<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0375-0760</journal-id>
<journal-title><![CDATA[Revista Cubana de Medicina Tropical]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Cubana Med Trop]]></abbrev-journal-title>
<issn>0375-0760</issn>
<publisher>
<publisher-name><![CDATA[Centro Nacional de Información de Ciencias Médicas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0375-07602022000100004</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Infecciones múltiples por Alphapapillomavirus, especie 9, en mujeres ecuatorianas con lesiones intraepiteliales y cáncer cervicouterino]]></article-title>
<article-title xml:lang="en"><![CDATA[Multiple infections by Alphapapillomavirus, specie 9, in Ecuadorian women with intraepithelial lesions and cervical cancer]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bedoya Pilozo]]></surname>
<given-names><![CDATA[César Humberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Soto Brito]]></surname>
<given-names><![CDATA[Yudira]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Espinosa García]]></surname>
<given-names><![CDATA[Maylen]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chedraui Alvarez]]></surname>
<given-names><![CDATA[Peter]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Escobar Valdiviezo]]></surname>
<given-names><![CDATA[Gustavo Saúl]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Loja Chango]]></surname>
<given-names><![CDATA[Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sánchez Giler]]></surname>
<given-names><![CDATA[Sunny]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Kourí Cardellá]]></surname>
<given-names><![CDATA[Vivian]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Nacional de Investigación en Salud Pública (INSPI) Dirección de Investigación, Desarrollo e Innovación ]]></institution>
<addr-line><![CDATA[ Guayaquil]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Luis Vernaza  ]]></institution>
<addr-line><![CDATA[ Guayaquil]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto de Medicina Tropical Pedro Kourí Laboratorio de Infecciones de Transmisión Sexual Departamento de Virología]]></institution>
<addr-line><![CDATA[ La Habana]]></addr-line>
<country>Cuba</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Hospital IESS CEIBOS  ]]></institution>
<addr-line><![CDATA[ Guayaquil]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Universidad Católica de Santiago de Guayaquil Facultad Ciencias Médicas Instituto de Biomedicina]]></institution>
<addr-line><![CDATA[ Guayaquil]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Universidad de Especialidades Espíritu Santos Facultad de Ciencias Médicas ]]></institution>
<addr-line><![CDATA[ Espíritu Santos]]></addr-line>
<country>Ecuador</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2022</year>
</pub-date>
<volume>74</volume>
<numero>1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S0375-07602022000100004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S0375-07602022000100004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S0375-07602022000100004&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción: El significado biológico de las infecciones múltiples con virus del papiloma humano de alto riesgo oncogénico (VPH-AR), pertenecientes a la familia Alphapapillomavirus, en la carcinogénesis cervical aún es controversial.  Objetivo:  Proporcionar información sobre la circulación del VPH-AR del género Alphapapillomavirus-especie 9, e infecciones múltiples en mujeres ecuatorianas con lesiones intraepiteliales y cáncer cervicouterino (CaCU).  Métodos:  Se estudiaron 300 mujeres, residentes en la región Litoral del Ecuador. Se detectó la infección viral en muestras cervicales, mediante PCR anidada con cebadores genéricos MY09/11 y GP5/GP6. Los genotipos virales fueron identificados con el sistema comercial ANYPLEX II VPH28. La razón de prevalencia (RP) fue utilizada como medida de asociación entre las lesiones citológicas y las infecciones simples, múltiples o combinaciones de genotipos.  Resultados:  Se detectó VPH en el 92,00 % (276/300) de las mujeres, con frecuencias altas de infección por genotipos individuales, principalmente de alto riesgo oncogénico. Los VPH-AR más frecuentes fueron VPH58 (18,17 %), 70 (8,64 %), 53 (8,34 %), 35 (7,45 %), 16 (7,37 %), 33 (6,55 %), 31 (5,58 %) y 18 (4,24 %). En el 91,66 % (253/276) de las muestras se detectaron infecciones múltiples, hasta con 13 tipos en una misma paciente, incluyendo varias especies del género Alphapapillomavirus. La combinación VPH16/VPH58 fue la más frecuente en lesiones de alto grado (RP = 2,9; p = 0,000), y la coinfección triple VPH16/VPH58/VPH70 predominó en las mujeres con CaCU (RP = 3,5; p = 0,007).  Conclusión: Los resultados demuestran que la combinación VPH16/VPH58 del género Alphapapillomavirus, especie 9, podría ser un factor clave en la aparición de lesiones premalignas y su progresión hacia el CaCU.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction: It is still controversial the biological connotation of multiple infections with high-risk human papillomaviruses (hrHPV), that belong to the genus Alphapapillomavirus, for the cervical carcinogenesis.  Objective: To provide information on the circulation of hrHPV, genus Alphapapillomavirus, specie 9, and the multiple infections in Ecuadorian women with intraepithelial lesions and cervical cancer.  Methods: 300 women, from the coastal region of Ecuador, were screened. Viral infection was detected in cervix samples by nested PCR with MY09/11 and GP5/GP6 generic primers. Viral genotypes were identified using the commercial kit ANYPLEX II VPH28. The prevalence ratio (PR) was used to measure the association between cytological lesions and the simple, multiple or combined genotype infections.  Results: Ninety-two percent of women (276/300) tested positive for HPV. Frequency of infection for single genotypes was high, mainly those of high oncogenic risk. The most frequent hrHPV genotypes were HPV58 (18.17%), 70 (8.64%), 53 (8.34%), 35 (7.45%), 16 (7.37%), 33 (6.55%), 31 (5.58%) and 18 (4.24%). In 91.66% (253/300) of the samples, multiple infections were detected, with up to 13 types in a single patient, including various species from the genus Alphapapillomavirus. The combination HPV16/HPV58 was the most frequent on high-grade lesions (PR = 2.9; p = 0,000), and HPV16/HPV58/HPV70 triple co-infection prevailed in women with cervical cancer (PR = 3.5; p = 0.007).  Conclusions: The results evidence that the combination HPV16/HPV58, genus Alphapapillomavirus, specie 9, could be a key factor in the occurrence of premalignant lesions and their evolution into cervical cancer.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[virus del papiloma humano]]></kwd>
<kwd lng="es"><![CDATA[Alphapapillomavirus]]></kwd>
<kwd lng="es"><![CDATA[genotipos oncogénicos]]></kwd>
<kwd lng="es"><![CDATA[infecciones múltiples]]></kwd>
<kwd lng="es"><![CDATA[PCR]]></kwd>
<kwd lng="es"><![CDATA[Ecuador]]></kwd>
<kwd lng="en"><![CDATA[human papillomavirus]]></kwd>
<kwd lng="en"><![CDATA[Alphapapillomavirus]]></kwd>
<kwd lng="en"><![CDATA[oncogenic genotypes]]></kwd>
<kwd lng="en"><![CDATA[multiple infections]]></kwd>
<kwd lng="en"><![CDATA[PCR]]></kwd>
<kwd lng="en"><![CDATA[Ecuador]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zur Hausen]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Papillomavirus infections -a major cause of human cancers]]></article-title>
<source><![CDATA[Biochim Biophys Acta]]></source>
<year>1996</year>
<volume>1288</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>F55-78</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bruni]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Albero]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Serrano]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Mena]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Collado]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<source><![CDATA[Human Papillomavirus and Related Diseases in the World. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre)]]></source>
<year>2021</year>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bzhalava]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Eklund]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Dillner]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[International standardization and classification of human papillomavirus types]]></article-title>
<source><![CDATA[Virology]]></source>
<year>2015</year>
<volume>476</volume>
<page-range>341-4</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Joura]]></surname>
<given-names><![CDATA[EA]]></given-names>
</name>
<name>
<surname><![CDATA[Ault]]></surname>
<given-names><![CDATA[KA]]></given-names>
</name>
<name>
<surname><![CDATA[Bosch]]></surname>
<given-names><![CDATA[FX]]></given-names>
</name>
<name>
<surname><![CDATA[Brown]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Cuzick]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Ferris]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Attribution of 12 high-risk human papillomavirus genotypes to infection and cervical disease]]></article-title>
<source><![CDATA[Cancer Epidemiol Biomarkers Prev]]></source>
<year>2014</year>
<volume>23</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>1997-2008</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Picconi]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Villa]]></surname>
<given-names><![CDATA[LL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Human Papillomavirus Research in Latin America]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Ludert]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Pujol]]></surname>
<given-names><![CDATA[FH]]></given-names>
</name>
<name>
<surname><![CDATA[Arbiza]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<source><![CDATA[Human Virology in Latin America]]></source>
<year>2017</year>
<publisher-loc><![CDATA[Buenos Aires ]]></publisher-loc>
<publisher-name><![CDATA[Springer International Publishing]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Molina-Pineda]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[López-Cardona]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Limón-Toledo]]></surname>
<given-names><![CDATA[LP]]></given-names>
</name>
<name>
<surname><![CDATA[Cantón-Romero]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez-Silva]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Ramos-Sánchez]]></surname>
<given-names><![CDATA[HV]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[High frequency of HPV genotypes 59, 66, 52, 51, 39 and 56 in women from Western Mexico]]></article-title>
<source><![CDATA[BMC Infect Dis]]></source>
<year>2020</year>
<volume>20</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>889</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Batista]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Saddi]]></surname>
<given-names><![CDATA[VA]]></given-names>
</name>
<name>
<surname><![CDATA[Carvalho]]></surname>
<given-names><![CDATA[KPA]]></given-names>
</name>
<name>
<surname><![CDATA[Ribeiro]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
<name>
<surname><![CDATA[Segati]]></surname>
<given-names><![CDATA[KD]]></given-names>
</name>
<name>
<surname><![CDATA[Carneiro]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Human papillomavirus genotypes 68 and 58 are the most prevalent genotypes in women from quilombo communities in the state of Maranhao, Brazil]]></article-title>
<source><![CDATA[Int J Infect Dis]]></source>
<year>2017</year>
<volume>55</volume>
<page-range>51-5</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Colpani]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Soares Falcetta]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Bacelo Bidinotto]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Kops]]></surname>
<given-names><![CDATA[NL]]></given-names>
</name>
<name>
<surname><![CDATA[Falavigna]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Serpa Hammes]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence of human papillomavirus (HPV) in Brazil A systematic review and meta-analysis]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2020</year>
<volume>15</volume>
<numero>2</numero>
<issue>2</issue>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chiesa]]></surname>
<given-names><![CDATA[IJ]]></given-names>
</name>
<name>
<surname><![CDATA[Perez]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Nuñez]]></surname>
<given-names><![CDATA[GG]]></given-names>
</name>
<name>
<surname><![CDATA[Pirola]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Genetic variability and phylogeny analysis of partial L1 gene of human papillomavirus variants in Buenos Aires, Argentina]]></article-title>
<source><![CDATA[Virusdisease]]></source>
<year>2016</year>
<volume>27</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>41-7</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mejía]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Muñoz]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Trueba]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Tinoco]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Zapata]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence of human papillomavirus types in cervical cancerous and precancerous lesions of Ecuadorian women]]></article-title>
<source><![CDATA[J Med Virol]]></source>
<year>2016</year>
<volume>88</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>144-52</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Molet]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Girlich]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Bonnin]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
<name>
<surname><![CDATA[Proust]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bouligand]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Bachelerie]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Identification by high-throughput sequencing of HPV variants and quasispecies that are untypeable by linear reverse blotting assay in cervical specimens]]></article-title>
<source><![CDATA[Papillomavirus research (Amsterdam, Netherlands)]]></source>
<year>2019</year>
<volume>8</volume>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[YJ]]></given-names>
</name>
<name>
<surname><![CDATA[Kim]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Chun]]></surname>
<given-names><![CDATA[JY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Single-channel multiplexing without melting curve analysis in real-time PCR]]></article-title>
<source><![CDATA[Sci Rep]]></source>
<year>2014</year>
<volume>4</volume>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Marcuccilli]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Farchi]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Mirandola]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Ciccozzi]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Paba]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Bonanno]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Performance evaluation of Anyplex&#8482; II HPV28 detection kit in a routine diagnostic setting: comparison with the HPV Sign® Genotyping Test]]></article-title>
<source><![CDATA[J Virol Methods]]></source>
<year>2015</year>
<volume>217</volume>
<page-range>8-13</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bruni]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Albero]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Serrano]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Mena]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Collado]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<source><![CDATA[Human Papillomavirus and Related Diseases in Ecuador. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre)]]></source>
<year>2020</year>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bedoya-Pilozo]]></surname>
<given-names><![CDATA[CH]]></given-names>
</name>
<name>
<surname><![CDATA[Medina Magües]]></surname>
<given-names><![CDATA[LG]]></given-names>
</name>
<name>
<surname><![CDATA[Espinosa-García]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Sánchez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Parrales Valdiviezo]]></surname>
<given-names><![CDATA[JV]]></given-names>
</name>
<name>
<surname><![CDATA[Molina]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Molecular epidemiology and phylogenetic analysis of human papillomavirus infection in women with cervical lesions and cancer from the coastal region of Ecuador]]></article-title>
<source><![CDATA[Rev Argent Microbiol]]></source>
<year>2018</year>
<volume>50</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>136-46</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Carrión-Ordoñez]]></surname>
<given-names><![CDATA[JI]]></given-names>
</name>
<name>
<surname><![CDATA[Soto-Brito]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Escandón]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[García-Pupo]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Pupo-Antúnez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Human papillomavirus infection and associated risk factors in Ecuadorian women from two communities of Cañar province]]></article-title>
<source><![CDATA[J Cervical Cancer Res]]></source>
<year>2020</year>
<volume>3</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>307-17</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nayar]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Wilbur]]></surname>
<given-names><![CDATA[DC]]></given-names>
</name>
<name>
<surname><![CDATA[Nayar]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Wilbur]]></surname>
<given-names><![CDATA[DC]]></given-names>
</name>
</person-group>
<source><![CDATA[The Bethesda System for Reporting Cervical Cytology]]></source>
<year>2014</year>
<edition>3rd</edition>
<page-range>342</page-range><publisher-loc><![CDATA[Chicago, IL ]]></publisher-loc>
<publisher-name><![CDATA[Springer]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gravitt]]></surname>
<given-names><![CDATA[PE]]></given-names>
</name>
<name>
<surname><![CDATA[Peyton]]></surname>
<given-names><![CDATA[CL]]></given-names>
</name>
<name>
<surname><![CDATA[Alessi]]></surname>
<given-names><![CDATA[TQ]]></given-names>
</name>
<name>
<surname><![CDATA[Wheeler]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Coutlee]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Hildesheim]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Improved amplification of genital human papillomaviruses]]></article-title>
<source><![CDATA[J Clin Microbiol]]></source>
<year>2000</year>
<volume>38</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>357-61</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[de Roda Husman]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Walboomers]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[van den Brule]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Meijer]]></surname>
<given-names><![CDATA[CJ]]></given-names>
</name>
<name>
<surname><![CDATA[Snijders]]></surname>
<given-names><![CDATA[PJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The use of general primers GP5 and GP6 elongated at their 3' ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR]]></article-title>
<source><![CDATA[J Gen Virol]]></source>
<year>1995</year>
<volume>76</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1057-62</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<collab>World Medical Association</collab>
<article-title xml:lang=""><![CDATA[Declaration of Helsinki ethical principles for medical research involving human subjects]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2013</year>
<volume>310</volume>
<numero>20</numero>
<issue>20</issue>
<page-range>2191-4</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[van Delden]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Revised CIOMS International Ethical Guidelines for Health-Related Research Involving Humans]]></article-title>
<collab>van der Graaf R</collab>
<source><![CDATA[JAMA]]></source>
<year>2017</year>
<volume>317</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>135-6</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Guo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Khanna]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Dawlett]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Kologinczak]]></surname>
<given-names><![CDATA[TL]]></given-names>
</name>
<name>
<surname><![CDATA[Lyons]]></surname>
<given-names><![CDATA[GR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Three-year risk of high-grade CIN for women aged 30 years or older who undergo baseline Pap cytology and HPV co-screening]]></article-title>
<source><![CDATA[Cancer Cytopathol]]></source>
<year>2017</year>
<volume>125</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>644-51</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pimple]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
<name>
<surname><![CDATA[Mishra]]></surname>
<given-names><![CDATA[GA]]></given-names>
</name>
<name>
<surname><![CDATA[Deodhar]]></surname>
<given-names><![CDATA[KK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evidence based appropriate triage strategies for implementing high risk HPV as primary technology in cervical cancer screening]]></article-title>
<source><![CDATA[Minerva Ginecol]]></source>
<year>2020</year>
<volume>72</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>96-105</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chan]]></surname>
<given-names><![CDATA[CK]]></given-names>
</name>
<name>
<surname><![CDATA[Aimagambetova]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Ukybassova]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Kongrtay]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Azizan]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Human Papillomavirus Infection and Cervical Cancer Epidemiology, Screening and Vaccination-Review of Current Perspectives]]></article-title>
<source><![CDATA[J Oncol]]></source>
<year>2019</year>
<volume>2019</volume>
</nlm-citation>
</ref>
<ref id="B25">
<label>25</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Adcock]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Cuzick]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Hunt]]></surname>
<given-names><![CDATA[WC]]></given-names>
</name>
<name>
<surname><![CDATA[McDonald]]></surname>
<given-names><![CDATA[RM]]></given-names>
</name>
<name>
<surname><![CDATA[Wheeler]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Role of HPV Genotype, Multiple Infections, and Viral Load on the Risk of High-Grade Cervical Neoplasia]]></article-title>
<source><![CDATA[Cancer Epidemiol Biomarkers Prev]]></source>
<year>2019</year>
<volume>28</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>1816-24</page-range></nlm-citation>
</ref>
<ref id="B26">
<label>26</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Romero-Morelos]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Uribe-Jimenez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bandala]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Poot-Velez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Ornelas-Corral]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Rodriguez-Esquivel]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Genotyping of human papilloma virus in a group of Mexican women treated in a highly specialist hospital: Multiple infections and their potential transcendence in the current vaccination programme]]></article-title>
<source><![CDATA[Med Clin (Barc)]]></source>
<year>2017</year>
<volume>149</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>287-92</page-range></nlm-citation>
</ref>
<ref id="B27">
<label>27</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chan]]></surname>
<given-names><![CDATA[PK]]></given-names>
</name>
<name>
<surname><![CDATA[Ho]]></surname>
<given-names><![CDATA[WC]]></given-names>
</name>
<name>
<surname><![CDATA[Chan]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Wong]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Yeung]]></surname>
<given-names><![CDATA[AC]]></given-names>
</name>
<name>
<surname><![CDATA[Chor]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Meta-analysis on prevalence and attribution of human papillomavirus types 52 and 58 in cervical neoplasia worldwide]]></article-title>
<source><![CDATA[PLoS One]]></source>
<year>2014</year>
<volume>9</volume>
<numero>9</numero>
<issue>9</issue>
</nlm-citation>
</ref>
<ref id="B28">
<label>28</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Campoverde]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Arcentales]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Caguana]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Caracterización de los genotipos frecuentes del virus del papiloma humano en mujeres atendidas en los hospitales monte SINAI y del seguro social Cuenca-Ecuador. 2008-2014]]></article-title>
<source><![CDATA[Rev Fac Cien Méd Univ Cuenca]]></source>
<year>2017</year>
<numero>1</numero>
<issue>1</issue>
<page-range>7-19</page-range></nlm-citation>
</ref>
<ref id="B29">
<label>29</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tornesello]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Buonaguro]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Izzo]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Lopez]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Vega]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Maldonado Reyes]]></surname>
<given-names><![CDATA[CF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A pilot study on the distribution of human papillomavirus genotypes and HPV-16 variants in cervical neoplastic lesions from Ecuadorian women]]></article-title>
<source><![CDATA[J Med Virol]]></source>
<year>2008</year>
<volume>80</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>1959-65</page-range></nlm-citation>
</ref>
<ref id="B30">
<label>30</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wentzensen]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Nason]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Schiffman]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Dodd]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Hunt]]></surname>
<given-names><![CDATA[WC]]></given-names>
</name>
<name>
<surname><![CDATA[Wheeler]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[No evidence for synergy between human papillomavirus genotypes for the risk of high-grade squamous intraepithelial lesions in a large population-based study]]></article-title>
<source><![CDATA[J Infect Dis]]></source>
<year>2014</year>
<volume>209</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>855-64</page-range></nlm-citation>
</ref>
<ref id="B31">
<label>31</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[De Brot]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Pellegrini]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Moretti]]></surname>
<given-names><![CDATA[ST]]></given-names>
</name>
<name>
<surname><![CDATA[Carraro]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Soares]]></surname>
<given-names><![CDATA[FA]]></given-names>
</name>
<name>
<surname><![CDATA[Rocha]]></surname>
<given-names><![CDATA[RM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Infections with multiple high-risk HPV types are associated with high-grade and persistent low-grade intraepithelial lesions of the cervix]]></article-title>
<source><![CDATA[Cancer Cytopathol]]></source>
<year>2017</year>
<volume>125</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>138-43</page-range></nlm-citation>
</ref>
<ref id="B32">
<label>32</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Salazar]]></surname>
<given-names><![CDATA[KL]]></given-names>
</name>
<name>
<surname><![CDATA[Zhou]]></surname>
<given-names><![CDATA[HS]]></given-names>
</name>
<name>
<surname><![CDATA[Xu]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Peterson]]></surname>
<given-names><![CDATA[LE]]></given-names>
</name>
<name>
<surname><![CDATA[Schwartz]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
<name>
<surname><![CDATA[Mody]]></surname>
<given-names><![CDATA[DR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Multiple Human Papilloma Virus Infections and their Impact on the Development of High-Risk Cervical Lesions]]></article-title>
<source><![CDATA[Acta Cytol]]></source>
<year>2015</year>
<volume>59</volume>
<page-range>391-8</page-range></nlm-citation>
</ref>
<ref id="B33">
<label>33</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sobota]]></surname>
<given-names><![CDATA[RS]]></given-names>
</name>
<name>
<surname><![CDATA[Ramogola-Masire]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Williams]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Co-infection with HPV types from the same species provides natural cross-protection from progression to cervical cancer]]></article-title>
<source><![CDATA[Infect Agent Cancer]]></source>
<year>2018</year>
<volume>9</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>26-30</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
