Coordination of the Yanomami Indigenous Special Health District (DSEIY), the presidency of the District Indigenous Health Councils (CONDISI) and the leadership of the Indigenous Health House (CASAI). It was also submitted to the National Research Ethics Council (CONEP Protocol ID-60086116.2.0000.0081) and was conducted in accordance with the Helsinki Declaration. For inclusion in this study, the participants gave their permission through an informed consent form.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAkoğlu G, Metin A, Ceylan GG, Emre S, Akpolat D, S\u0026uuml;ng\u0026uuml; N (2015) Focal epithelial hyperplasia associated with human papillomavirus 13 and common human leukocyte antigen alleles in a Turkish family. Int J Dermatol 54(2):174-8. doi: 10.1111/ijd.12538. \u003c/li\u003e\n\u003cli\u003eBendtsen, S. K., Jakobsen, K. K., Carlander, A. F., Gr\u0026oslash;nh\u0026oslash;j, C., \u0026amp; von Buchwald, C. (2021). Focal Epithelial Hyperplasia. Viruses 13(8), 1529. https://doi.org/10.3390/v13081529\u003c/li\u003e\n\u003cli\u003eBennett LK, Hinshaw M. (2009) Heck\u0026apos;s disease: diagnosis and susceptibility. Pediatr Dermatol. 26(1):87-9. doi: 10.1111/j.1525-1470.2008.00830.x.\u003c/li\u003e\n\u003cli\u003eBorborema-Santos CM, Castro MM, Santos PJ, Talhari S, Astolfi-Filho S. (2006) Oral focal epithelial hyperplasia: report of five cases. Braz Dent J 17(1):79-82. \u003c/li\u003e\n\u003cli\u003eBrehm MA, Gordon K, Firan M, Rady P, Agim N. (2016) Case Report of Focal Epithelial. Hyperplasia (Heck\u0026apos;s Disease) with Polymerase Chain Reaction Detection of Human. Papillomavirus 13. Pediatr Dermatol 33(3):e224-5. doi:10.1111/pde.12862. \u003c/li\u003e\n\u003cli\u003eConde-Ferr\u0026aacute;ez L, Ek-Hern\u0026aacute;ndez GE, Canch\u0026eacute;-Pech JR, G\u0026oacute;mez-Carballo JG, Kant\u0026uacute;n-Moreno NE, Gonz\u0026aacute;lez-Losa MDR (2021) Genomic characterization of human papillomavirus type 13, associated to multifocal epithelial hyperplasia, in a Mayan community. Infect Genet Evol 91:104595. doi:10.1016/j.meegid.2020.104595\u003c/li\u003e\n\u003cli\u003ede Castro LA, de Castro JG, da Cruz AD, Barbosa BH, de Spindula-Filho JV, Costa MB (2016) Focal Epithelial Hyperplasia (Heck\u0026apos;s Disease) in a 57-Year-Old Brazilian Patient: A Case Report and Literature Review. J Clin Med Res 8(4):346-50. doi: 10.14740/jocmr2466w. \u003c/li\u003e\n\u003cli\u003ede Souza VA, Sumita LM, Nascimento MC, Oliveira J, Mascheretti M, Quiroga M, Freire WS, Tateno A, Boulos M, Mayaud P, Pannuti CS (2007). Human herpesvirus-8 infection and oral shedding in Amerindian and non-Amerindian populations in the Brazilian Amazon region. J Infect Dis 196(6), 844\u0026ndash;852. https://doi.org/10.1086/520549\u003c/li\u003e\n\u003cli\u003eDurso BC, Pinto JM, Jorge J Jr, de Almeida OP (2005) Extensive focal epithelial hyperplasia: case report. J Can Dent Assoc 71(10):769-71. \u003c/li\u003e\n\u003cli\u003eEspinoza H, Ha KT, Pham TT, Espinoza JL (2021). Genetic Predisposition to Persistent Human Papillomavirus-Infection and Virus-Induced Cancers. Microorganisms, 9(10), 2092. https://doi.org/10.3390/microorganisms9102092\u003c/li\u003e\n\u003cli\u003eFalaki F, Amir Chaghmaghi M, Pakfetrat A, Delavarian Z, Mozaffari PM, Pazooki N (2009) Detection of human papilloma virus DNA in seven cases of focal epithelial hyperplasia in Iran. J Oral Pathol Med 38(10):773-6. doi: 10.1111/j.1600-0714.2009.00784.x. \u003c/li\u003e\n\u003cli\u003eG\u0026ouml;kahmetoğlu S, Ferahbaş A, Can\u0026ouml;z \u0026Ouml; (2014) Focal epithelial hyperplasia in a Turkish family. Infez Med 22(4):322-5.\u003c/li\u003e\n\u003cli\u003eGravitt PE, Peyton CL, Alessi TQ, Wheeler CM, Coutl\u0026eacute;e F, Hildesheim A, Schiffman MH, Scott DR, Apple RJ (2000) Improved amplification of genital human papillomaviruses J Clin Microbiol 38(1):357-61.\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;ltekin SE, Tokman Yildirim B, Sarisoy S (2011) Oral focal epithelial hyperplasia: report of 3 cases with human papillomavirus DNA sequencing analysis. Pediatr Dent 33(7):522-4. \u003c/li\u003e\n\u003cli\u003eHashemipour MA, Shoryabi A, Adhami S, Mehrabizadeh Honarmand H (2010) Extensive focal epithelial hyperplasia. Arch Iran Med 13(1):48-52.\u003c/li\u003e\n\u003cli\u003eHerrel NR, Johnson NL, Cameron JE, Leigh J, Hagensee ME (2009) Development and Validation of a HPV-32 Specific PCR Assay. Virol J 6, 90 https://doi.org/10.1186/1743-422X-6-90\u003c/li\u003e\n\u003cli\u003eJamieson LM, Antonsson A, Garvey G, Ju X, Smith M, Logan RM, Johnson NW, Hedges J, Sethi S, Dunbar T, Leane C, Hill I, Brown A, Roder D, De Souza M, Canfell K (2020). Prevalence of Oral Human Papillomavirus Infection Among Australian Indigenous Adults. JAMA Netw Open 3(6), e204951. https://doi.org/10.1001/jamanetworkopen.2020.4951\u003c/li\u003e\n\u003cli\u003eJayasooriya PR, Abeyratne S, Ranasinghe AW, Tilakaratne WM (2004) Focal epithelial hyperplasia (Heck\u0026apos;s disease): report of two cases with PCR detection of human papillomavirus DNA. Oral Dis 10(4):240-3. \u003c/li\u003e\n\u003cli\u003eJim\u0026eacute;nez Aguilar SM, Rodr\u0026iacute;guez DL, Mu\u0026ntilde;oz Estrada VF, C\u0026aacute;zarez Salazar SG, Velarde F\u0026eacute;lix JS, M\u0026eacute;ndez Mart\u0026iacute;nez RS (2023) Great diversity of oncogenic human papillomaviruses is revealed in an outbreak of multifocal epithelial hyperplasia. J Am Acad Dermatol. 88(5), 1115\u0026ndash;1117. https://doi.org/10.1016/j.jaad.2019.12.041\u003c/li\u003e\n\u003cli\u003eLiu N, Li Y, Zhou Y, Zeng X (2012) Focal epithelial hyperplasia (Heck\u0026apos;s disease) in two Chinese females. Int J Oral Maxillofac Surg 41(8):1001-4. doi:10.1016/j.ijom.2011.10.032. \u003c/li\u003e\n\u003cli\u003eLopez-Villanueva ME, Conde-Ferr\u0026aacute;ez L, Ayora-Talavera G, Cer\u0026oacute;n-Espinosa JD, Gonz\u0026aacute;lez-Losa Mdel R (2011) Human papillomavirus 13 in a Mexican Mayan community with multifocal epithelial hyperplasia: could saliva be involved in household transmission? Eur J Dermatol 21(3):396-400. \u003c/li\u003e\n\u003cli\u003eMartins WD, de Lima AA, Vieira S (2006) Focal epithelial hyperplasia (Heck\u0026apos;s disease): report of a case in a girl of Brazilian Indian descent. Int J Paediatr Dent 16(1):65-8.\u003c/li\u003e\n\u003cli\u003eOzden B, Gunduz K, Gunhan O, Ozden FO (2011) A Case Report of Focal Epithelial Hyperplasia (Heck\u0026apos;s disease) with PCR Detection of Human Papillomavirus. J Maxillofac Oral Surg 10(4):357-60. doi: 10.1007/s12663-011-0184-2. \u003c/li\u003e\n\u003cli\u003ePrabhat MP, Raja Lakshmi C, Sai Madhavi N, Bhavana SM, Sarat G, Ramamohan K (2013) Multifocal Epithelial Hyperplasia of Oral Cavity Expressing HPV 16 Gene: A Rare Entity. Case Rep Dent. 2013:871306. doi: 10.1155/2013/871306. \u003c/li\u003e\n\u003cli\u003eSantos PPA, Vasconcelos MG, Pereira KMA, de Souza LB; Freitas RA, Costa ALL, Costa de Medeiros AM (2007) Hiperplasia epitelial focal (doen\u0026ccedil;a de Heck) em descendente de \u0026iacute;ndios brasileiros: relato de caso. J Bras Patol Med Lab 43(6):431-434. \u003c/li\u003e\n\u003cli\u003eSethi S, Ali A, Ju X, Antonsson A, Logan R, Jamieson L. (2022). An update on Heck\u0026apos;s disease-a systematic review. J Public Health (Oxf). 44(2), 269\u0026ndash;285. https://doi.org/10.1093/pubmed/fdaa256\u003c/li\u003e\n\u003cli\u003eWang Q, Xu L, Li X, Yu M, Chen Q. (2023). Multifocal epithelial hyperplasia confined to the interdental papilla of an adult Chinese man: a rare case report and literature review. BMC Oral Health, 23(1), 699. https://doi.org/10.1186/s12903-023-03282-7\u003cstrong\u003e\u003cstrong\u003e\u003cstrong\u003e\u003cstrong\u003e\u003cstrong\u003e\u003cstrong\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Human Papillomavirus Viruses, Focal Epithelial Hyperplasia, Indigenous Peoples, Polymerase Chain Reaction, Saliva","lastPublishedDoi":"10.21203/rs.3.rs-4850572/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4850572/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003e: Heck's disease (HD) is a virus-induced proliferation, normally benign and rare disease affecting the oral mucosa of children and young adults from different regions of the world and ethnic groups.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003edetermine the prevalence of HD and the detection of 30 different genotypes of HPV in the oral cavity of an indigenous population.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003e81 saliva samples were collected from indigenous people of the Yanomami ethnic group, including their family members, with a clinically history of HD. DNA was extracted and a commercial assay, which includes 28 types of human papillomavirus (HPV), was used for analysis, and RT-PCR to identify HPV-13 and HPV-32.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003efrom 81 saliva samples analysed, 33 (40.7%) clinically had HD. In the initial HPV genotyping analysis, 39 (48.2%) were positive for at least one genotype. All individuals who clinically had the lesion were positive for HPV-13 or HPV-32. The majority of the 13 families (46.2%) were positive for HPV-13, whereas HPV-32 was found in 38.5%, and only 15.4% had both genotypes. Of the other genotypes of HPV, only 10 individuals were positive, eight were positive for high-risk HPV group (HPV-16, 18, 58, 59, 69 and 82) and two were positive for low-risk HPV-40, 43.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOur study confirms the presence of HPV-13 and HPV-32, which are associated with Heck's disease. Additionally, there seems to be a familial segregation of these viruses.\u003c/p\u003e\u003ch2\u003eClinical Relevance:\u003c/h2\u003e \u003cp\u003eUnderstanding the nature of this type of lesion and its characterization within families can inform preventive measures through public health policies.\u003c/p\u003e","manuscriptTitle":"Different HPV Genotypes Related to Heck's Disease in an Indigenous Population of Roraima: a cross- sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-30 06:10:22","doi":"10.21203/rs.3.rs-4850572/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3de01591-0785-48d4-bd6d-9b010acd636b","owner":[],"postedDate":"August 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-05T18:23:44+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-30 06:10:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4850572","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4850572","identity":"rs-4850572","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}