Ethiology and pathophysiology of whart HPV infection: A Review Article

Introduction: Genital Human Papillomavirus (HPV) infection is a self-limiting and often asymptomatic disease. Genital HPV infection is divided into high-risk HPV (HPV 16 and 18) and low-risk HPV (HPV 6 and 11). Low-risk or non-oncogenic HPV produces a clinical picture of anogenital warts, which may be condylomatous, papules, or keratotic. The subclinical form of genital HPV infection can present with an "aceto-white" lesion found on the cervix that will appear when examined using an acetic acid solution evaluated by colposcopy. Based on the association with cervical cancer and precursor lesions, HPV can also be classified as high-risk (HR-HPV) and low-risk (LR-HPV) oncogenic types. LR-HPV types, such as HPV 6 and 11, can cause generalized genital warts or benign hyperproliferative lesions with a very limited predisposition to malignant progression, while infection with HR-HPV types, HPV 16 and 18, is associated with the development of pre-malignant and cervical lesions. Discussion: Human Papillomavirus is a small DNA virus (50-55nm) belonging to the family Papillomaviridae and genus Papillomavirus.  Human papillomavirus (HPV) is a relatively small non-enveloped virus containing a double-stranded circular DNA genome associated with histone-like proteins and protected by a capsid formed by two final proteins, L1 and L2. Each capsid consists of 72 capsomeres, The pathogenesis of HPV begins with infection of stem cells in the basal layer of the epithelium. Once inside the cell, the virus requires expression of the E1 and E2 genes to maintain a low genome copy number. These proteins bind to the origin of replication and the virus secretes cellular DNA polymerases and other proteins required for DNA replication. In the suprabasal layer, the expression of genes E1, E2, E5, E6 and E7 contributes to the maintenance of the viral genome and induces cell proliferation, increasing the number of HPV-infected cells in the epithelium, resulting in a higher number of cells that will eventually produce infectious virions.  Conclusion: In benign HPV lesions, cell proliferation increases leading to increased nutrition, resulting in competition for nutrients and oxygen. Both HR-HPV and LR-HPV E7 proteins increase the level of the transcription factor Hypoxia-inducible factor-1 (HIF-1), and induce increased expression of HIF-1 target genes under hypoxic conditions. Increased HIF-1 activity results in increased transcription of a subset of genes that support angiogenesis, and the induction of this angiogenesis is critical for the persistence and growth of HPV lesions such as genital warts.