RESEARCH ARTICLE
HPV Infection and Cervical Screening in Socially Isolated Indigenous Women Inhabitants of the Amazonian Rainforest Allex Jardim Fonseca1,2*, Daniela Taeko2, Thiciane Araújo Chaves2, Lucia Dayanny da Costa Amorim2, Raisa Saron Wanderley Murari2, Angélica Espinosa Miranda3, Zigui Chen4, Robert David Burk4,5,6,7‡, Luiz Carlos Lima Ferreira8‡ 1 Postgraduate Program in Tropical Medicine, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil, 2 Department of Health Sciences Research, Universidade Federal de Roraima, Boa Vista, Brazil, 3 Center for Infectious Diseases, Universidade Federal do Espírito Santo, Maruípe, Vitoria, Brazil, 4 Department of Pediatrics, Albert Einstein College of Medicine, New York, United States of America, 5 Department of Microbiology & Immunology, Albert Einstein College of Medicine, New York, United States of America, 6 Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, United States of America, 7 Department of Obstetrics, Gynecology & Women’s Health, Albert Einstein College of Medicine, New York, United States of America, 8 Department of Tropical Pathology, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil OPEN ACCESS Citation: Fonseca AJ, Taeko D, Chaves TA, Amorim LDdC, Murari RSW, Miranda AE, et al. (2015) HPV Infection and Cervical Screening in Socially Isolated Indigenous Women Inhabitants of the Amazonian Rainforest. PLoS ONE 10(7): e0133635. doi:10.1371/ journal.pone.0133635 Editor: Maria Lina Tornesello, Istituto Nazionale Tumori, ITALY Received: March 22, 2015 Accepted: June 30, 2015 Published: July 24, 2015 Copyright: © 2015 Fonseca et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This study was partially funded by CNPq/ Instituto de Amparo à Ciência, Tecnologia e Inovação - RR. Sources from Universidade do Estado do Amazonas (Brazil) were used for data collection and data analysis. Sources from Laboratory Burk/Albert Einstein College of Medicine (USA) were used to laboratory and data analysis. Competing Interests: The authors have declared that no competing interests exist.
‡ These authors are co-senior authors on this work. * [email protected]
Abstract Objective Indigenous women from the Amazon regions have some of the highest rates of cervical cancer in the world. This study evaluated cervical cytology and human papillomavirus (HPV) in native women that differ by lifestyle and interaction with western society. Yanomami women are isolated deep in the Amazon with a hunter/gatherer lifestyle. Macuxi and Wapishana women live in proximity to western society.
Methods To select a representative group of women from each district, random cluster sampling was used, considering each registered village as a cluster. Cervical samples were collected for cytology and HPV detection and typing by PCR amplification and next generation sequencing. The study was approved by the National IRB and by tribal leaders.
Results 664 native women were enrolled from 13 indigenous villages (76% participation rate). Yanomami women had higher rates of abnormal cytology (5.1% vs. 1.8%, p = 0.04) and prevalent HR-HPV (34.1% vs. 19.2%, p35y of age were significantly more likely to have HR-HPV, whereas women 35y did not significantly differ between groups. Prevalence of HPV was significantly different amongst geographically clustered
PLOS ONE | DOI:10.1371/journal.pone.0133635 July 24, 2015
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HPV Infection in Amazonian Indigenous Women
Yanomami women (p
HPV Infection and Cervical Screening in Socially Isolated Indigenous Women Inhabitants of the Amazonian Rainforest Allex Jardim Fonseca1,2*, Daniela Taeko2, Thiciane Araújo Chaves2, Lucia Dayanny da Costa Amorim2, Raisa Saron Wanderley Murari2, Angélica Espinosa Miranda3, Zigui Chen4, Robert David Burk4,5,6,7‡, Luiz Carlos Lima Ferreira8‡ 1 Postgraduate Program in Tropical Medicine, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil, 2 Department of Health Sciences Research, Universidade Federal de Roraima, Boa Vista, Brazil, 3 Center for Infectious Diseases, Universidade Federal do Espírito Santo, Maruípe, Vitoria, Brazil, 4 Department of Pediatrics, Albert Einstein College of Medicine, New York, United States of America, 5 Department of Microbiology & Immunology, Albert Einstein College of Medicine, New York, United States of America, 6 Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, United States of America, 7 Department of Obstetrics, Gynecology & Women’s Health, Albert Einstein College of Medicine, New York, United States of America, 8 Department of Tropical Pathology, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil OPEN ACCESS Citation: Fonseca AJ, Taeko D, Chaves TA, Amorim LDdC, Murari RSW, Miranda AE, et al. (2015) HPV Infection and Cervical Screening in Socially Isolated Indigenous Women Inhabitants of the Amazonian Rainforest. PLoS ONE 10(7): e0133635. doi:10.1371/ journal.pone.0133635 Editor: Maria Lina Tornesello, Istituto Nazionale Tumori, ITALY Received: March 22, 2015 Accepted: June 30, 2015 Published: July 24, 2015 Copyright: © 2015 Fonseca et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This study was partially funded by CNPq/ Instituto de Amparo à Ciência, Tecnologia e Inovação - RR. Sources from Universidade do Estado do Amazonas (Brazil) were used for data collection and data analysis. Sources from Laboratory Burk/Albert Einstein College of Medicine (USA) were used to laboratory and data analysis. Competing Interests: The authors have declared that no competing interests exist.
‡ These authors are co-senior authors on this work. * [email protected]
Abstract Objective Indigenous women from the Amazon regions have some of the highest rates of cervical cancer in the world. This study evaluated cervical cytology and human papillomavirus (HPV) in native women that differ by lifestyle and interaction with western society. Yanomami women are isolated deep in the Amazon with a hunter/gatherer lifestyle. Macuxi and Wapishana women live in proximity to western society.
Methods To select a representative group of women from each district, random cluster sampling was used, considering each registered village as a cluster. Cervical samples were collected for cytology and HPV detection and typing by PCR amplification and next generation sequencing. The study was approved by the National IRB and by tribal leaders.
Results 664 native women were enrolled from 13 indigenous villages (76% participation rate). Yanomami women had higher rates of abnormal cytology (5.1% vs. 1.8%, p = 0.04) and prevalent HR-HPV (34.1% vs. 19.2%, p35y of age were significantly more likely to have HR-HPV, whereas women 35y did not significantly differ between groups. Prevalence of HPV was significantly different amongst geographically clustered
PLOS ONE | DOI:10.1371/journal.pone.0133635 July 24, 2015
1 / 18
HPV Infection in Amazonian Indigenous Women
Yanomami women (p
