HPV-Positive Cervical Cancer

HPV-positive cervical cancer is primarily driven by high-risk human papillomavirus (HPV) infection, with the viral genome encoding early (E) genes E6 and E7 as key oncogenic drivers. These proteins inactivate tumor suppressor proteins p53 and Rb, respectively, promoting cellular immortalization and malignant transformation. The integration of HPV DNA into the host genome, commonly disrupting the E2 gene—a negative regulator of E6/E7—leads to uncontrolled expression of these oncogenes and progression to cancer. However, some cases occur without integration, maintaining episomal HPV DNA with intact E2, which correlates with better prognosis. The L1 gene, encoding the major capsid protein, is crucial for vaccine-induced immunity and serves as a target for prophylactic vaccines like Gardasil and Cervarix. Emerging research highlights the prognostic and predictive value of methylation status in L1 and E2 genes: high methylation of HPV16 L1 and E2 is associated with improved response to antiviral therapy with cidofovir, while low or absent methylation predicts better response to immune stimulation via TLR7 agonist imiquimod, underscoring the potential of epigenetic markers in guiding personalized treatment strategies.