To Örebro University

Cervical cancer (CC) is the fourth most frequent cancer and cause of death related to cancer in women worldwide. CC is mainly caused by a persistent infection with human papillomaviruses (HPV). Mozambique is one of the African countries with high prevalence of HPV and HIV. The development of CC may be different in HIV immuno-compromised patients. In this thesis we investigated both the pathogenetic perspective of HPV, and the expression of immunotherapeutic target concerning the possible impacts in an HIV endemic milieu. In paper I, virtual tissue microarrays (TMA) were used to validate the representativity to study biomarkers in CC compared to whole slide images. Our study presents an approach to address TMA sampling that could be generalized to TMA-based research. In paper II, the immunoregulatory programmed deathligand 1 (PD-L1) was immunohistochemically assessed in cervical squamous carcinomas (SCC) in TMA. 575 cases of SCC were included, HIV status was available in 46% cases. Our findings indicated that the immunotherapeutic target of PD-L1 is not influenced by HIV status. In paper III, 40 cases of endocervical adenocarcinomas (ECA) were included. HIV status was established, and HPV was detected in all cases. In paper IV, 260 cases of SCC with known HIV status, were assessed concerning HPV genotype differences between HIV positive and negative cases. With a combination of HPV detection methods, almost all cases of our series were HPV positive. Our results in paper III and IV indicate that the newly established vaccination scheme in Mozambique, using quadrivalent vaccine would have the same potential to prevent morbidity and reduce mortality of CC regardless of a concomitant HIV infection or not.