Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia

El cáncer cervical (CC) es una de las principales preocupaciones de salud pública en países en desarrollo, ocupando el cuarto lugar entre los tipos más comunes de cáncer que afectan a mujeres. El factor de riesgo predominante en el desarrollo de CC es la infección por el Virus del Papiloma Humano de...

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Autores:: Arteaga Pautt, Heiser

Tipo de recurso:: Doctoral thesis

Fecha de publicación:: 0025

Institución:: Universidad de Córdoba

Repositorio:: Repositorio Institucional Unicórdoba

Idioma:: spa

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network_acronym_str	UCORDOBA2
network_name_str	Repositorio Institucional Unicórdoba
repository_id_str
dc.title.none.fl_str_mv	Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia
title	Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia
spellingShingle	Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia Organización Mundial de la Salud Infección de transmisión sexual Enfermedad Pélvica Inflamatoria VPH Virus de Papiloma Humano ADN Ácido desoxirribonucleico ARN Ácido Ribonucleico Cancer cervical Virus de Papiloma humano de alto riesgo Reacción en cadena de la polimerasa Lesión escamosa intraepitelial de bajo grado Lesión escamosa intraepitelial de alto grado Pares de bases Región reguladora corriente arriba Origen de replicación Región Larga de control Promotor región tardía Promotor región temprana Neoplasia intraepitelial cervical intraepitelial Células escamosas atípicas de significado indeterminado Carcinoma de células escamosas Adenocarcinoma Virus de Papiloma Humano de alto riesgo Virus de Papiloma Humano de bajo riesgo World Health Organization Sexually transmitted infection Pelvic inflammatory disease HPV Human papillomavirus DNA Deoxyribonucleic acid RNA Ribonucleic acid Cervical cancer High-risk human papillomavirus Polymerase chain reaction Low-grade squamous intraepithelial lesion High-grade squamous intraepithelial lesion Base pairs, Upstream regulatory region Origin of replication Long control region Late promoter Early promoter Cervical intraepithelial neoplasia Atypical squamous cells of undetermined significance Squamous cell carcinoma Adenocarcinoma High-risk human papillomavirus Low-risk human papillomavirus
title_short	Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia
title_full	Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia
title_fullStr	Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia
title_full_unstemmed	Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia
title_sort	Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia
dc.creator.fl_str_mv	Arteaga Pautt, Heiser
dc.contributor.advisor.none.fl_str_mv	Soto De León, Sara Cecilia
dc.contributor.author.none.fl_str_mv	Arteaga Pautt, Heiser
dc.contributor.jury.none.fl_str_mv	Alvarez Aldana, Adalucy Sierra Verbel, Álvaro Arroyo Salgado, Bárbara
dc.subject.proposal.none.fl_str_mv	Organización Mundial de la Salud Infección de transmisión sexual Enfermedad Pélvica Inflamatoria VPH Virus de Papiloma Humano ADN Ácido desoxirribonucleico ARN Ácido Ribonucleico Cancer cervical Virus de Papiloma humano de alto riesgo Reacción en cadena de la polimerasa Lesión escamosa intraepitelial de bajo grado Lesión escamosa intraepitelial de alto grado Pares de bases Región reguladora corriente arriba Origen de replicación Región Larga de control Promotor región tardía Promotor región temprana Neoplasia intraepitelial cervical intraepitelial Células escamosas atípicas de significado indeterminado Carcinoma de células escamosas Adenocarcinoma Virus de Papiloma Humano de alto riesgo Virus de Papiloma Humano de bajo riesgo
topic	Organización Mundial de la Salud Infección de transmisión sexual Enfermedad Pélvica Inflamatoria VPH Virus de Papiloma Humano ADN Ácido desoxirribonucleico ARN Ácido Ribonucleico Cancer cervical Virus de Papiloma humano de alto riesgo Reacción en cadena de la polimerasa Lesión escamosa intraepitelial de bajo grado Lesión escamosa intraepitelial de alto grado Pares de bases Región reguladora corriente arriba Origen de replicación Región Larga de control Promotor región tardía Promotor región temprana Neoplasia intraepitelial cervical intraepitelial Células escamosas atípicas de significado indeterminado Carcinoma de células escamosas Adenocarcinoma Virus de Papiloma Humano de alto riesgo Virus de Papiloma Humano de bajo riesgo World Health Organization Sexually transmitted infection Pelvic inflammatory disease HPV Human papillomavirus DNA Deoxyribonucleic acid RNA Ribonucleic acid Cervical cancer High-risk human papillomavirus Polymerase chain reaction Low-grade squamous intraepithelial lesion High-grade squamous intraepithelial lesion Base pairs, Upstream regulatory region Origin of replication Long control region Late promoter Early promoter Cervical intraepithelial neoplasia Atypical squamous cells of undetermined significance Squamous cell carcinoma Adenocarcinoma High-risk human papillomavirus Low-risk human papillomavirus
dc.subject.keywords.none.fl_str_mv	World Health Organization Sexually transmitted infection Pelvic inflammatory disease HPV Human papillomavirus DNA Deoxyribonucleic acid RNA Ribonucleic acid Cervical cancer High-risk human papillomavirus Polymerase chain reaction Low-grade squamous intraepithelial lesion High-grade squamous intraepithelial lesion Base pairs, Upstream regulatory region Origin of replication Long control region Late promoter Early promoter Cervical intraepithelial neoplasia Atypical squamous cells of undetermined significance Squamous cell carcinoma Adenocarcinoma High-risk human papillomavirus Low-risk human papillomavirus
description	El cáncer cervical (CC) es una de las principales preocupaciones de salud pública en países en desarrollo, ocupando el cuarto lugar entre los tipos más comunes de cáncer que afectan a mujeres. El factor de riesgo predominante en el desarrollo de CC es la infección por el Virus del Papiloma Humano de alto riesgo (VPH-AR). Esta infección se caracteriza por variables intrínsecas del virus como el genotipo infectante, la carga viral y la presencia de múltiples genotipos. Además, factores individuales, ambientales y conductuales como el consumo de alcohol, tabaquismo y el uso de anticonceptivos hormonales también influyen significativamente. Recientemente, la microbiota cervical ha ganado atención debido a su potencial influencia en la susceptibilidad y progresión del VPH. En la región Caribe de Colombia, hay una falta de estudios sobre la frecuencia específica de los tipos de VPH-AR. Este estudio se enfocó en determinar la frecuencia de VPH-AR y su asociación con variables sociodemográficas en mujeres que asisten a controles de citología cervical en la IPS Liga Cordobesa Contra el Cáncer. También se investigó la composición del microbiota cervical en mujeres infectadas con VPH-AR, diferenciando entre infecciones únicas y múltiples. Participaron voluntariamente 450 mujeres, quienes, tras firmar un consentimiento informado, completaron una encuesta que recopiló datos sociodemográficos, clínicos y de comportamiento sexual. Se les realizaron pruebas de citología cervical y análisis molecular mediante PCR. De las muestras positivas, se tipificaron los VPH con el kit de Optiplex HPV Genotyping. Para el análisis de la microbiota cervical, se seleccionaron 60 muestras con cantidad óptima de ADN y se procesaron con la técnica de Ilumina.
publishDate	0025
dc.date.issued.none.fl_str_mv	0025-06-27
dc.date.accessioned.none.fl_str_mv	2025-06-27T20:16:26Z
dc.date.available.none.fl_str_mv	2025-06-27T20:16:26Z
dc.type.none.fl_str_mv	Trabajo de grado - Doctorado
dc.type.driver.none.fl_str_mv	info:eu-repo/semantics/doctoralThesis
dc.type.coar.none.fl_str_mv	http://purl.org/coar/resource_type/c_db06
dc.type.version.none.fl_str_mv	info:eu-repo/semantics/acceptedVersion
dc.type.content.none.fl_str_mv	Text
dc.type.redcol.none.fl_str_mv	http://purl.org/redcol/resource_type/TD
format	http://purl.org/coar/resource_type/c_db06
status_str	acceptedVersion
dc.identifier.uri.none.fl_str_mv	https://repositorio.unicordoba.edu.co/handle/ucordoba/9223
dc.identifier.instname.none.fl_str_mv	Universidad de Córdoba
dc.identifier.reponame.none.fl_str_mv	Repositorio Institucional Unicórdoba
dc.identifier.repourl.none.fl_str_mv	https://repositorio.unicordoba.edu.co
url	https://repositorio.unicordoba.edu.co/handle/ucordoba/9223 https://repositorio.unicordoba.edu.co
identifier_str_mv	Universidad de Córdoba Repositorio Institucional Unicórdoba
dc.language.iso.none.fl_str_mv	spa
language	spa
dc.relation.references.none.fl_str_mv	Aagaard, K., Riehle, K., Ma, J., Segata, N., Mistretta, T. A., Coarfa, C., . . . Versalovic, J. (2012). A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. PLoS One, 7(6), e36466. doi:10.1371/journal.pone.0036466 Análisis de Situación de Salud, Colombia, 2022. (2022). Bogotá: Gobierno de Colombia Retrieved from https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/PSP/asis-colombia-2022.pdf Appleby, P., & Beral, V. J. I. J. C. Berrington de Gonzalez A et al (2006) Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23, 017 women without carcinoma of the cervix from 23 epidemiological studies. 118, 1481-1495. Arany, I., Tyring, S. J. I. j. o. S., & AIDS. (1998). Systemic immunosuppression by HIV infection influences HPV transcription and thus local immune responses in condyloma acuminatum. 9(5), 268-271. Arends, M., Buckley, C., & Wells, M. J. J. o. c. p. (1998). Aetiology, pathogenesis, and pathology of cervical neoplasia. 51(2), 96-103. Arteaga-Pautt, H., Bru-Cordero, O. E., Ricardo-Caldera, D., Espitia-Perez, L., Aviles-Vergara, P., Tovar-Acero, C., . . . Soto-De Leon, S. C. (2024). High frequency of alpha7-HPV in Colombian Caribbean coast women: cervical cancer screening analysis. BMC Infect Dis, 24(1), 539. doi:10.1186/s12879-024-09410-0 Bastianelli, C., Farris, M., Bianchi, P., & Benagiano, G. (2021). The effect of different contraceptive methods on the vaginal microbiome. Expert Rev Clin Pharmacol, 14(7), 821-836. doi:10.1080/17512433.2021.1917373 Bayo, S., Bosch, F. X., de Sanjosé, S., Muñoz, N., Combita, A. L., Coursaget, P., . . . Meijer, C. J. J. I. j. o. e. (2002). Risk factors of invasive cervical cancer in Mali. 31(1), 202-209. Bello, B. D., Spinillo, A., Alberizzi, P., Cesari, S., Gardella, B., D'Ambrosio, G., . . . Silini, E. M. (2009). Cervical infections by multiple human papillomavirus (HPV) genotypes: Prevalence and impact on the risk of precancerous epithelial lesions. J Med Virol, 81(4), 703-712. doi:10.1002/jmv.21429 Boris, S., & Barbes, C. (2000). Role played by lactobacilli in controlling the population of vaginal pathogens. Microbes Infect, 2(5), 543-546. Bosch, F. X., Qiao, Y. L., & Castellsague, X. (2006). CHAPTER 2 The epidemiology of human papillomavirus infection and its association with cervical cancer. Int J Gynaecol Obstet, 94 Suppl 1, S8-S21. doi:10.1016/S0020-7292(07)60004-6 Brake, T., & Lambert, P. F. (2005). Estrogen contributes to the onset, persistence, and malignant progression of cervical cancer in a human papillomavirus-transgenic mouse model. Proc Natl Acad Sci U S A, 102(7), 2490-2495. doi:10.1073/pnas.0409883102 Brotman, R. M., Ravel, J., Bavoil, P. M., Gravitt, P. E., & Ghanem, K. G. (2014). Microbiome, sex hormones, and immune responses in the reproductive tract: challenges for vaccine development against sexually transmitted infections. Vaccine, 32(14), 1543-1552. doi:10.1016/j.vaccine.2013.10.010 Brotman, R. M., Ravel, J., Bavoil, P. M., Gravitt, P. E., & Ghanem, K. G. J. V. (2014). Microbiome, sex hormones, and immune responses in the reproductive tract: challenges for vaccine development against sexually transmitted infections. 32(14), 1543-1552. Burchell, A. N., Winer, R. L., de Sanjosé, S., & Franco, E. L. J. V. (2006). Epidemiology and transmission dynamics of genital HPV infection. 24, S52-S61. Caballero Machado, J. I., & Laguna García, F. G. (2017). Factores endógenos y exógenos asociados a neoplasia intraepitelial cervical en mujeres de 20-55 años del Centro de Salud Perla María Norori-León, II semestre 2017. Camargo, M., Soto-De Leon, S. C., Sanchez, R., Perez-Prados, A., Patarroyo, M. E., & Patarroyo, M. A. (2011). Frequency of human papillomavirus infection, coinfection, and association with different risk factors in Colombia. Ann Epidemiol, 21(3), 204-213. doi:10.1016/j.annepidem.2010.11.003 Camargo, M., Soto-De Leon, S. C., Sanchez, R., Perez-Prados, A., Patarroyo, M. E., & Patarroyo, M. A. J. A. o. e. (2011). Frequency of human papillomavirus infection, coinfection, and association with different risk factors in Colombia. 21(3), 204-213 Camargo, M., Vega, L., Munoz, M., Sanchez, R., Patarroyo, M. E., Ramirez, J. D., & Patarroyo, M. A. (2022). Changes in the Cervical Microbiota of Women with Different High-Risk Human Papillomavirus Loads. Viruses, 14(12). doi:10.3390/v14122674 Caporaso, J. G., Lauber, C. L., Walters, W. A., Berg-Lyons, D., Lozupone, C. A., Turnbaugh, P. J., . . . Knight, R. (2011). Global patterns of 16S rRNA diversity at a depth of millions of sequences per sample. Proc Natl Acad Sci U S A, 108 Suppl 1(Suppl 1), 4516-4522. doi:10.1073/pnas.1000080107 Castellsagué, X., Bosch, F. X., & Muñoz, N. J. V. r. (2002). Environmental co-factors in HPV carcinogenesis. 89(2), 191-199. Chaturvedi, A. K., Katki, H. A., Hildesheim, A., Rodriguez, A. C., Quint, W., Schiffman, M., . . . Group, C. V. T. (2011). Human papillomavirus infection with multiple types: pattern of coinfection and risk of cervical disease. J Infect Dis, 203(7), 910-920. doi:10.1093/infdis/jiq139 Chee, W. J. Y., Chew, S. Y., & Than, L. T. L. (2020). Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health. Microb Cell Fact, 19(1), 203. doi:10.1186/s12934-020-01464-4 Chesson, H. W., Dunne, E. F., Hariri, S., & Markowitz, L. E. J. S. t. d. (2014). The estimated lifetime probability of acquiring human papillomavirus in the United States. 41(11), 660-664. Clifford, G., Franceschi, S., Diaz, M., Munoz, N., & Villa, L. L. (2006). Chapter 3: HPV type-distribution in women with and without cervical neoplastic diseases. Vaccine, 24 Suppl 3, S3/26-34. doi:10.1016/j.vaccine.2006.05.026 Clifford, G. M., Smith, J. S., Aguado, T., & Franceschi, S. (2003). Comparison of HPV type distribution in high-grade cervical lesions and cervical cancer: a meta-analysis. Br J Cancer, 89(1), 101-105. doi:10.1038/sj.bjc.6601024 Costo, C.-C. d. A. C. F. C. d. E. d. A. (2022). A brief cancer situation 2021. Bogota, D.C. Retrieved from https://cuentadealtocosto.org/wp-content/uploads/2022/08/A%20brief%20cancer%20situation%202021.pdf Coutlee, F., Mayrand, M. H., Roger, M., & Franco, E. L. (2009). Detection and typing of human papillomavirus nucleic acids in biological fluids. Public Health Genomics, 12(5-6), 308-318. doi:10.1159/000214921 12(5-6), 308-318. doi:10.1159/000214921 Coutlee, F., Rouleau, D., Ferenczy, A., & Franco, E. (2005). The laboratory diagnosis of genital human papillomavirus infections. Can J Infect Dis Med Microbiol, 16(2), 83-91. doi:10.1155/2005/798710 De Roda Husman, A. M., Walboomers, J. M., van den Brule, A. J., Meijer, C. J., & Snijders, P. J. (1995). The use of general primers GP5 and GP6 elongated at their 3' ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. J Gen Virol, 76 ( Pt 4), 1057-1062. De Seta, F., Campisciano, G., Zanotta, N., Ricci, G., & Comar, M. (2019). The Vaginal Community State Types Microbiome-Immune Network as Key Factor for Bacterial Vaginosis and Aerobic Vaginitis. Front Microbiol, 10, 2451. doi:10.3389/fmicb.2019.02451 Del Rio-Ospina, L., Soto-De Leon, S. C., Camargo, M., Moreno-Perez, D. A., Sanchez, R., Perez-Prados, A., . . . Patarroyo, M. A. (2015). The DNA load of six high-risk human papillomavirus types and its association with cervical lesions. BMC Cancer, 15, 100. doi:10.1186/s12885-015-1126-z Deng, T., Shang, A., Zheng, Y., Zhang, L., Sun, H., & Wang, W. J. B. (2022). Log (Lactobacillus crispatus/Gardnerella vaginalis): a new indicator of diagnosing bacterial vaginosis. 13(2), 2981-2991. Doorbar, J., Egawa, N., Griffin, H., Kranjec, C., & Murakami, I. J. R. i. m. v. (2015). Human papillomavirus molecular biology and disease association. 25, 2-23. Drolet, M., Bénard, É., Pérez, N., Brisson, M., Ali, H., Boily, M.-C., . . . Callander, D. J. T. L. (2019). Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. 394(10197), 497-509 Ewels, P., Peltzer, A., Fillinger, S., Patel, H., Alneberg, J., Wilm, A., . . . Nahnsen, S. (2022). The nf-core framework for community-curated bioinformatics pipelines: Zenodo. Retrieved from https://doi.org/10.5281/zenodo.7057828 Fan, Z., Han, D., Fan, X., Zeng, Y., Zhao, L. J. F. i. C., & Microbiology, I. (2024). Analysis of the correlation between cervical HPV infection, cervical lesions and vaginal microecology. 14, 1405789. Fantin, C., Freitas, J., Teles, H., Oliveira, B., Brito, D. J. B. J. o. M., & Research, B. (2023). High prevalence of HPV 18 and multiple infections with oncogenic HPV genotypes in women at risk of cervical cancer examined in Manaus, Brazil. 56, e12720 Farinelli, E. C., Baquero, O. S., Stephan, C., & Chiaravalloti-Neto, F. (2018). Low socioeconomic condition and the risk of dengue fever: A direct relationship. Acta Trop, 180, 47-57. doi:10.1016/j.actatropica.2018.01.005 Fettweis, J. M., Serrano, M. G., Girerd, P. H., Jefferson, K. K., & Buck, G. A. (2012). A new era of the vaginal microbiome: advances using next-generation sequencing. Chem Biodivers, 9(5), 965-976. doi:10.1002/cbdv.201100359 Fettweis, J. M., Serrano, M. G., Sheth, N. U., Mayer, C. M., Glascock, A. L., Brooks, J. P., . . . Buck, G. A. (2012). Species-level classification of the vaginal microbiome. BMC Genomics, 13 Suppl 8, S17. doi:10.1186/1471-2164-13-S8-S17 France, M. T., Ma, B., Gajer, P., Brown, S., Humphrys, M. S., Holm, J. B., . . . Ravel, J. J. M. (2020). VALENCIA: a nearest centroid classification method for vaginal microbial communities based on composition. 8, 1-15. Garbuglia, A. R., Piselli, P., Lapa, D., Sias, C., Del Nonno, F., Baiocchini, A., . . . Capobianchi, M. R. J. J. o. C. V. (2012). Frequency and multiplicity of human papillomavirus infection in HIV-1 positive women in Italy. 54(2), 141-146. García, P. P., Ferreyra, M. C. C., Salgado, M. C. C., Hinojosa, M. A. T., & Jiménez, L. Á. J. A. F. (2021). Asociación entre la ingesta de folatos y vitamina C con la neoplasia intraepitelial escamosa cervical. 28(3), 179-184. Ghasemian, E., Harding-Esch, E., Mabey, D., & Holland, M. J. (2023). When Bacteria and Viruses Collide: A Tale of Chlamydia trachomatis and Sexually Transmitted Viruses. Viruses, 15(9). doi:10.3390/v15091954 Gravitt, P. E., Rositch, A. F., Silver, M. I., Marks, M. A., Chang, K., Burke, A. E., & Viscidi, R. P. (2013). A cohort effect of the sexual revolution may be masking an increase in human papillomavirus detection at menopause in the United States. J Infect Dis, 207(2), 272-280. doi:10.1093/infdis/jis660 Happel, A. U., Varsani, A., Balle, C., Passmore, J. A., & Jaspan, H. (2020). The Vaginal Virome-Balancing Female Genital Tract Bacteriome, Mucosal Immunity, and Sexual and Reproductive Health Outcomes? Viruses, 12(8). doi:10.3390/v12080832 Herrera-Ortiz, A., Conde-Glez, C. J., Olamendi-Portugal, M. L., García-Cisneros, S., Plett-Torres, T., Sánchez-Alemán, M. A. J. J. o. i., & health, p. (2018). College women, HPV genotyping and sexual behavior before HPV vaccination: Results from samples stored for a long time. 11(2), 286-289. Husnjak, K., Grce, M., Magdić, L., & Pavelić, K. (2000). Comparison of five different polymerase chain reaction methods for detection of human papillomavirus in cervical cell specimens. Journal of virological methods, 88(2), 125-134 %@ 0166-0934. nternational Collaboration of Epidemiological Studies of Cervical, C., Appleby, P., Beral, V., Berrington de Gonzalez, A., Colin, D., Franceschi, S., . . . Sweetland, S. (2006). Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer, 118(6), 1481-1495. doi:10.1002/ijc.21493 Jansen, J. A., den Braber, E. T., Walboomers, X. F., & de Ruijter, J. E. (1999). Soft tissue and epithelial models. Adv Dent Res, 13, 57-66. doi:10.1177/08959374990130011601 Javadi, K., Ferdosi-Shahandashti, E., Rajabnia, M., & Khaledi, M. (2024). Vaginal microbiota and gynecological cancers: a complex and evolving relationship. Infect Agent Cancer, 19(1), 27. doi:10.1186/s13027-024-00590-7 Kar, M., Nisheetha, A., Kumar, A., Jagtap, S., Shinde, J., Singla, M., . . . Medigeshi, G. R. (2019). Isolation and molecular characterization of dengue virus clinical isolates from pediatric patients in New Delhi. Int J Infect Dis, 84S, S25-S33. doi:10.1016/j.ijid.2018.12.003 Kjellberg, L., Hallmans, G., Åhren, A., Johansson, R., Bergman, F., Wadell, G., . . . Dillner, J. J. B. j. o. c. (2000). Smoking, diet, pregnancy and oral contraceptive use as risk factors for cervical intra-epithelial neoplasia in relation to human papillomavirus infection. 82(7), 1332-1338. Klomp, J. M., Verbruggen, B. S. M., Korporaal, H., Boon, M. E., de Jong, P., Kramer, G. C., . . . Heintz, A. P. M. J. D. c. (2008). Gardnerella vaginalis and Lactobacillus sp in liquid‐based cervical samples in healthy and disturbed vaginal flora using cultivation‐independent methods. 36(5), 277-284. Kwasniewski, W., Wolun‑Cholewa, M., Kotarski, J., Warchol, W., Kuzma, D., Kwasniewska, A., & Gozdzicka‑Jozefiak, A. J. O. l. (2018). Microbiota dysbiosis is associated with HPV‑induced cervical carcinogenesis. 16(6), 7035-7047. Landy, R., Pesola, F., Castanon, A., & Sasieni, P. (2016). Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case-control study. Br J Cancer, 115(9), 1140-1146. doi:10.1038/bjc.2016.290 Lee, J. E., Lee, S., Lee, H., Song, Y. M., Lee, K., Han, M. J., . . . Ko, G. (2013). Association of the vaginal microbiota with human papillomavirus infection in a Korean twin cohort. PLoS One, 8(5), e63514. doi:10.1371/journal.pone.0063514 Lema, C. H., Hurtado, L. V., Segurondo, D., Romero, F., Dulon, A., Asturizaga, D., . . . Sonoda, S. (2001). Human Papillomavirus Infection among Bolivian Amazonian Women. Asian Pac J Cancer Prev, 2(2), 135-141. Levi, J. E., Kleter, B., Quint, W. G., Fink, M. C., Canto, C. L., Matsubara, R., . . . Neto, J. E. J. J. o. c. m. (2002). High prevalence of human papillomavirus (HPV) infections and high frequency of multiple HPV genotypes in human immunodeficiency virus-infected women in Brazil. 40(9), 3341-3345. Lewis, F. M. T., Bernstein, K. T., & Aral, S. O. (2017). Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases. Obstet Gynecol, 129(4), 643-654. doi:10.1097/AOG.0000000000001932 Liu, H., Shen, Y., Yin, J., Yuan, Z., Jiang, Y., Xu, Y., . . . Cao, J. J. B. I. D. (2014). Prevalence and genetic characterization of Cryptosporidium, Enterocytozoon, Giardia and Cyclospora in diarrheal outpatients in China. 14, 1-6. Lõhmussaar, K., Oka, R., Valle-Inclan, J. E., Smits, M. H., Wardak, H., Korving, J., . . . Kranenburg, O. W. J. C. S. C. (2021). Patient-derived organoids model cervical tissue dynamics and viral oncogenesis in cervical cancer. 28(8), 1380-1396. e1386. Luo, Q., Zeng, X., Luo, H., Pan, L., Huang, Y., Zhang, H., & Han, N. (2023). Epidemiologic characteristics of high-risk HPV and the correlation between multiple infections and cervical lesions. BMC Infect Dis, 23(1), 667. doi:10.1186/s12879-023-08634-w Manju, V., Sailaja, J. K., & Nalini, N. J. C. b. (2002). Circulating lipid peroxidation and antioxidant status in cervical cancer patients: a case-control study. 35(8), 621-625. McCall, S. J., Clark, A. B., Luben, R. N., Wareham, N. J., Khaw, K.-T., & Myint, P. K. J. N. (2019). Plasma vitamin C levels: Risk factors for deficiency and association with self-reported functional health in the European Prospective Investigation into Cancer-Norfolk. 11(7), 1552. McClymont, E., Tan, D. H., Bondy, S., Albert, A., Coutlée, F., Lee, M., . . . AIDS. (2023). HSV-2 infection and HPV incidence, persistence, and precancerous lesions in a cohort of HPV-vaccinated women living with HIV. 34(6), 402-407. Mejlhede, N., Pedersen, B. V., Frisch, M., & Fomsgaard, A. J. A. (2010). Multiple human papilloma virus types in cervical infections: competition or synergy? , 118(5), 346-352. Mitra, A., MacIntyre, D. A., Marchesi, J. R., Lee, Y. S., Bennett, P. R., & Kyrgiou, M. (2016). The vaginal microbiota, human papillomavirus infection and cervical intraepithelial neoplasia: what do we know and where are we going next? Microbiome, 4(1), 58. doi:10.1186/s40168-016-0203-0 ML, O., JA, H., JI, M., & JC, R. (2015). Observatorio nacional de cáncer Colombia., 33(2), 262-276. Molano, M., Posso, H., Weiderpass, E., van den Brule, A. J., Ronderos, M., Franceschi, S., . . . Study, H. P. V. S. G. H. (2002). Prevalence and determinants of HPV infection among Colombian women with normal cytology. Br J Cancer, 87(3), 324-333. doi:10.1038/sj.bjc.6600442 Molijn, A., Kleter, B., Quint, W., & van Doorn, L. J. (2005). Molecular diagnosis of human papillomavirus (HPV) infections. J Clin Virol, 32 Suppl 1, S43-51. doi:10.1016/j.jcv.2004.12.004 Muhamad Rizal, N. S., Neoh, H. M., Ramli, R., PR, A. L. K. P., Hanafiah, A., Abdul Samat, M. N., . . . Khor, B. Y. (2020). Advantages and Limitations of 16S rRNA Next-Generation Sequencing for Pathogen Identification in the Diagnostic Microbiology Laboratory:Perspectives from a Middle-Income Country. Diagnostics (Basel), 10(10). doi:10.3390/diagnostics10100816 Munoz, M., Camargo, M., Soto-De Leon, S. C., Rojas-Villarraga, A., Sanchez, R., Jaimes, C., . . . Patarroyo, M. A. (2012). The diagnostic performance of classical molecular tests used for detecting human papillomavirus. J Virol Methods, 185(1), 32-38. doi:10.1016/j.jviromet.2012.05.023 Munoz, M., Camargo, M., Soto-De Leon, S. C., Rojas-Villarraga, A., Sanchez, R., Jaimes, C., . . . Patarroyo, M. A. (2012). The diagnostic performance of classical molecular tests used for detecting human papillomavirus. J Virol Methods, 185(1), 32-38. doi:10.1016/j.jviromet.2012.05.023 Munoz, N., Bosch, F. X., de Sanjose, S., Tafur, L., Izarzugaza, I., Gili, M., . . . et al. (1992). The causal link between human papillomavirus and invasive cervical cancer: a population-based case-control study in Colombia and Spain. Int J Cancer, 52(5), 743-749. doi:10.1002/ijc.2910520513 Munoz, N., Castellsague, X., Berrington de Gonzalez, A., & Gissmann, L. (2006). Chapter 1: HPV in the etiology of human cancer. Vaccine, 24 Suppl 3, S3/1-10. doi:10.1016/j.vaccine.2006.05.115 Munoz, N., Castellsague, X., de Gonzalez, A. B., & Gissmann, L. (2006). Chapter 1: HPV in the etiology of human cancer. Vaccine, 24 Suppl 3, S3/1-10. doi:10.1016/j.vaccine.2006.05.115 Munteanu, C., & Schwartz, B. (2022). The relationship between nutrition and the immune system. Front Nutr, 9, 1082500. doi:10.3389/fnut.2022.1082500 system. Front Nutr, 9, 1082500. doi:10.3389/fnut.2022.1082500 Muñoz, N., Hernandez-Suarez, G., Mendez, F., Molano, M., Posso, H., Moreno, V., . . . Munoz, A. J. B. j. o. c. (2009). Persistence of HPV infection and risk of high-grade cervical intraepithelial neoplasia in a cohort of Colombian women. 100(7), 1184-1190. 1190. Nalliah, S., Karikalan, B., & Kademane, K. J. A. P. J. o. c. p. (2015). Multifaceted usage of HPV related tests and products in the management of cervical cancer-a review. 16(6), 2145-2150. Nalliah, S., Karikalan, B., & Kademane, K. J. A. P. J. o. c. p. (2015). Multifaceted usage of HPV related tests and products in the management of cervical cancer-a review. 16(6), 2145-2150. Ocana, V. S., Bru, E., De Ruiz Holgado, A. A., & Nader-Macias, M. E. (1999). Surface characteristics of lactobacilli isolated from human vagina. J Gen Appl Microbiol, 45(5), 203-212. Oliveira, L. H., Rosa, M. L., & Cavalcanti, S. M. (2008). Patterns of genotype distribution in multiple human papillomavirus infections. Clin Microbiol Infect, 14(1), 60-65. doi:10.1111/j.1469-0691.2007.01887.x Orlando, G., Tanzi, E., Chatenoud, L., Gramegna, M., Rizzardini, G., & Group, V. S. (2012). Rationale and design of a multicenter prospective cohort study for the eVALuation and monitoring of HPV infections and relATEd cervical diseases in high-risk women (VALHIDATE study). BMC Cancer, 12, 204. doi:10.1186/1471-2407-12-204 Palani, D., Bapatdhar, N., Manchiraju, R., Kumar, B. P., Ghosh, S., & Palaniappan, S. K. J. b. (2024). IntegrIBS: Evaluating the Potential and Challenges of Building a Robust IBS Classifier with Integrated Microbiome Data. 2024.2006. 2021.600147. Pankaj, S., Rani, J., Kumari, P., Abhilashi, K., Choudhary, V., Kumari, S., . . . Jee, B. J. N. M. J. o. I. (2024). Prevalence, risk factors and genotype distribution of human papillomavirus infection among women with and without invasive cervical cancer: Findings from a hospital-based study in Bihar, India. 37(1). Paul, P., Hammer, A., Rositch, A. F., Burke, A. E., Viscidi, R. P., Silver, M. I., . . . Gravitt, P. E. (2021). Rates of New Human Papillomavirus Detection and Loss of Detection in Middle-aged Women by Recent and Past Sexual Behavior. J Infect Dis, 223(8), 1423-1432. doi:10.1093/infdis/jiaa557 Peremykina, A., Cheranev, V., Krivoy, A., Andreev, A. O., Repinskaia, Z., Asaturova, A. V., . . . Bayramova, G. R. J. F. i. M. (2024). Microbiome markers in HPV-positive and HPV-negative women of reproductive age with ASCUS and SIL determined by V4 region of 16S rRNA gene sequencing. 15, 1334502. Petry, K. U. (2011). Modern methods for the diagnosis of HPV and cervical intraepithelial neoplasia in the prevention of cervical cancer: UNI-MED-Verlag. PINZÓN, S. M. C. (2020). Asociación del Virus del Papiloma Humano con la presencia de dos infecciones de transmisión sexual en mujeres colombianas. Universidad del Rosario, Quast, C., Pruesse, E., Yilmaz, P., Gerken, J., Schweer, T., Yarza, P., . . . Glockner, F. O. (2013). The SILVA ribosomal RNA gene database project: improved data processing and web-based tools. Nucleic Acids Res, 41(Database issue), D590-596. doi:10.1093/nar/gks1219 Quinónez-Calvache, E. M., Ríos-Chaparro, D. I., Ramírez, J. D., Soto-De León, S. C., Camargo, M., Del Río-Ospina, L., . . . Patarroyo, M. A. J. P. O. (2016). Chlamydia trachomatis frequency in a cohort of HPV-infected Colombian women. 11(1), e0147504. Quintero, M. A., Ossa, H. d. J. Z., Cuevas, L. M. T., Sánchez, D. C., Arévalo, M. T. V., & Hernández, P. A. H. J. R. G. y. P. d. S. (2011). Infecciones de transmisión sexual en Colombia: análisis basado en la Encuesta Nacional de Salud-año 2007. 10(20), 3. Ravel, J., Gajer, P., Abdo, Z., Schneider, G. M., Koenig, S. S., McCulle, S. L., . . . Forney, L. J. (2011). Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A, 108 Suppl 1, 4680-4687. doi:10.1073/pnas.1002611107 Ravel, J., Gajer, P., Abdo, Z., Schneider, G. M., Koenig, S. S., McCulle, S. L., . . . Tacket, C. O. J. P. o. t. N. A. o. S. (2011). Vaginal microbiome of reproductive-age women. 108(supplement_1), 4680-4687. Rodriguez‐Garcia, M., Patel, M. V., Shen, Z., & Wira, C. R. J. A. c. (2021). The impact of aging on innate and adaptive immunity in the human female genital tract. 20(5), e13361. Sakamoto, J., Kamiura, S., Okayama, K., Okodo, M., Shibata, T., Osaka, Y., . . . Sasagawa, T. (2018). Single type infection of human papillomavirus as a cause for high-grade cervical intraepithelial neoplasia and invasive cancer in Japan. Papillomavirus Res, 6, 46-51. doi:10.1016/j.pvr.2018.10.001 Saraf, V. S., Sheikh, S. A., Ahmad, A., Gillevet, P. M., Bokhari, H., & Javed, S. J. A. o. m. (2021). Vaginal microbiome: normalcy vs dysbiosis. 203, 3793-3802. Sasagawa, T., Takagi, H., Makinoda, S. J. J. o. I., & Chemotherapy. (2012). Immune responses against human papillomavirus (HPV) infection and evasion of host defense in cervical cancer. 18(6), 807-815. Sendagorta-Cudós, E., Burgos-Cibrián, J., & Rodríguez-Iglesias, M. J. E. i. y. m. c. (2019). Infecciones genitales por el virus del papiloma humano. 37(5), 324-334. Serrano, B., Brotons, M., Bosch, F. X., & Bruni, L. (2018). Epidemiology and burden of HPV-related disease. Best practice & research Clinical obstetrics & gynaecology, 47, 14-26 %@ 1521-6934. Shen, Y., Xia, J., Li, H., Xu, Y., & Xu, S. (2021). Human papillomavirus infection rate, distribution characteristics, and risk of age in pre- and postmenopausal women. BMC Womens Health, 21(1), 80. doi:10.1186/s12905-021-01217-4 Sierra-Torres, C. H., Acosta-Aragon, M. P., & Orejuela-Aristizabal, L. (2006). [Papillomavirus and factors associated with high-risk, cervical intraepithelial neoplasia in Cauca, Colombia]. Rev Salud Publica (Bogota), 8 Suppl 1, 47-58. Social, M. d. S. y. P. (2014a). Guía de práctica clínica (GPC) para la detección y manejo de lesiones precancerosas de cuello uterino. . (Guía No. GPC 2014 – 44). Bogotá, Colombia Sohrabi, A., Hajia, M., Jamali, F., & Kharazi, F. (2017). Is incidence of multiple HPV genotypes rising in genital infections? J Infect Public Health, 10(6), 730-733. doi:10.1016/j.jiph.2016.10.006 Sohrabi, A., Hajia, M., Jamali, F., & Kharazi, F. (2017). Is incidence of multiple HPV genotypes rising in genital infections? J Infect Public Health, 10(6), 730-733. doi:10.1016/j.jiph.2016.10.006 Soto-De Leon, S., Camargo, M., Sanchez, R., Munoz, M., Perez-Prados, A., Purroy, A., . . . Patarroyo, M. A. (2011). Distribution patterns of infection with multiple types of human papillomaviruses and their association with risk factors. PLoS One, 6(2), e14705. doi:10.1371/journal.pone.0014705 Soto-De Leon, S. C., Del Rio-Ospina, L., Camargo, M., Sanchez, R., Moreno-Perez, D. A., Perez-Prados, A., . . . Patarroyo, M. A. (2014). Persistence, clearance and reinfection regarding six high risk human papillomavirus types in Colombian women: a follow-up study. BMC Infect Dis, 14, 395. doi:10.1186/1471-2334-14-395 Spurgeon, M. E., Chung, S. H., & Lambert, P. F. (2014). Recurrence of cervical cancer in mice after selective estrogen receptor modulator therapy. Am J Pathol, 184(2), 530-540. doi:10.1016/j.ajpath.2013.10.013 Stefanache, A., Lungu, II, Butnariu, I. A., Calin, G., Gutu, C., Marcu, C., . . . Damir, D. (2023). Understanding How Minerals Contribute to Optimal Immune Function. J Immunol Res, 2023, 3355733. doi:10.1155/2023/3355733 Su, Y., Zheng, T., Bi, Z., Jia, X., Li, Y., Kuang, X., . . . Xia, N. (2024). Pattern of multiple human papillomavirus infection and type competition: An analysis in healthy Chinese women aged 18-45 years. Hum Vaccin Immunother, 20(1), 2334474. doi:10.1080/21645515.2024.2334474 Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 71(3), 209-249. doi:10.3322/caac.21660 Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. J. C. a. c. j. f. c. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 71(3), 209-249. Tapias Ortega, J. M. (2017). Pobreza y violencia en la Región Caribe colombiana: un enfoque espacial. Ensayos sobre Política Económica, 35(83), 139-153. doi:10.1016/j.espe.2016.12.002 van de Wijgert, J. H., Borgdorff, H., Verhelst, R., Crucitti, T., Francis, S., Verstraelen, H., & Jespers, V. (2014). The vaginal microbiota: what have we learned after a decade of molecular characterization? PLoS One, 9(8), e105998. doi:10.1371/journal.pone.0105998 Watts, D. H., Fazzari, M., Minkoff, H., Hillier, S. L., Sha, B., Glesby, M., . . . Strickler, H. D. (2005). Effects of bacterial vaginosis and other genital infections on the natural history of human papillomavirus infection in HIV-1-infected and high-risk HIV-1-uninfected women. J Infect Dis, 191(7), 1129-1139. doi:10.1086/427777 Wentzensen, N., Nason, M., Schiffman, M., Dodd, L., Hunt, W. C., Wheeler, C. M., & New Mexico, H. P. V. P. R. S. C. (2014). No evidence for synergy between human papillomavirus genotypes for the risk of high-grade squamous intraepithelial lesions in a large population-based study. J Infect Dis, 209(6), 855-864. doi:10.1093/infdis/jit577 Williams, V. M., Filippova, M., Soto, U., & Duerksen-Hughes, P. J. J. F. v. (2011). HPV-DNA integration and carcinogenesis: putative roles for inflammation and oxidative stress. 6(1), 45-57. Wright, J. D., Goff, B., & Falk, S. (2014). Cervical intraepithelial neoplasia: Terminology, incidence, pathogenesis, and prevention. Lancet, 370(9599), 1609-1621. Zhang, N., Chen, Z., Huang, M., Lu, Q., Yang, H., Xiang, J., . . . Han, N. J. J. o. M. V. (2024). Cervicovaginal microbiota long‐term dynamics and prediction of different outcomes in persistent human papillomavirus infection. 96(2), e29451. Zhang, X., Dai, B., Zhang, B., & Wang, Z. J. G. o. (2012). Vitamin A and risk of cervical cancer: a meta-analysis. 124(2), 366-373. Zheng, N., Guo, R., Wang, J., Zhou, W., & Ling, Z. (2021). Contribution of Lactobacillus iners to Vaginal Health and Diseases: A Systematic Review. Front Cell Infect Microbiol, 11, 792787. doi:10.3389/fcimb.2021.792787 Zhou, X., Brown, C. J., Abdo, Z., Davis, C. C., Hansmann, M. A., Joyce, P., . . . Forney, L. J. (2007). Differences in the composition of vaginal microbial communities found in healthy Caucasian and black women. ISME J, 1(2), 121-133. doi:10.1038/ismej.2007.12
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dc.rights.license.none.fl_str_mv	Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)
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dc.publisher.faculty.none.fl_str_mv	Facultad de Medicina Veterinaria y Zootecnia
dc.publisher.place.none.fl_str_mv	Montería, Córdoba, Colombia
dc.publisher.program.none.fl_str_mv	Doctorado en Microbiología y Salud Tropical
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spelling	Soto De León, Sara Cecilia7356aa40-3bf1-40d2-8597-5cb8e28c0a24-1Arteaga Pautt, Heiser441d2b85-c88d-4b2a-aa61-f855de96f2a6-1Alvarez Aldana, Adalucy7b2d485b-9839-4a14-bec0-872d61b9e669-1Sierra Verbel, Álvarobe6ec478-dd68-4b37-bcc6-6ae1e7d83d89-1Arroyo Salgado, Bárbara7bab0ce3-140a-4827-9194-678674efc1f9-12025-06-27T20:16:26Z2025-06-27T20:16:26Z0025-06-27https://repositorio.unicordoba.edu.co/handle/ucordoba/9223Universidad de CórdobaRepositorio Institucional Unicórdobahttps://repositorio.unicordoba.edu.coEl cáncer cervical (CC) es una de las principales preocupaciones de salud pública en países en desarrollo, ocupando el cuarto lugar entre los tipos más comunes de cáncer que afectan a mujeres. El factor de riesgo predominante en el desarrollo de CC es la infección por el Virus del Papiloma Humano de alto riesgo (VPH-AR). Esta infección se caracteriza por variables intrínsecas del virus como el genotipo infectante, la carga viral y la presencia de múltiples genotipos. Además, factores individuales, ambientales y conductuales como el consumo de alcohol, tabaquismo y el uso de anticonceptivos hormonales también influyen significativamente. Recientemente, la microbiota cervical ha ganado atención debido a su potencial influencia en la susceptibilidad y progresión del VPH. En la región Caribe de Colombia, hay una falta de estudios sobre la frecuencia específica de los tipos de VPH-AR. Este estudio se enfocó en determinar la frecuencia de VPH-AR y su asociación con variables sociodemográficas en mujeres que asisten a controles de citología cervical en la IPS Liga Cordobesa Contra el Cáncer. También se investigó la composición del microbiota cervical en mujeres infectadas con VPH-AR, diferenciando entre infecciones únicas y múltiples. Participaron voluntariamente 450 mujeres, quienes, tras firmar un consentimiento informado, completaron una encuesta que recopiló datos sociodemográficos, clínicos y de comportamiento sexual. Se les realizaron pruebas de citología cervical y análisis molecular mediante PCR. De las muestras positivas, se tipificaron los VPH con el kit de Optiplex HPV Genotyping. Para el análisis de la microbiota cervical, se seleccionaron 60 muestras con cantidad óptima de ADN y se procesaron con la técnica de Ilumina.Cervical cancer (CC) is a major public health concern in developing countries, ranking fourth among the most common cancers affecting women. The primary risk factor for developing CC is infection with high-risk types of Human Papillomavirus (HPV-AR). This infection is characterized by intrinsic viral variables such as the infecting genotype, viral load, and the presence of multiple genotypes. Additionally, individual, environmental, and behavioral factors like alcohol consumption, smoking, and the use of hormonal contraceptives significantly influence the risk. Recently, cervical microbiota has attracted attention for its potential role in influencing HPV susceptibility and progression. In the Colombian Caribbean region, there is a notable lack of studies on the specific frequency of high-risk HPV types (HPV-AR). This study aimed to determine the type-specific frequency of HPV-AR and its association with sociodemographic variables in women attending cervical cytology screening at the IPS Liga Cordobesa Contra el Cáncer. The study also explored the cervical microbiota composition in women infected with HPV-AR, distinguishing between single and multiple infections. The study involved 450 voluntary participants who, after signing informed consent forms, completed a survey collecting sociodemographic, clinical, and sexual behavior information. Each woman underwent cervical cytology and molecular analysis through Polymerase Chain Reaction (PCR). Positive samples were genotyped using the Optiplex HPV Genotyping kit. For cervical microbiota analysis, 60 samples with optimal DNA quantities were selected and processed using Illumina sequencing techniques.ABREVIATURAS.. 8RESUMEN 9ABSTRACT 12ESTRUCTURA DEL TRABAJO 15INTRODUCCIÓN 17OBJETIVOS 29CAPITULO I 30CAPITULO 2 39CAPITULO 3 25CAPITULO 4 62CONCLUSIONES FINALES 76RECOMENDACIONES 78PERSPECTIVAS ........79CONSIDERACIONES ÉTICAS 80REFERENCIAS BIBLIOGRÁFICAS 81ANEXOS 93ANEXO 1: CONSENTIMIENTO INFORMADO 94ANEXO 2: FICHA EPIDEMIOLÓGICA 99ANEXO 3: ACTA DE COMITÉ ÉTICA 100ANEXO 4: ARTÍCULO CIENTÍFICO PUBLICADO 101DoctoradoDoctor(a) en Microbiología y Salud TropicalTrabajos de Investigación y/o Extensiónapplication/pdfspaCopyright Universidad de Córdoba, 2025https://creativecommons.org/licenses/by-nc-nd/4.0/Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de ColombiaTrabajo de grado - Doctoradoinfo:eu-repo/semantics/doctoralThesishttp://purl.org/coar/resource_type/c_db06info:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TDAagaard, K., Riehle, K., Ma, J., Segata, N., Mistretta, T. A., Coarfa, C., . . . Versalovic, J. (2012). A metagenomic approach to characterization of the vaginal microbiome signature in pregnancy. PLoS One, 7(6), e36466. doi:10.1371/journal.pone.0036466Análisis de Situación de Salud, Colombia, 2022. (2022). Bogotá: Gobierno de Colombia Retrieved from https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/PSP/asis-colombia-2022.pdfAppleby, P., & Beral, V. J. I. J. C. Berrington de Gonzalez A et al (2006) Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23, 017 women without carcinoma of the cervix from 23 epidemiological studies. 118, 1481-1495.Arany, I., Tyring, S. J. I. j. o. S., & AIDS. (1998). Systemic immunosuppression by HIV infection influences HPV transcription and thus local immune responses in condyloma acuminatum. 9(5), 268-271.Arends, M., Buckley, C., & Wells, M. J. J. o. c. p. (1998). Aetiology, pathogenesis, and pathology of cervical neoplasia. 51(2), 96-103.Arteaga-Pautt, H., Bru-Cordero, O. E., Ricardo-Caldera, D., Espitia-Perez, L., Aviles-Vergara, P., Tovar-Acero, C., . . . Soto-De Leon, S. C. (2024). High frequency of alpha7-HPV in Colombian Caribbean coast women: cervical cancer screening analysis. BMC Infect Dis, 24(1), 539. doi:10.1186/s12879-024-09410-0Bastianelli, C., Farris, M., Bianchi, P., & Benagiano, G. (2021). The effect of different contraceptive methods on the vaginal microbiome. Expert Rev Clin Pharmacol, 14(7), 821-836. doi:10.1080/17512433.2021.1917373Bayo, S., Bosch, F. X., de Sanjosé, S., Muñoz, N., Combita, A. L., Coursaget, P., . . . Meijer, C. J. J. I. j. o. e. (2002). Risk factors of invasive cervical cancer in Mali. 31(1), 202-209.Bello, B. D., Spinillo, A., Alberizzi, P., Cesari, S., Gardella, B., D'Ambrosio, G., . . . Silini, E. M. (2009). Cervical infections by multiple human papillomavirus (HPV) genotypes: Prevalence and impact on the risk of precancerous epithelial lesions. J Med Virol, 81(4), 703-712. doi:10.1002/jmv.21429Boris, S., & Barbes, C. (2000). Role played by lactobacilli in controlling the population of vaginal pathogens. Microbes Infect, 2(5), 543-546.Bosch, F. X., Qiao, Y. L., & Castellsague, X. (2006). CHAPTER 2 The epidemiology of human papillomavirus infection and its association with cervical cancer. Int J Gynaecol Obstet, 94 Suppl 1, S8-S21. doi:10.1016/S0020-7292(07)60004-6Brake, T., & Lambert, P. F. (2005). Estrogen contributes to the onset, persistence, and malignant progression of cervical cancer in a human papillomavirus-transgenic mouse model. Proc Natl Acad Sci U S A, 102(7), 2490-2495. doi:10.1073/pnas.0409883102Brotman, R. M., Ravel, J., Bavoil, P. M., Gravitt, P. E., & Ghanem, K. G. (2014). Microbiome, sex hormones, and immune responses in the reproductive tract: challenges for vaccine development against sexually transmitted infections. Vaccine, 32(14), 1543-1552. doi:10.1016/j.vaccine.2013.10.010Brotman, R. M., Ravel, J., Bavoil, P. M., Gravitt, P. E., & Ghanem, K. G. J. V. (2014). Microbiome, sex hormones, and immune responses in the reproductive tract: challenges for vaccine development against sexually transmitted infections. 32(14), 1543-1552.Burchell, A. N., Winer, R. L., de Sanjosé, S., & Franco, E. L. J. V. (2006). Epidemiology and transmission dynamics of genital HPV infection. 24, S52-S61.Caballero Machado, J. I., & Laguna García, F. G. (2017). Factores endógenos y exógenos asociados a neoplasia intraepitelial cervical en mujeres de 20-55 años del Centro de Salud Perla María Norori-León, II semestre 2017.Camargo, M., Soto-De Leon, S. C., Sanchez, R., Perez-Prados, A., Patarroyo, M. E., & Patarroyo, M. A. (2011). Frequency of human papillomavirus infection, coinfection, and association with different risk factors in Colombia. Ann Epidemiol, 21(3), 204-213. doi:10.1016/j.annepidem.2010.11.003Camargo, M., Soto-De Leon, S. C., Sanchez, R., Perez-Prados, A., Patarroyo, M. E., & Patarroyo, M. A. J. A. o. e. (2011). Frequency of human papillomavirus infection, coinfection, and association with different risk factors in Colombia. 21(3), 204-213Camargo, M., Vega, L., Munoz, M., Sanchez, R., Patarroyo, M. E., Ramirez, J. D., & Patarroyo, M. A. (2022). Changes in the Cervical Microbiota of Women with Different High-Risk Human Papillomavirus Loads. Viruses, 14(12). doi:10.3390/v14122674Caporaso, J. G., Lauber, C. L., Walters, W. A., Berg-Lyons, D., Lozupone, C. A., Turnbaugh, P. J., . . . Knight, R. (2011). Global patterns of 16S rRNA diversity at a depth of millions of sequences per sample. Proc Natl Acad Sci U S A, 108 Suppl 1(Suppl 1), 4516-4522. doi:10.1073/pnas.1000080107Castellsagué, X., Bosch, F. X., & Muñoz, N. J. V. r. (2002). Environmental co-factors in HPV carcinogenesis. 89(2), 191-199.Chaturvedi, A. K., Katki, H. A., Hildesheim, A., Rodriguez, A. C., Quint, W., Schiffman, M., . . . Group, C. V. T. (2011). Human papillomavirus infection with multiple types: pattern of coinfection and risk of cervical disease. J Infect Dis, 203(7), 910-920. doi:10.1093/infdis/jiq139Chee, W. J. Y., Chew, S. Y., & Than, L. T. L. (2020). Vaginal microbiota and the potential of Lactobacillus derivatives in maintaining vaginal health. Microb Cell Fact, 19(1), 203. doi:10.1186/s12934-020-01464-4Chesson, H. W., Dunne, E. F., Hariri, S., & Markowitz, L. E. J. S. t. d. (2014). The estimated lifetime probability of acquiring human papillomavirus in the United States. 41(11), 660-664.Clifford, G., Franceschi, S., Diaz, M., Munoz, N., & Villa, L. L. (2006). Chapter 3: HPV type-distribution in women with and without cervical neoplastic diseases. Vaccine, 24 Suppl 3, S3/26-34. doi:10.1016/j.vaccine.2006.05.026Clifford, G. M., Smith, J. S., Aguado, T., & Franceschi, S. (2003). Comparison of HPV type distribution in high-grade cervical lesions and cervical cancer: a meta-analysis. Br J Cancer, 89(1), 101-105. doi:10.1038/sj.bjc.6601024Costo, C.-C. d. A. C. F. C. d. E. d. A. (2022). A brief cancer situation 2021. Bogota, D.C. Retrieved from https://cuentadealtocosto.org/wp-content/uploads/2022/08/A%20brief%20cancer%20situation%202021.pdfCoutlee, F., Mayrand, M. H., Roger, M., & Franco, E. L. (2009). Detection and typing of human papillomavirus nucleic acids in biological fluids. Public Health Genomics, 12(5-6), 308-318. doi:10.1159/00021492112(5-6), 308-318. doi:10.1159/000214921 Coutlee, F., Rouleau, D., Ferenczy, A., & Franco, E. (2005). The laboratory diagnosis of genital human papillomavirus infections. Can J Infect Dis Med Microbiol, 16(2), 83-91. doi:10.1155/2005/798710De Roda Husman, A. M., Walboomers, J. M., van den Brule, A. J., Meijer, C. J., & Snijders, P. J. (1995). The use of general primers GP5 and GP6 elongated at their 3' ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. J Gen Virol, 76 ( Pt 4), 1057-1062.De Seta, F., Campisciano, G., Zanotta, N., Ricci, G., & Comar, M. (2019). The Vaginal Community State Types Microbiome-Immune Network as Key Factor for Bacterial Vaginosis and Aerobic Vaginitis. Front Microbiol, 10, 2451. doi:10.3389/fmicb.2019.02451Del Rio-Ospina, L., Soto-De Leon, S. C., Camargo, M., Moreno-Perez, D. A., Sanchez, R., Perez-Prados, A., . . . Patarroyo, M. A. (2015). The DNA load of six high-risk human papillomavirus types and its association with cervical lesions. BMC Cancer, 15, 100. doi:10.1186/s12885-015-1126-zDeng, T., Shang, A., Zheng, Y., Zhang, L., Sun, H., & Wang, W. J. B. (2022). Log (Lactobacillus crispatus/Gardnerella vaginalis): a new indicator of diagnosing bacterial vaginosis. 13(2), 2981-2991.Doorbar, J., Egawa, N., Griffin, H., Kranjec, C., & Murakami, I. J. R. i. m. v. (2015). Human papillomavirus molecular biology and disease association. 25, 2-23.Drolet, M., Bénard, É., Pérez, N., Brisson, M., Ali, H., Boily, M.-C., . . . Callander, D. J. T. L. (2019). Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. 394(10197), 497-509Ewels, P., Peltzer, A., Fillinger, S., Patel, H., Alneberg, J., Wilm, A., . . . Nahnsen, S. (2022). The nf-core framework for community-curated bioinformatics pipelines: Zenodo. Retrieved from https://doi.org/10.5281/zenodo.7057828Fan, Z., Han, D., Fan, X., Zeng, Y., Zhao, L. J. F. i. C., & Microbiology, I. (2024). Analysis of the correlation between cervical HPV infection, cervical lesions and vaginal microecology. 14, 1405789.Fantin, C., Freitas, J., Teles, H., Oliveira, B., Brito, D. J. B. J. o. M., & Research, B. (2023). High prevalence of HPV 18 and multiple infections with oncogenic HPV genotypes in women at risk of cervical cancer examined in Manaus, Brazil. 56, e12720Farinelli, E. C., Baquero, O. S., Stephan, C., & Chiaravalloti-Neto, F. (2018). Low socioeconomic condition and the risk of dengue fever: A direct relationship. Acta Trop, 180, 47-57. doi:10.1016/j.actatropica.2018.01.005Fettweis, J. M., Serrano, M. G., Girerd, P. H., Jefferson, K. K., & Buck, G. A. (2012). A new era of the vaginal microbiome: advances using next-generation sequencing. Chem Biodivers, 9(5), 965-976. doi:10.1002/cbdv.201100359Fettweis, J. M., Serrano, M. G., Sheth, N. U., Mayer, C. M., Glascock, A. L., Brooks, J. P., . . . Buck, G. A. (2012). Species-level classification of the vaginal microbiome. BMC Genomics, 13 Suppl 8, S17. doi:10.1186/1471-2164-13-S8-S17France, M. T., Ma, B., Gajer, P., Brown, S., Humphrys, M. S., Holm, J. B., . . . Ravel, J. J. M. (2020). VALENCIA: a nearest centroid classification method for vaginal microbial communities based on composition. 8, 1-15.Garbuglia, A. R., Piselli, P., Lapa, D., Sias, C., Del Nonno, F., Baiocchini, A., . . . Capobianchi, M. R. J. J. o. C. V. (2012). Frequency and multiplicity of human papillomavirus infection in HIV-1 positive women in Italy. 54(2), 141-146.García, P. P., Ferreyra, M. C. C., Salgado, M. C. C., Hinojosa, M. A. T., & Jiménez, L. Á. J. A. F. (2021). Asociación entre la ingesta de folatos y vitamina C con la neoplasia intraepitelial escamosa cervical. 28(3), 179-184.Ghasemian, E., Harding-Esch, E., Mabey, D., & Holland, M. J. (2023). When Bacteria and Viruses Collide: A Tale of Chlamydia trachomatis and Sexually Transmitted Viruses. Viruses, 15(9). doi:10.3390/v15091954Gravitt, P. E., Rositch, A. F., Silver, M. I., Marks, M. A., Chang, K., Burke, A. E., & Viscidi, R. P. (2013). A cohort effect of the sexual revolution may be masking an increase in human papillomavirus detection at menopause in the United States. J Infect Dis, 207(2), 272-280. doi:10.1093/infdis/jis660Happel, A. U., Varsani, A., Balle, C., Passmore, J. A., & Jaspan, H. (2020). The Vaginal Virome-Balancing Female Genital Tract Bacteriome, Mucosal Immunity, and Sexual and Reproductive Health Outcomes? Viruses, 12(8). doi:10.3390/v12080832Herrera-Ortiz, A., Conde-Glez, C. J., Olamendi-Portugal, M. L., García-Cisneros, S., Plett-Torres, T., Sánchez-Alemán, M. A. J. J. o. i., & health, p. (2018). College women, HPV genotyping and sexual behavior before HPV vaccination: Results from samples stored for a long time. 11(2), 286-289.Husnjak, K., Grce, M., Magdić, L., & Pavelić, K. (2000). Comparison of five different polymerase chain reaction methods for detection of human papillomavirus in cervical cell specimens. Journal of virological methods, 88(2), 125-134 %@ 0166-0934.nternational Collaboration of Epidemiological Studies of Cervical, C., Appleby, P., Beral, V., Berrington de Gonzalez, A., Colin, D., Franceschi, S., . . . Sweetland, S. (2006). Carcinoma of the cervix and tobacco smoking: collaborative reanalysis of individual data on 13,541 women with carcinoma of the cervix and 23,017 women without carcinoma of the cervix from 23 epidemiological studies. Int J Cancer, 118(6), 1481-1495. doi:10.1002/ijc.21493Jansen, J. A., den Braber, E. T., Walboomers, X. F., & de Ruijter, J. E. (1999). Soft tissue and epithelial models. Adv Dent Res, 13, 57-66. doi:10.1177/08959374990130011601Javadi, K., Ferdosi-Shahandashti, E., Rajabnia, M., & Khaledi, M. (2024). Vaginal microbiota and gynecological cancers: a complex and evolving relationship. Infect Agent Cancer, 19(1), 27. doi:10.1186/s13027-024-00590-7Kar, M., Nisheetha, A., Kumar, A., Jagtap, S., Shinde, J., Singla, M., . . . Medigeshi, G. R. (2019). Isolation and molecular characterization of dengue virus clinical isolates from pediatric patients in New Delhi. Int J Infect Dis, 84S, S25-S33. doi:10.1016/j.ijid.2018.12.003Kjellberg, L., Hallmans, G., Åhren, A., Johansson, R., Bergman, F., Wadell, G., . . . Dillner, J. J. B. j. o. c. (2000). Smoking, diet, pregnancy and oral contraceptive use as risk factors for cervical intra-epithelial neoplasia in relation to human papillomavirus infection. 82(7), 1332-1338.Klomp, J. M., Verbruggen, B. S. M., Korporaal, H., Boon, M. E., de Jong, P., Kramer, G. C., . . . Heintz, A. P. M. J. D. c. (2008). Gardnerella vaginalis and Lactobacillus sp in liquid‐based cervical samples in healthy and disturbed vaginal flora using cultivation‐independent methods. 36(5), 277-284.Kwasniewski, W., Wolun‑Cholewa, M., Kotarski, J., Warchol, W., Kuzma, D., Kwasniewska, A., & Gozdzicka‑Jozefiak, A. J. O. l. (2018). Microbiota dysbiosis is associated with HPV‑induced cervical carcinogenesis. 16(6), 7035-7047.Landy, R., Pesola, F., Castanon, A., & Sasieni, P. (2016). Impact of cervical screening on cervical cancer mortality: estimation using stage-specific results from a nested case-control study. Br J Cancer, 115(9), 1140-1146. doi:10.1038/bjc.2016.290Lee, J. E., Lee, S., Lee, H., Song, Y. M., Lee, K., Han, M. J., . . . Ko, G. (2013). Association of the vaginal microbiota with human papillomavirus infection in a Korean twin cohort. PLoS One, 8(5), e63514. doi:10.1371/journal.pone.0063514Lema, C. H., Hurtado, L. V., Segurondo, D., Romero, F., Dulon, A., Asturizaga, D., . . . Sonoda, S. (2001). Human Papillomavirus Infection among Bolivian Amazonian Women. Asian Pac J Cancer Prev, 2(2), 135-141.Levi, J. E., Kleter, B., Quint, W. G., Fink, M. C., Canto, C. L., Matsubara, R., . . . Neto, J. E. J. J. o. c. m. (2002). High prevalence of human papillomavirus (HPV) infections and high frequency of multiple HPV genotypes in human immunodeficiency virus-infected women in Brazil. 40(9), 3341-3345.Lewis, F. M. T., Bernstein, K. T., & Aral, S. O. (2017). Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases. Obstet Gynecol, 129(4), 643-654. doi:10.1097/AOG.0000000000001932Liu, H., Shen, Y., Yin, J., Yuan, Z., Jiang, Y., Xu, Y., . . . Cao, J. J. B. I. D. (2014). Prevalence and genetic characterization of Cryptosporidium, Enterocytozoon, Giardia and Cyclospora in diarrheal outpatients in China. 14, 1-6.Lõhmussaar, K., Oka, R., Valle-Inclan, J. E., Smits, M. H., Wardak, H., Korving, J., . . . Kranenburg, O. W. J. C. S. C. (2021). Patient-derived organoids model cervical tissue dynamics and viral oncogenesis in cervical cancer. 28(8), 1380-1396. e1386.Luo, Q., Zeng, X., Luo, H., Pan, L., Huang, Y., Zhang, H., & Han, N. (2023). Epidemiologic characteristics of high-risk HPV and the correlation between multiple infections and cervical lesions. BMC Infect Dis, 23(1), 667. doi:10.1186/s12879-023-08634-wManju, V., Sailaja, J. K., & Nalini, N. J. C. b. (2002). Circulating lipid peroxidation and antioxidant status in cervical cancer patients: a case-control study. 35(8), 621-625.McCall, S. J., Clark, A. B., Luben, R. N., Wareham, N. J., Khaw, K.-T., & Myint, P. K. J. N. (2019). Plasma vitamin C levels: Risk factors for deficiency and association with self-reported functional health in the European Prospective Investigation into Cancer-Norfolk. 11(7), 1552.McClymont, E., Tan, D. H., Bondy, S., Albert, A., Coutlée, F., Lee, M., . . . AIDS. (2023). HSV-2 infection and HPV incidence, persistence, and precancerous lesions in a cohort of HPV-vaccinated women living with HIV. 34(6), 402-407.Mejlhede, N., Pedersen, B. V., Frisch, M., & Fomsgaard, A. J. A. (2010). Multiple human papilloma virus types in cervical infections: competition or synergy? , 118(5), 346-352.Mitra, A., MacIntyre, D. A., Marchesi, J. R., Lee, Y. S., Bennett, P. R., & Kyrgiou, M. (2016). The vaginal microbiota, human papillomavirus infection and cervical intraepithelial neoplasia: what do we know and where are we going next? Microbiome, 4(1), 58. doi:10.1186/s40168-016-0203-0ML, O., JA, H., JI, M., & JC, R. (2015). Observatorio nacional de cáncer Colombia., 33(2), 262-276.Molano, M., Posso, H., Weiderpass, E., van den Brule, A. J., Ronderos, M., Franceschi, S., . . . Study, H. P. V. S. G. H. (2002). Prevalence and determinants of HPV infection among Colombian women with normal cytology. Br J Cancer, 87(3), 324-333. doi:10.1038/sj.bjc.6600442Molijn, A., Kleter, B., Quint, W., & van Doorn, L. J. (2005). Molecular diagnosis of human papillomavirus (HPV) infections. J Clin Virol, 32 Suppl 1, S43-51. doi:10.1016/j.jcv.2004.12.004Muhamad Rizal, N. S., Neoh, H. M., Ramli, R., PR, A. L. K. P., Hanafiah, A., Abdul Samat, M. N., . . . Khor, B. Y. (2020). Advantages and Limitations of 16S rRNA Next-Generation Sequencing for Pathogen Identification in the Diagnostic Microbiology Laboratory:Perspectives from a Middle-Income Country. Diagnostics (Basel), 10(10). doi:10.3390/diagnostics10100816Munoz, M., Camargo, M., Soto-De Leon, S. C., Rojas-Villarraga, A., Sanchez, R., Jaimes, C., . . . Patarroyo, M. A. (2012). The diagnostic performance of classical molecular tests used for detecting human papillomavirus. J Virol Methods, 185(1), 32-38. doi:10.1016/j.jviromet.2012.05.023Munoz, M., Camargo, M., Soto-De Leon, S. C., Rojas-Villarraga, A., Sanchez, R., Jaimes, C., . . . Patarroyo, M. A. (2012). The diagnostic performance of classical molecular tests used for detecting human papillomavirus. J Virol Methods, 185(1), 32-38. doi:10.1016/j.jviromet.2012.05.023Munoz, N., Bosch, F. X., de Sanjose, S., Tafur, L., Izarzugaza, I., Gili, M., . . . et al. (1992). The causal link between human papillomavirus and invasive cervical cancer: a population-based case-control study in Colombia and Spain. Int J Cancer, 52(5), 743-749. doi:10.1002/ijc.2910520513Munoz, N., Castellsague, X., Berrington de Gonzalez, A., & Gissmann, L. (2006). Chapter 1: HPV in the etiology of human cancer. Vaccine, 24 Suppl 3, S3/1-10. doi:10.1016/j.vaccine.2006.05.115Munoz, N., Castellsague, X., de Gonzalez, A. B., & Gissmann, L. (2006). Chapter 1: HPV in the etiology of human cancer. Vaccine, 24 Suppl 3, S3/1-10. doi:10.1016/j.vaccine.2006.05.115Munteanu, C., & Schwartz, B. (2022). The relationship between nutrition and the immune system. Front Nutr, 9, 1082500. doi:10.3389/fnut.2022.1082500system. Front Nutr, 9, 1082500. doi:10.3389/fnut.2022.1082500 Muñoz, N., Hernandez-Suarez, G., Mendez, F., Molano, M., Posso, H., Moreno, V., . . . Munoz, A. J. B. j. o. c. (2009). Persistence of HPV infection and risk of high-grade cervical intraepithelial neoplasia in a cohort of Colombian women. 100(7), 1184-1190.1190. Nalliah, S., Karikalan, B., & Kademane, K. J. A. P. J. o. c. p. (2015). Multifaceted usage of HPV related tests and products in the management of cervical cancer-a review. 16(6), 2145-2150.Nalliah, S., Karikalan, B., & Kademane, K. J. A. P. J. o. c. p. (2015). Multifaceted usage of HPV related tests and products in the management of cervical cancer-a review. 16(6), 2145-2150.Ocana, V. S., Bru, E., De Ruiz Holgado, A. A., & Nader-Macias, M. E. (1999). Surface characteristics of lactobacilli isolated from human vagina. J Gen Appl Microbiol, 45(5), 203-212.Oliveira, L. H., Rosa, M. L., & Cavalcanti, S. M. (2008). Patterns of genotype distribution in multiple human papillomavirus infections. Clin Microbiol Infect, 14(1), 60-65. doi:10.1111/j.1469-0691.2007.01887.xOrlando, G., Tanzi, E., Chatenoud, L., Gramegna, M., Rizzardini, G., & Group, V. S. (2012). Rationale and design of a multicenter prospective cohort study for the eVALuation and monitoring of HPV infections and relATEd cervical diseases in high-risk women (VALHIDATE study). BMC Cancer, 12, 204. doi:10.1186/1471-2407-12-204Palani, D., Bapatdhar, N., Manchiraju, R., Kumar, B. P., Ghosh, S., & Palaniappan, S. K. J. b. (2024). IntegrIBS: Evaluating the Potential and Challenges of Building a Robust IBS Classifier with Integrated Microbiome Data. 2024.2006. 2021.600147.Pankaj, S., Rani, J., Kumari, P., Abhilashi, K., Choudhary, V., Kumari, S., . . . Jee, B. J. N. M. J. o. I. (2024). Prevalence, risk factors and genotype distribution of human papillomavirus infection among women with and without invasive cervical cancer: Findings from a hospital-based study in Bihar, India. 37(1).Paul, P., Hammer, A., Rositch, A. F., Burke, A. E., Viscidi, R. P., Silver, M. I., . . . Gravitt, P. E. (2021). Rates of New Human Papillomavirus Detection and Loss of Detection in Middle-aged Women by Recent and Past Sexual Behavior. J Infect Dis, 223(8), 1423-1432. doi:10.1093/infdis/jiaa557Peremykina, A., Cheranev, V., Krivoy, A., Andreev, A. O., Repinskaia, Z., Asaturova, A. V., . . . Bayramova, G. R. J. F. i. M. (2024). Microbiome markers in HPV-positive and HPV-negative women of reproductive age with ASCUS and SIL determined by V4 region of 16S rRNA gene sequencing. 15, 1334502.Petry, K. U. (2011). Modern methods for the diagnosis of HPV and cervical intraepithelial neoplasia in the prevention of cervical cancer: UNI-MED-Verlag.PINZÓN, S. M. C. (2020). Asociación del Virus del Papiloma Humano con la presencia de dos infecciones de transmisión sexual en mujeres colombianas. Universidad del Rosario,Quast, C., Pruesse, E., Yilmaz, P., Gerken, J., Schweer, T., Yarza, P., . . . Glockner, F. O. (2013). The SILVA ribosomal RNA gene database project: improved data processing and web-based tools. Nucleic Acids Res, 41(Database issue), D590-596. doi:10.1093/nar/gks1219Quinónez-Calvache, E. M., Ríos-Chaparro, D. I., Ramírez, J. D., Soto-De León, S. C., Camargo, M., Del Río-Ospina, L., . . . Patarroyo, M. A. J. P. O. (2016). Chlamydia trachomatis frequency in a cohort of HPV-infected Colombian women. 11(1), e0147504.Quintero, M. A., Ossa, H. d. J. Z., Cuevas, L. M. T., Sánchez, D. C., Arévalo, M. T. V., & Hernández, P. A. H. J. R. G. y. P. d. S. (2011). Infecciones de transmisión sexual en Colombia: análisis basado en la Encuesta Nacional de Salud-año 2007. 10(20), 3.Ravel, J., Gajer, P., Abdo, Z., Schneider, G. M., Koenig, S. S., McCulle, S. L., . . . Forney, L. J. (2011). Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A, 108 Suppl 1, 4680-4687. doi:10.1073/pnas.1002611107Ravel, J., Gajer, P., Abdo, Z., Schneider, G. M., Koenig, S. S., McCulle, S. L., . . . Tacket, C. O. J. P. o. t. N. A. o. S. (2011). Vaginal microbiome of reproductive-age women. 108(supplement_1), 4680-4687.Rodriguez‐Garcia, M., Patel, M. V., Shen, Z., & Wira, C. R. J. A. c. (2021). The impact of aging on innate and adaptive immunity in the human female genital tract. 20(5), e13361.Sakamoto, J., Kamiura, S., Okayama, K., Okodo, M., Shibata, T., Osaka, Y., . . . Sasagawa, T. (2018). Single type infection of human papillomavirus as a cause for high-grade cervical intraepithelial neoplasia and invasive cancer in Japan. Papillomavirus Res, 6, 46-51. doi:10.1016/j.pvr.2018.10.001Saraf, V. S., Sheikh, S. A., Ahmad, A., Gillevet, P. M., Bokhari, H., & Javed, S. J. A. o. m. (2021). Vaginal microbiome: normalcy vs dysbiosis. 203, 3793-3802.Sasagawa, T., Takagi, H., Makinoda, S. J. J. o. I., & Chemotherapy. (2012). Immune responses against human papillomavirus (HPV) infection and evasion of host defense in cervical cancer. 18(6), 807-815.Sendagorta-Cudós, E., Burgos-Cibrián, J., & Rodríguez-Iglesias, M. J. E. i. y. m. c. (2019). Infecciones genitales por el virus del papiloma humano. 37(5), 324-334.Serrano, B., Brotons, M., Bosch, F. X., & Bruni, L. (2018). Epidemiology and burden of HPV-related disease. Best practice & research Clinical obstetrics & gynaecology, 47, 14-26 %@ 1521-6934.Shen, Y., Xia, J., Li, H., Xu, Y., & Xu, S. (2021). Human papillomavirus infection rate, distribution characteristics, and risk of age in pre- and postmenopausal women. BMC Womens Health, 21(1), 80. doi:10.1186/s12905-021-01217-4Sierra-Torres, C. H., Acosta-Aragon, M. P., & Orejuela-Aristizabal, L. (2006). [Papillomavirus and factors associated with high-risk, cervical intraepithelial neoplasia in Cauca, Colombia]. Rev Salud Publica (Bogota), 8 Suppl 1, 47-58.Social, M. d. S. y. P. (2014a). Guía de práctica clínica (GPC) para la detección y manejo de lesiones precancerosas de cuello uterino. . (Guía No. GPC 2014 – 44). Bogotá, ColombiaSohrabi, A., Hajia, M., Jamali, F., & Kharazi, F. (2017). Is incidence of multiple HPV genotypes rising in genital infections? J Infect Public Health, 10(6), 730-733. doi:10.1016/j.jiph.2016.10.006Sohrabi, A., Hajia, M., Jamali, F., & Kharazi, F. (2017). Is incidence of multiple HPV genotypes rising in genital infections? J Infect Public Health, 10(6), 730-733. doi:10.1016/j.jiph.2016.10.006Soto-De Leon, S., Camargo, M., Sanchez, R., Munoz, M., Perez-Prados, A., Purroy, A., . . . Patarroyo, M. A. (2011). Distribution patterns of infection with multiple types of human papillomaviruses and their association with risk factors. PLoS One, 6(2), e14705. doi:10.1371/journal.pone.0014705Soto-De Leon, S. C., Del Rio-Ospina, L., Camargo, M., Sanchez, R., Moreno-Perez, D. A., Perez-Prados, A., . . . Patarroyo, M. A. (2014). Persistence, clearance and reinfection regarding six high risk human papillomavirus types in Colombian women: a follow-up study. BMC Infect Dis, 14, 395. doi:10.1186/1471-2334-14-395Spurgeon, M. E., Chung, S. H., & Lambert, P. F. (2014). Recurrence of cervical cancer in mice after selective estrogen receptor modulator therapy. Am J Pathol, 184(2), 530-540. doi:10.1016/j.ajpath.2013.10.013Stefanache, A., Lungu, II, Butnariu, I. A., Calin, G., Gutu, C., Marcu, C., . . . Damir, D. (2023). Understanding How Minerals Contribute to Optimal Immune Function. J Immunol Res, 2023, 3355733. doi:10.1155/2023/3355733Su, Y., Zheng, T., Bi, Z., Jia, X., Li, Y., Kuang, X., . . . Xia, N. (2024). Pattern of multiple human papillomavirus infection and type competition: An analysis in healthy Chinese women aged 18-45 years. Hum Vaccin Immunother, 20(1), 2334474. doi:10.1080/21645515.2024.2334474Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 71(3), 209-249. doi:10.3322/caac.21660Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. J. C. a. c. j. f. c. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 71(3), 209-249.Tapias Ortega, J. M. (2017). Pobreza y violencia en la Región Caribe colombiana: un enfoque espacial. Ensayos sobre Política Económica, 35(83), 139-153. doi:10.1016/j.espe.2016.12.002van de Wijgert, J. H., Borgdorff, H., Verhelst, R., Crucitti, T., Francis, S., Verstraelen, H., & Jespers, V. (2014). The vaginal microbiota: what have we learned after a decade of molecular characterization? PLoS One, 9(8), e105998. doi:10.1371/journal.pone.0105998Watts, D. H., Fazzari, M., Minkoff, H., Hillier, S. L., Sha, B., Glesby, M., . . . Strickler, H. D. (2005). Effects of bacterial vaginosis and other genital infections on the natural history of human papillomavirus infection in HIV-1-infected and high-risk HIV-1-uninfected women. J Infect Dis, 191(7), 1129-1139. doi:10.1086/427777Wentzensen, N., Nason, M., Schiffman, M., Dodd, L., Hunt, W. C., Wheeler, C. M., & New Mexico, H. P. V. P. R. S. C. (2014). No evidence for synergy between human papillomavirus genotypes for the risk of high-grade squamous intraepithelial lesions in a large population-based study. J Infect Dis, 209(6), 855-864. doi:10.1093/infdis/jit577Williams, V. M., Filippova, M., Soto, U., & Duerksen-Hughes, P. J. J. F. v. (2011). HPV-DNA integration and carcinogenesis: putative roles for inflammation and oxidative stress. 6(1), 45-57.Wright, J. D., Goff, B., & Falk, S. (2014). Cervical intraepithelial neoplasia: Terminology, incidence, pathogenesis, and prevention. Lancet, 370(9599), 1609-1621.Zhang, N., Chen, Z., Huang, M., Lu, Q., Yang, H., Xiang, J., . . . Han, N. J. J. o. M. V. (2024). Cervicovaginal microbiota long‐term dynamics and prediction of different outcomes in persistent human papillomavirus infection. 96(2), e29451.Zhang, X., Dai, B., Zhang, B., & Wang, Z. J. G. o. (2012). Vitamin A and risk of cervical cancer: a meta-analysis. 124(2), 366-373.Zheng, N., Guo, R., Wang, J., Zhou, W., & Ling, Z. (2021). Contribution of Lactobacillus iners to Vaginal Health and Diseases: A Systematic Review. Front Cell Infect Microbiol, 11, 792787. doi:10.3389/fcimb.2021.792787Zhou, X., Brown, C. J., Abdo, Z., Davis, C. C., Hansmann, M. A., Joyce, P., . . . Forney, L. J. (2007). Differences in the composition of vaginal microbial communities found in healthy Caucasian and black women. ISME J, 1(2), 121-133. doi:10.1038/ismej.2007.12Organización Mundial de la SaludInfección de transmisión sexualEnfermedad Pélvica Inflamatoria VPHVirus de Papiloma Humano ADNÁcido desoxirribonucleico ARNÁcido RibonucleicoCancer cervicalVirus de Papiloma humano de alto riesgoReacción en cadena de la polimerasaLesión escamosa intraepitelial de bajo gradoLesión escamosa intraepitelial de alto gradoPares de basesRegión reguladora corriente arribaOrigen de replicaciónRegión Larga de controlPromotor región tardíaPromotor región tempranaNeoplasia intraepitelial cervical intraepitelialCélulas escamosas atípicas de significado indeterminadoCarcinoma de células escamosasAdenocarcinomaVirus de Papiloma Humano de alto riesgoVirus de Papiloma Humano de bajo riesgoWorld Health OrganizationSexually transmitted infectionPelvic inflammatory disease HPVHuman papillomavirus DNADeoxyribonucleic acid RNARibonucleic acidCervical cancerHigh-risk human papillomavirusPolymerase chain reactionLow-grade squamous intraepithelial lesionHigh-grade squamous intraepithelial lesionBase pairs, Upstream regulatory regionOrigin of replicationLong control regionLate promoterEarly promoterCervical intraepithelial neoplasiaAtypical squamous cells of undetermined significanceSquamous cell carcinomaAdenocarcinomaHigh-risk human papillomavirusLow-risk human papillomavirusFacultad de Medicina Veterinaria y ZootecniaMontería, Córdoba, ColombiaDoctorado en Microbiología y Salud TropicalPublicationORIGINALArteaga-Pautt.pdfArteaga-Pautt.pdfapplication/pdf12636373https://repositorio.unicordoba.edu.co/bitstreams/fa760c51-511b-4d5d-9993-344dde411459/downloaddcd24f4c499913c0d5dbfa0d90652c2aMD51Formato de autorización.pdfFormato de autorización.pdfapplication/pdf410752https://repositorio.unicordoba.edu.co/bitstreams/f8392536-f97d-4fc4-b951-4e80db7ea946/downloadbf2cdb71f0264fcb81384dffe6a8ff39MD53LICENSElicense.txtlicense.txttext/plain; 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

Caracterización molecular de la microbiota bacteriana cervical y del virus de papiloma humano (VPH) en muestras de mujeres provenientes de dos regiones de Colombia

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