Divergent Human Papillomavirus Genotype Spectra in Three Indigenous Communities of Venezuela: Implications for Vaccine Choice and Cervical Screening

Background: Genotype-resolved data on human papillomavirus (HPV) are almost absent for Venezuelan indigenous women. Methods: We studied 260 women from La Guajira (Wayuu, n = 94), Maniapure (Eñepa, n = 141), and Delta Amacuro (Warao, n = 25), processing all self-collected samples with a single real-time PCR assay that resolves 21 genotypes; cytology was available for 144. Results: HPV prevalence was 55.4% (95% CI 49.3–61.3) and high-risk prevalence was 51.2% (95% CI 45.1–57.2), rising from 42.6% in La Guajira to 59.6% in Maniapure and 80.0% in Delta Amacuro (p = 0.001). Nineteen genotypes were detected. HPV-31 was most frequent (15.8%), followed by HPV-16 (11.5%), and each community had its own profile, with HPV-68 and HPV-56 leading in Delta Amacuro. Half of the infected women carried more than one type. Cytology and HPV testing overlapped little: 20 of 78 HPV-positive women with a smear (25.6%) had an abnormal result (κ = 0.056). At least one nonavalent vaccine type was present in 69.4% of infected women, compared with 30.6% for the bivalent vaccine. Conclusions: HPV vaccination is not part of the Venezuelan national program; these data favor the nonavalent formulation, and HPV-based screening would need a feasible triage pathway for the many women who test positive.