Multiple human papillomavirus infection and ascus-lsil progression: A review

Recent literature highlighted the role of Multiple Human Papillomavirus (HPV) infections in the development of CIN2+. A better understanding of single-genotype and combined multiple-genotype oncogenic potential has become essential to plan future screening and to evaluate the prospective susceptibility to high risk cervical lesions progression. Analysing the literature data, we evaluated the prevalence and the prognostic significance of multiple HPV infections and their type-specific interactions in women with ASCUS and L-SIL cytology. Multiple HPV infections are detected in about 16.7% of women with ASCUS cytology and in 28.7% of LSIL Pap smear results. In ASCUS patients the rates of severe biopsy proven lesions are 8.6% and 31.6% in women with single and multiple HPV infections respectively. Similarly, in women with LSIL cytology, the likelihood of CIN2+ is 12.5% in patients with single and 28.4% in those with multiple HPV infection. Despite the well-known oncogenic risk of HPV16 and HPV18, recent studies provide a new insight in the high prevalence of other HRHPVs and their significant contribution to a large proportion of high-grade cervical lesions in women with ASCUS/LSIL. This review provides further evidence that multiple HR-HPV infection is a significant risk factor for severe cervical lesions in women with ASCUS and LSIL cytology, and highlights that increased oncogenic risk might be strictly associated with peculiar type-specific profiles.