Introduction: Dysbiosis on the cervicovaginal microbiota often characterized by low Lactobacillus species have been implicated in cervical microenvironment changes [1] which contribute to persistent HPV infection [2] and cervical cancer [1,3]. Yet, there is a paucity of data on the vaginal cervicovaginal microbiota in Mozambican women.

Aim: We aimed to elucidate the relationships between microbiota and persistent high-risk HPV infection, to better understand an increased cervical cancer risk among Mozambican women livinh with HIV.

Methods: In this pilot and ongoing study, we recruited 72 participants (All Mozambican native women; HIV-positive, n= 60 vs HIV-negative, n= 12) and examined for persistent high-risk HPV infection, in the DREAM Sant’Egidio HPV-Cervical Cancer Screening Program, in Maputo, Mozambique. All participants have previously examined for high-risk HPV status and cervicovaginal microbiota composition. HPV detection was performed using a commercial HPV DNA assay, and microbiome analysis was performed with commercial kits for the detection of 10 typical cervicovaginal bacteria by PCR, with 16S rRNA gene sequencing (V1-V2 region).

Results: Overall, we found persistent high-risk HPV infection in 34 (47,4%) women (HIV-positive, n= 29 vs HIV-negative, n= 5), with most infections related to other high-risk HPV types than HPV 16/18. On the baseline microbiota testing, the profiles were dominated by a mixture of bacterial vaginosis-associated bacteria, CST IV (11.1% for CST-A, and 65.3% for CST-B), and Lactobacillus crispatus, CST I associated with vaginal health (23.6%). Only 8.3% of women with persistent high-risk HPV infection exhibited L. crispatus dominance, compared to 38.9% who exhibited a mixture of bacterial vaginosis-associated bacteria, CST IV (4.2% for CST-A, and 34.7% for CST-B). Women with HIV also had more frequently CST-IV vaginal dysbiosis profile.

Conclusions: This study sheds light on the interplay between HPV, cervicovaginal microbiota, and host defense, which may play a role in the cervical cancer disparity among Mozambican women. Thus it highlight the need for comprehensive microbiota studies in the country, to further potentially consider the cervicovaginal microbiota testing for the identification of women at risk for HPV-dependent cervical cancer amog Mozambican populations.

Keywords: Cervical cancer, Human papillomavirus, Cervicovaginal microbiome.