Evolution and intratype variability of HPV-16 and HPV-18: epidemiological and clinical implications

The evolution of human papillomavirus (HPV) and its intratype variability may influence pathogenesis, persistence, and oncogenic risk. The objective of this study was to explore the evolution and genetic diversity of HPV-16 and HPV-18, as well as their potential clinical implications. A systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 recommendations by searching MEDLINE via PubMed and Web of Science for studies published between 2015 and 2023 on the prevalence or frequency of lineages, sublineages, and intratype variants. Twelve studies were included, and a descriptive synthesis was performed. Lineages and sublineages showed heterogeneous geographic distributions. Lineage A predominated in HPV-18 in most of the populations studied, whereas lineage B was more frequent in sub-Saharan Africa. In HPV-16, certain variants were associated with differences in viral persistence and oncogenic risk. Overall, intratype diversity may provide relevant information for risk stratification, molecular surveillance, and the development of diagnostic and preventive strategies, although its clinical utility requires further validation.