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Servikal Örneklerde Human Papilloma Virüs (HPV) Sıklığının Araştırılması ve Genotiplerinin Analizi

Yıl 2024, , 50 - 57, 30.04.2024
https://doi.org/10.34084/bshr.1455863

Öz

Kısa Başlık: Human Papilloma Virüs (HPV) Sıklığının Araştırılması

Giriş ve Amaç: Human Papilloma virüsler çift zincirli DNA yapısında olup papillomavirüs ailesindendirler. Human Papilloma Virüs (HPV)’ün servikal karsinomla bağlantılı olduğunu gösteren birçok kanıt bulunmaktadır. Bu çalışmada servikal sürüntü örneklerinde HPV-DNA varlığı araştırılmış ve pozitif bulunan örneklerin HPV genotiplerinin saptanması amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmada 1 Ocak 2020 ile 31 Aralık 2022 tarihleri arasında Afyonkarahisar Sağlık Bilimleri Üniversitesi Tıp Fakültesi Hastanesi Tıbbi Mikrobiyoloji Laboratuvarına HPV-DNA varlığının taranması amacıyla gönderilen servikal sürüntü örneklerine ait üç yıllık sonuçlar retrospektif olarak değerlendirilmiştir. HPV genotiplendirmesi için ekstraksiyon işlemi cobas 4800 (cobas® x480) (Roche Diagnostics, Indianapolis, ABD) tam otomatize cihazı ile yapılmış ve numuneler Real-time PCR (cobas® z 480) sistemi kullanılarak üretici firma direktifleri doğrultusunda çalışılmıştır.
Bulgular: HPV-DNA, incelenen toplam 4960 hastanın 415’inde (%8.4) pozitif, 4545’inde (%91.6) ise negatif saptanmıştır. HPV pozitifliği açısından değerlendirildiğinde en yüksek pozitifliğin sırasıyla %68 oranında HR-HPV, %17,3 oranında HPV 16 ve %8,2 oranında HPV 16 ve HR-HPV birlikte pozitifliği olduğu görülmüştür. HPV-DNA pozitifliği en fazla %38 ile 35-44 yaş grubunda görülürken, en az %3,4 ile 25 yaş altı hasta grubunda bulunmuştur.
Sonuç: Çalışmamızın amacı, bölgemizdeki HPV görülme sıklığı ve yaygın alt tiplerinin belirlenmesi ile bölge ve ülkemiz verilerine katkı sağlamak, ayrıca aşı çalışmalarına yol gösterebilecek verilerin toplanmasıdır. Tarama programları ile birlikte yürütülecek olan aşı programları, risk altındaki bu popülasyonda enfeksiyonun yayılması için sınırlayıcı olacak ve HPV ile ilişkili kanserlerin önlenmesini sağlayabilecektir.

Kaynakça

  • 1. Gülçin, A. L. P. İnsan Papillomavirusunun Genomik Yapısı ve Proteinleri. Mikrobiyol Bul. 2012; 46(3), 507-515.
  • 2. Cuzick J, Bergeron C, von Knebel DM, et al. New technologies and procedures for cervical cancer screening. Vaccine. 2012; 30(Suppl 5):F107–F116.
  • 3. Williams VM, Filippova M, Soto U, et al. HPV-DNA integration and carcinogenesis: Putative roles for inflammation and oxidative stress. Vol. 6, Future Virology. NIH Public Access. 2011; p. 45–57.
  • 4. Doorbar J., Quint W., Banks L., et al. The biology and life-cycle of human papillomaviruses. Vaccine. 2012; 30:F55–F70.
  • 5. Tulay P., Serakinci N. The role of human papillomaviruses in cancer progression. J. Cancer Metastasis Treat. 2016; 2:201.
  • 6. Graham S.V. The human papillomavirus replication cycle, and its links to cancer progression: A comprehensive review. Clin. Sci. 2017;131:2201–2221.
  • 7. Huh WK, Ault KA, Chelmow D, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Gynecologic Oncology. 2015;136:178–182.
  • 8. Jain M, Yadav D, Jarouliya U, et al. Epidemiology, Molecular Pathogenesis, Immuno-Pathogenesis, Immune Escape Mechanisms and Vaccine Evaluation for HPV-Associated Carcinogenesis. Pathogens. 2023;12(12):1380.
  • 9. Bruni L., Albero G., Serrano B., et al. Human Papillomavirus and Related Diseases in the World. Summary Report 22 October 2021. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre); Barcelona, Spain: 2023.
  • 10. Forman D., de Martel C., Lacey C.J., et al. Global burden of human papillomavirus and related diseases. Vaccine. 2012;30:F12–F23.
  • 11. Johnson, C.A., James, D., Marzan, A., et al. Cervical cancer: an overview of pathophysiology and management. In Seminars in oncology nursing. 2019; 35, 2, pp. 166-174.
  • 12. World Health Organization. WHO Guideline for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention: Use of mRNA Tests for Human Papillomavirus (HPV) World Health Organization; Geneva, Switzerland: 2021.
  • 13. Tan S.C., Ismail M.P., Duski D.R., ve ark. Prevalence and type distribution of human papillomavirus (hpv) in malaysian women with and without cervical cancer: An updated estimate. Biosci. Rep. 2018;38:BSR20171268.
  • 14. Bennett R, Cerigo H, Coutlée F, et al. Incidence, persistence, and determinants of human papillomavirus infection in a population of Inuit women in northern Quebec. Sexually Transmitted Diseases. 2015; 42: 272–278.
  • 15. Schmeink CE, Massuger LF, Lenselink CH, et al. Prospective follow-up of 2,065 young unscreened women to study human papillomavirus incidence and clearance. International Journal of Cancer. 2013;133:172–181.
  • 16. Pedroza-Gonzalez A, Reyes-Reali J, Campos-Solorzano M, et al. Human papillomavirus infection and seroprevalence among female university students in Mexico. Hum Vaccin Immunother. 2022;18(1): 2028514.
  • 17. Stensen S, Kjaer SK, Jensen SM, et al. Factors associated with type-specific persistence of high-risk human papillomavirus infection: a population-based study. International Journal of Cancer. 2016;138:361–368.
  • 18. Ingabire C, Lim MK, Won YJ, et al. Human papillomavirus genotype-specific persistence and potential risk factors among korean women: results from a 2-year follow-up study. Cancer Research and Treatment. 2018;50:813–822.
  • 19. Rositch AF, Koshiol J, Hudgens MG, et al. Patterns of persistent genital human papillomavirus infection among women worldwide: a literature review and meta-analysis. International Journal of Cancer. 2013;133:1271–1285.
  • 20. Gultekin M, Dundar S, Keskinkilic B, ve ark. How to triage HPV positive cases: Results of four million females. Gynecol Oncol. 2020;158(1):105-11.
  • 21. Yerlikaya H., Filiz O, Murat, A. ve ark. Servikal Örneklerde Human Papillomavirüs Genotiplendirme ve Sitopatoloji Sonuçlarının Değerlendirilmesi. Dicle Tıp Dergisi. 2023; 50(2), 235-244.
  • 22. Peker BO, Müderris T, Gül Yurtsever S, ve ark. Servikal fırça örneklerinde insan papilloma virüs prevalansı ve genotip dağılımı; üç yıllık analiz. Turk Mikrobiyol Cemiy Derg. 2022;52(3):168-174.
  • 23. Alacam S, Bakir A. Human papillomavirus prevalence and genotype distribution in cervical swab samples in Istanbul, Turkey. J Infect Dev Ctries. 2021;15(8):1190-6.
  • 24. Yakut S, Gareayaghi N, Yıldız Zeyrek F ve ark. Bir üniversite hastanesine başvuran kadın hastalarda yüksek riskli hpv sıklığı ve genotip dağılımı sonuçlarının 3 yıllık retrospektif analizi. Turk Mikrobiyol Cemiy Derg. 2023;53(4):272-277.
  • 25. Liang HY, Chen XH, Zhang SW. Relationship between persistent infection of high-risk HPV and occurrence of cervical lesions. China Modern Doctor. 2017;55:52–55,58.
  • 26. Liu, J., Shi, Y., Wang, L., et al. Epidemiology and persistence of cervical human papillomavirus infection among outpatient women in Heilongjiang province: A retrospective cohort study. Journal of Medical Virology. 2020; 92(12), 3784-3792.
  • 27. Zhao M, Zhou D, Zhang M, et al. Characteristic of persistent human papillomavirus infection in women worldwide: a meta-analysis. PeerJ. 2023;11:e16247.
  • 28. Zhang J, Cheng K, Wang Z. Prevalence and distribution of human papillomavirus genotypes in cervical intraepithelial neoplasia in China: a meta-analysis. Arch Gynecol Obstet. 2020;302:1329–1337.
  • 29. Zhang H., Zhang S. Prevalence and genotype distribution of human papillomavirus infection among female outpatients in Northeast China: a population-based survey of 110,927 women. Archives of Gynecology and Obstetrics. 2023;308(1), 35-41.
  • 30. Lagheden C, Eklund C, Lamin H, et al. Nationwide comprehensive human papillomavirus (HPV) genotyping of invasive cervical cancer. British Journal of Cancer. 2018;118:1377–1381.
  • 31. Pirog EC, Lloveras B, Molijn A, et al. HPV prevalence and genotypes in different histological subtypes of cervical adenocarcinoma, a worldwide analysis of 760 cases. Modern Pathology. 2014; 27:1559–1567.
  • 32. Jing L, Zhong X, Zhong Z, et al. Prevalence of human papillomavirus infection in Guangdong Province, China: a population-based survey of 78, 355 women. Sexually Transmitted Diseases. 2014;41:732–738.
  • 33. Munjal K, Adamson CS, Rajendran V, et al. Human papillomavirus type distribution in invasive cervical cancers from Madhya Pradesh: implications for vaccination programs in central India. International Journal of Gynecological Pathology. 2014;33:531–536.
  • 34. Tchouaket MCT, Ka'e AC, Semengue ENJ, et al. Variability of High-Risk Human Papillomavirus and Associated Factors among Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Pathogens. 2023 Aug 11;12(8):1032.
  • 35. De Oliveira CM, Fregnani J, Villa LL. HPV vaccine: updates and highlights. Acta Cytologica. 2019;63:159–168.
  • 36. De Martel C, Plummer M, Vignat J, et al. Worldwide burden of cancer attributable to HPV by site, country and HPV type. International Journal of Cancer. 2017;141:664–670.
  • 37. Molina-Pineda A, López-Cardona MG, Limón-Toledo LP, et al. High frequency of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico. BMC Infectious Diseases. 2020;20:889.
  • 38. Ma M, Zhu J, Yang Y, et al. The distribution and pathogenic risk of non-9-valent vaccine covered HPV subtypes in cervical lesions. Cancer Medicine. 2022;11:1542–1552.
  • 39. Schlecht NF, Diaz A, Nucci-Sack A, et al. Incidence and types of human papillomavirus infections in adolescent girls and young women immunized with the human papillomavirus vaccine. JAMA Network Open. 2021;4:e2121893.
  • 40. Muderris T, Afsar I, Yıldız A, ve ark. HPV genotype distribution among women with normal and abnormal cervical cytology in Turkey. Rev Esp Quimioter. 2019;32(6):516-24.
  • 41. Aydoğan S, Yazhan A, Taş EE, ve ark. The presence and distribution of high risk HPV types in simultaneous cervical cytology samples. Turk Hij Den Biyol Derg, 2018; 75(1): 13-20.
  • 42. Rosa MI, Fachel JMG, Rosa DD, et al. Persistence and clearance of human papillomavirus infection: a prospective cohort study. American Journal of Obstetrics and Gynecology. 2008;199(617):e611-617.
  • 43. Tounkara FK, Téguété I, Guédou FA, et al. Type-specific incidence, persistence and factors associated with human papillomavirus infection among female sex workers in Benin and Mali, West Africa. International Journal of Infectious Diseases. 2021;106:348–357.
  • 44. Erickson BK, Alvarez RD, Huh WK. Human papillomavirus: what every provider should know. Am J Obstet Gynecol. 2013;208(3):169-75.
  • 45. Wheeler BS, Rositch AF, Poole C, et al. Patterns of incident genital human papillomavirus infection in women: A literature review and metaanalysis. Int J STD AIDS. 2019;30(13):1246-56.
  • 46. Salazar KL, Zhou HS, Xu J, et al. Multiple Human papilloma virus infections and their impact on the development of high-risk cervical lesions. Acta Cytol. 2015;59(5):391-8.
  • 47. Nishimura H., Yeh P.T., Oguntade H., et al. Hpv self-sampling for cervical cancer screening: A systematic review of values and preferences. BMJ Glob. Health. 2021;6:e003743.
  • 48. Deshmukh AA, Suk R, Shiels MS, et al. Incidence trends and burden of human papillomavirus-associated cancers among women in the United States, 2001-2017. J Natl Cancer Inst. 2021;113(6):792-6.

Investigation of Human Papillomavirus (HPV) Frequency and Genotype Analysis in Cervical Samples

Yıl 2024, , 50 - 57, 30.04.2024
https://doi.org/10.34084/bshr.1455863

Öz

Aim: Human Papillomaviruses (HPVs) are double-stranded DNA viruses belonging to the Papillomaviridae family. There is ample evidence demonstrating the association of Human Papillomavirus (HPV) with cervical carcinoma. This study aimed to investigate the presence of HPV DNA in cervical swab samples and determine the HPV genotypes in positive samples.
Materials and Methods: The three-year results of cervical swab samples sent to the Medical Microbiology Laboratory of Afyonkarahisar Health Sciences University Faculty of Medicine Hospital for screening for HPV DNA presence between January 1, 2020, and December 31, 2022, were retrospectively evaluated in this study. HPV genotyping was performed using the cobas 4800 (cobas® x480) fully automated system (Roche Diagnostics, Indianapolis, USA) for extraction, and the samples were analyzed using the Real-time PCR (cobas® z 480) system following the manufacturer's instructions.
Results: HPV-DNA was detected in 415 out of a total of 4960 patients (8.4%), while 4545 (91.6%) tested negative. Evaluation of HPV positivity revealed that the highest positivity rates were observed in HR-HPV at 68%, HPV 16 at 17.3%, and HPV 16 combined with HR-HPV at 8.2%. HPV-DNA positivity was highest at 38% in the 35-44 age group, while it was lowest at 3.4% in patients under 25 years old.
Conclusion: Vaccination programs, alongside screening programs, will serve to restrict the spread of infection in at-risk populations and prevent HPV-related cancers. It is believed that nationwide HPV DNA screening studies and vaccination programs targeting HPV infections will be highly effective in reducing the prevalence of cervical cancer.

Kaynakça

  • 1. Gülçin, A. L. P. İnsan Papillomavirusunun Genomik Yapısı ve Proteinleri. Mikrobiyol Bul. 2012; 46(3), 507-515.
  • 2. Cuzick J, Bergeron C, von Knebel DM, et al. New technologies and procedures for cervical cancer screening. Vaccine. 2012; 30(Suppl 5):F107–F116.
  • 3. Williams VM, Filippova M, Soto U, et al. HPV-DNA integration and carcinogenesis: Putative roles for inflammation and oxidative stress. Vol. 6, Future Virology. NIH Public Access. 2011; p. 45–57.
  • 4. Doorbar J., Quint W., Banks L., et al. The biology and life-cycle of human papillomaviruses. Vaccine. 2012; 30:F55–F70.
  • 5. Tulay P., Serakinci N. The role of human papillomaviruses in cancer progression. J. Cancer Metastasis Treat. 2016; 2:201.
  • 6. Graham S.V. The human papillomavirus replication cycle, and its links to cancer progression: A comprehensive review. Clin. Sci. 2017;131:2201–2221.
  • 7. Huh WK, Ault KA, Chelmow D, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Gynecologic Oncology. 2015;136:178–182.
  • 8. Jain M, Yadav D, Jarouliya U, et al. Epidemiology, Molecular Pathogenesis, Immuno-Pathogenesis, Immune Escape Mechanisms and Vaccine Evaluation for HPV-Associated Carcinogenesis. Pathogens. 2023;12(12):1380.
  • 9. Bruni L., Albero G., Serrano B., et al. Human Papillomavirus and Related Diseases in the World. Summary Report 22 October 2021. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre); Barcelona, Spain: 2023.
  • 10. Forman D., de Martel C., Lacey C.J., et al. Global burden of human papillomavirus and related diseases. Vaccine. 2012;30:F12–F23.
  • 11. Johnson, C.A., James, D., Marzan, A., et al. Cervical cancer: an overview of pathophysiology and management. In Seminars in oncology nursing. 2019; 35, 2, pp. 166-174.
  • 12. World Health Organization. WHO Guideline for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention: Use of mRNA Tests for Human Papillomavirus (HPV) World Health Organization; Geneva, Switzerland: 2021.
  • 13. Tan S.C., Ismail M.P., Duski D.R., ve ark. Prevalence and type distribution of human papillomavirus (hpv) in malaysian women with and without cervical cancer: An updated estimate. Biosci. Rep. 2018;38:BSR20171268.
  • 14. Bennett R, Cerigo H, Coutlée F, et al. Incidence, persistence, and determinants of human papillomavirus infection in a population of Inuit women in northern Quebec. Sexually Transmitted Diseases. 2015; 42: 272–278.
  • 15. Schmeink CE, Massuger LF, Lenselink CH, et al. Prospective follow-up of 2,065 young unscreened women to study human papillomavirus incidence and clearance. International Journal of Cancer. 2013;133:172–181.
  • 16. Pedroza-Gonzalez A, Reyes-Reali J, Campos-Solorzano M, et al. Human papillomavirus infection and seroprevalence among female university students in Mexico. Hum Vaccin Immunother. 2022;18(1): 2028514.
  • 17. Stensen S, Kjaer SK, Jensen SM, et al. Factors associated with type-specific persistence of high-risk human papillomavirus infection: a population-based study. International Journal of Cancer. 2016;138:361–368.
  • 18. Ingabire C, Lim MK, Won YJ, et al. Human papillomavirus genotype-specific persistence and potential risk factors among korean women: results from a 2-year follow-up study. Cancer Research and Treatment. 2018;50:813–822.
  • 19. Rositch AF, Koshiol J, Hudgens MG, et al. Patterns of persistent genital human papillomavirus infection among women worldwide: a literature review and meta-analysis. International Journal of Cancer. 2013;133:1271–1285.
  • 20. Gultekin M, Dundar S, Keskinkilic B, ve ark. How to triage HPV positive cases: Results of four million females. Gynecol Oncol. 2020;158(1):105-11.
  • 21. Yerlikaya H., Filiz O, Murat, A. ve ark. Servikal Örneklerde Human Papillomavirüs Genotiplendirme ve Sitopatoloji Sonuçlarının Değerlendirilmesi. Dicle Tıp Dergisi. 2023; 50(2), 235-244.
  • 22. Peker BO, Müderris T, Gül Yurtsever S, ve ark. Servikal fırça örneklerinde insan papilloma virüs prevalansı ve genotip dağılımı; üç yıllık analiz. Turk Mikrobiyol Cemiy Derg. 2022;52(3):168-174.
  • 23. Alacam S, Bakir A. Human papillomavirus prevalence and genotype distribution in cervical swab samples in Istanbul, Turkey. J Infect Dev Ctries. 2021;15(8):1190-6.
  • 24. Yakut S, Gareayaghi N, Yıldız Zeyrek F ve ark. Bir üniversite hastanesine başvuran kadın hastalarda yüksek riskli hpv sıklığı ve genotip dağılımı sonuçlarının 3 yıllık retrospektif analizi. Turk Mikrobiyol Cemiy Derg. 2023;53(4):272-277.
  • 25. Liang HY, Chen XH, Zhang SW. Relationship between persistent infection of high-risk HPV and occurrence of cervical lesions. China Modern Doctor. 2017;55:52–55,58.
  • 26. Liu, J., Shi, Y., Wang, L., et al. Epidemiology and persistence of cervical human papillomavirus infection among outpatient women in Heilongjiang province: A retrospective cohort study. Journal of Medical Virology. 2020; 92(12), 3784-3792.
  • 27. Zhao M, Zhou D, Zhang M, et al. Characteristic of persistent human papillomavirus infection in women worldwide: a meta-analysis. PeerJ. 2023;11:e16247.
  • 28. Zhang J, Cheng K, Wang Z. Prevalence and distribution of human papillomavirus genotypes in cervical intraepithelial neoplasia in China: a meta-analysis. Arch Gynecol Obstet. 2020;302:1329–1337.
  • 29. Zhang H., Zhang S. Prevalence and genotype distribution of human papillomavirus infection among female outpatients in Northeast China: a population-based survey of 110,927 women. Archives of Gynecology and Obstetrics. 2023;308(1), 35-41.
  • 30. Lagheden C, Eklund C, Lamin H, et al. Nationwide comprehensive human papillomavirus (HPV) genotyping of invasive cervical cancer. British Journal of Cancer. 2018;118:1377–1381.
  • 31. Pirog EC, Lloveras B, Molijn A, et al. HPV prevalence and genotypes in different histological subtypes of cervical adenocarcinoma, a worldwide analysis of 760 cases. Modern Pathology. 2014; 27:1559–1567.
  • 32. Jing L, Zhong X, Zhong Z, et al. Prevalence of human papillomavirus infection in Guangdong Province, China: a population-based survey of 78, 355 women. Sexually Transmitted Diseases. 2014;41:732–738.
  • 33. Munjal K, Adamson CS, Rajendran V, et al. Human papillomavirus type distribution in invasive cervical cancers from Madhya Pradesh: implications for vaccination programs in central India. International Journal of Gynecological Pathology. 2014;33:531–536.
  • 34. Tchouaket MCT, Ka'e AC, Semengue ENJ, et al. Variability of High-Risk Human Papillomavirus and Associated Factors among Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Pathogens. 2023 Aug 11;12(8):1032.
  • 35. De Oliveira CM, Fregnani J, Villa LL. HPV vaccine: updates and highlights. Acta Cytologica. 2019;63:159–168.
  • 36. De Martel C, Plummer M, Vignat J, et al. Worldwide burden of cancer attributable to HPV by site, country and HPV type. International Journal of Cancer. 2017;141:664–670.
  • 37. Molina-Pineda A, López-Cardona MG, Limón-Toledo LP, et al. High frequency of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico. BMC Infectious Diseases. 2020;20:889.
  • 38. Ma M, Zhu J, Yang Y, et al. The distribution and pathogenic risk of non-9-valent vaccine covered HPV subtypes in cervical lesions. Cancer Medicine. 2022;11:1542–1552.
  • 39. Schlecht NF, Diaz A, Nucci-Sack A, et al. Incidence and types of human papillomavirus infections in adolescent girls and young women immunized with the human papillomavirus vaccine. JAMA Network Open. 2021;4:e2121893.
  • 40. Muderris T, Afsar I, Yıldız A, ve ark. HPV genotype distribution among women with normal and abnormal cervical cytology in Turkey. Rev Esp Quimioter. 2019;32(6):516-24.
  • 41. Aydoğan S, Yazhan A, Taş EE, ve ark. The presence and distribution of high risk HPV types in simultaneous cervical cytology samples. Turk Hij Den Biyol Derg, 2018; 75(1): 13-20.
  • 42. Rosa MI, Fachel JMG, Rosa DD, et al. Persistence and clearance of human papillomavirus infection: a prospective cohort study. American Journal of Obstetrics and Gynecology. 2008;199(617):e611-617.
  • 43. Tounkara FK, Téguété I, Guédou FA, et al. Type-specific incidence, persistence and factors associated with human papillomavirus infection among female sex workers in Benin and Mali, West Africa. International Journal of Infectious Diseases. 2021;106:348–357.
  • 44. Erickson BK, Alvarez RD, Huh WK. Human papillomavirus: what every provider should know. Am J Obstet Gynecol. 2013;208(3):169-75.
  • 45. Wheeler BS, Rositch AF, Poole C, et al. Patterns of incident genital human papillomavirus infection in women: A literature review and metaanalysis. Int J STD AIDS. 2019;30(13):1246-56.
  • 46. Salazar KL, Zhou HS, Xu J, et al. Multiple Human papilloma virus infections and their impact on the development of high-risk cervical lesions. Acta Cytol. 2015;59(5):391-8.
  • 47. Nishimura H., Yeh P.T., Oguntade H., et al. Hpv self-sampling for cervical cancer screening: A systematic review of values and preferences. BMJ Glob. Health. 2021;6:e003743.
  • 48. Deshmukh AA, Suk R, Shiels MS, et al. Incidence trends and burden of human papillomavirus-associated cancers among women in the United States, 2001-2017. J Natl Cancer Inst. 2021;113(6):792-6.
Toplam 48 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Tıbbi Enfeksiyon Ajanları, Tıbbi Viroloji
Bölüm Araştırma Makalesi
Yazarlar

Yeliz Çetinkol 0000-0003-4940-4498

Selahattin Ünlü 0009-0002-9185-0109

Melahat Gürbüz 0000-0001-6290-1216

Cengiz Demir 0000-0002-5569-886X

Erken Görünüm Tarihi 19 Mayıs 2024
Yayımlanma Tarihi 30 Nisan 2024
Gönderilme Tarihi 20 Mart 2024
Kabul Tarihi 3 Nisan 2024
Yayımlandığı Sayı Yıl 2024

Kaynak Göster

AMA Çetinkol Y, Ünlü S, Gürbüz M, Demir C. Investigation of Human Papillomavirus (HPV) Frequency and Genotype Analysis in Cervical Samples. J Biotechnol and Strategic Health Res. Nisan 2024;8(1):50-57. doi:10.34084/bshr.1455863
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