Regional Diversity of Human Papillomavirus Genotypes in Southeastern Brazil: Implications for Cervical Cancer...

Cervical cancer remains a major public health challenge in Brazil. A molecular testing for human papillomavirus (HPV) was incorporated into the national screening program, current strategies prioritize HPV-16 and HPV-18, potentially overlooking other high-risk genotypes circulating regionally. This cross-sectional study evaluated HPV prevalence and genotype distribution among 8073 women in routine cervical screening and a separately recruited research cohort of sexually active women aged 15-25 years in 25 municipalities in southern Espírito Santo, Brazil, from September 2024 to September 2025. Cervicovaginal samples were tested using the Allplex HPV28 real-time quantitative PCR assay, which detects 28 HPV genotypes. Sociodemographic and behavioral data were collected via standardized questionnaires and vaccination status was verified for women aged 15-25 years using official records. Associations were analyzed using odds ratios (ORs) and 95% confidence intervals (CIs). Overall HPV prevalence was 27.9%, increasing to 57.0% among those aged 15-25 years. Carcinogenic genotypes comprised 43.4% of infections. The most prevalent relevant genotypes were HPV-53 (3.6%), HPV-68 (3.1%), HPV-52 (2.9%), HPV-16 (2.9%), and HPV-58 (2.3%). Multiple carcinogenic/probable or possible carcinogenic infections occurred in 48.5% of HPV-positive cases, with HPV-52, HPV-53, and HPV-68 forming a central coinfection cluster. Among women aged 15-25 years, 30.4% were vaccinated; no vaccine-covered genotypes were detected in vaccinated women, compared with 6.4% in unvaccinated women (OR, 0.17; 95% CI, 0.009-3.08; p = 0.18). Non-16/18 genotypes predominate in this population, but the two most prevalent (HPV-53 and HPV-68) carry comparatively low attributable risk for invasive cervical cancer under current global classifications, whereas genotypes with established high carcinogenic potential (16, 18, 31, 33, 35, 45, 52, and 58) accounted for only 31.5% of detected infections. These findings support continued regional genotype surveillance and vaccine-impact monitoring but, in the absence of histological or invasive-cancer outcome data from this population, do not by themselves justify changes to screening panels or vaccine composition based on prevalence alone.