HUMAN PAPILLOMAVIRUS (HPV): CURRENT STRATEGIES FOR THE PREVENTION AND TREATMENT OF PRECANCEROUS LESIONS

Vollständiger Abstract

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Background: Human papillomavirus (HPV) infection is the primary etiology of cervical cancer and its immediate precursors, collectively known as cervical intraepithelial neoplasia (CIN). Although primary prevention via prophylactic vaccination and secondary screening have significantly reduced incidence, cervical cancer remains a major global health burden, particularly in low- and middle-income countries. This comprehensive review evaluates the current landscape of HPV virology, pathogenesis, advanced diagnostic risk-stratification biomarkers, and evolving management paradigms. Methods: This review synthesizes current literature regarding high-risk HPV types (predominantly HPV16 and 18), viral oncogene mechanisms (E6 and E7), multi-modal screening protocols, and therapeutic interventions ranging from standard surgical excisions to novel non-invasive modalities. Results: While large loop excision of the transformation zone (LLETZ) remains the gold standard for high-grade CIN, its associated obstetric complications necessitate fertility-sparing alternatives. Recent advances highlight the efficacy of non-invasive modalities—including thermal ablation, photodynamic therapy (PDT), and topical immunomodulators such as imiquimod—which achieve high rates of lesion regression and viral clearance while preserving cervical structural integrity. Furthermore, diagnostic precision has been markedly improved through the integration of molecular markers (p16/Ki-67, DNA methylation signatures, and circulating microRNAs) and emerging microbiome-targeted adjunctive therapies. Conclusions: The management of HPV-associated precancerous lesions is shifting from standardized surgical excision to a personalized, molecularly guided, and fertility-preserving paradigm. Future clinical efforts must focus on expanding global vaccine access while implementing multi-modal, minimally invasive therapeutic strategies.