{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:37:00Z","timestamp":1792460220692,"version":"4.5.0"},"reference-count":108,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Human papillomavirus (HPV) infection is a major driver of anogenital disease and virus-related carcinogenesis. Although most infections resolve spontaneously, persistent infection with high-risk genotypes may progress to high-grade squamous intraepithelial lesions (HSILs) and cancer, particularly in the setting of impaired immune surveillance. Unlike previous HPV-related reviews focused primarily on cervical disease, vaccination, or isolated immunosuppressed populations, this narrative review comparatively examines the clinical expression, colposcopic findings, screening strategies, and therapeutic implications of HPV-related disease across the immunological spectrum. This narrative review provides an integrative synthesis of HPV-related disease in the female lower genital tract across the immunological spectrum. A structured, non-systematic search of PubMed\/MEDLINE, Scopus, and Web of Science was conducted using terms related to \u201chuman papillomavirus\u201d, \u201cHPV\u201d, \u201ccervical intraepithelial neoplasia\u201d, \u201ccolposcopy\u201d, \u201cimmunosuppression\u201d, \u201cHIV\u201d, and \u201cvaccination\u201d. Immunosuppressed populations, including individuals living with HIV, transplant recipients, and patients receiving immunosuppressive therapy, exhibit higher rates of persistent infection, multifocal disease, recurrence, and progression to HSIL and invasive malignancy. These patients also present greater diagnostic complexity, broader anatomical involvement, and reduced response to conventional treatment. Rather than representing a uniform condition, HPV-related disease reflects a biologically dynamic spectrum shaped by host immune competence. This review highlights the distinct clinical, colposcopic, and therapeutic challenges observed in immunosuppressed populations and reinforces the need for individualized, risk-adapted strategies integrating contemporary advances in screening, vaccination, and HPV-related disease management.<\/jats:p>","DOI":"10.3390\/diagnostics16121932","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:13:37Z","timestamp":1782195217000},"page":"1932","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Human Papillomavirus Infection Across the Immunological Spectrum: Clinical Expression, Colposcopic Challenges, and Therapeutic Implications"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2942-6182","authenticated-orcid":false,"given":"Antonio","family":"Braga","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 22240-003, RJ, Brazil"},{"name":"Department of General and Specialized Surgery, School of Medicine and Surgery, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, RJ, Brazil"},{"name":"Postgraduate Program in Applied Health Sciences, University of Vassouras (Univassouras), Vassouras 27700-000, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6106-6503","authenticated-orcid":false,"given":"Gustavo Ribeiro","family":"Lima","sequence":"additional","affiliation":[{"name":"Service of Gynecology and Obstetrics, Ant\u00f4nio Pedro University Hospital, Fluminense Federal University (UFF), Niter\u00f3i 24070-090, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3192-8499","authenticated-orcid":false,"given":"Karine Mello","family":"Duvivier","sequence":"additional","affiliation":[{"name":"Service of Gynecology and Obstetrics, Ant\u00f4nio Pedro University Hospital, Fluminense Federal University (UFF), Niter\u00f3i 24070-090, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6145-2532","authenticated-orcid":false,"given":"Edward","family":"Araujo J\u00fanior","sequence":"additional","affiliation":[{"name":"Discipline of Woman Health, Municipal University of S\u00e3o Caetano do Sul (USCS), S\u00e3o Caetano do Sul 09521-160, SP, Brazil"},{"name":"Department of Obstetrics, Paulista School of Medicine, Federal University of S\u00e3o Paulo (EPM-UNIFESP), S\u00e3o Paulo 04023-062, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7207-7969","authenticated-orcid":false,"given":"Caroline Alves de Oliveira","family":"Martins","sequence":"additional","affiliation":[{"name":"Service of Gynecology and Obstetrics, Ant\u00f4nio Pedro University Hospital, Fluminense Federal University (UFF), Niter\u00f3i 24070-090, RJ, Brazil"},{"name":"Department of Maternal and Child Health, School of Medicine, Fluminense Federal University (UFF), Niter\u00f3i 24070-090, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9885-2724","authenticated-orcid":false,"given":"Isabel Cristina Chulvis do Val","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Service of Gynecology and Obstetrics, Ant\u00f4nio Pedro University Hospital, Fluminense Federal University (UFF), Niter\u00f3i 24070-090, RJ, Brazil"},{"name":"Department of Maternal and Child Health, School of Medicine, Fluminense Federal University (UFF), Niter\u00f3i 24070-090, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4212-0022","authenticated-orcid":false,"given":"Susana","family":"Cristina Aid\u00e9 Viviani Fialho","sequence":"additional","affiliation":[{"name":"Service of Gynecology and Obstetrics, Ant\u00f4nio Pedro University Hospital, Fluminense Federal University (UFF), Niter\u00f3i 24070-090, RJ, Brazil"},{"name":"Department of Maternal and Child Health, School of Medicine, Fluminense Federal University (UFF), Niter\u00f3i 24070-090, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"21048","DOI":"10.1038\/s41598-025-06700-8","article-title":"HPV cancer burden by anatomical site, country, and region in 2022","volume":"15","author":"Zhang","year":"2025","journal-title":"Sci. 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