Microbial Pathogenesis 183 (2023) 106302 Available online 9 August 2023 0882-4010/© 2023 Elsevier Ltd. All rights reserved. Exploring the correlation between progression of human papillomavirus infection towards carcinogenesis and nutrition Arash Letafati a, * , Tannaz Sakhavarz b , Mohammad Mahdi Khosravinia c , Omid Salahi Ardekani b , Samira Sadeghifar b , Mehdi Norouzi a, b , Mona Naseri b , Azam Ghaziasadi b , Seyed Mohammad Jazayeri a, b a Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran b Research Center for Clinical Virology, Tehran University of Medical Science, Tehran, Iran c Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran A R T I C L E INFO Keywords: HPV Nutrition Carcinogenesis Diet Cancer ABSTRACT Human papillomavirus (HPV) is a common sexually transmitted virus that can lead to the development of various types of cancer. While there are vaccines available to prevent HPV infection, there is also growing interest in the role of nutrition in reducing the risk of HPV-related cancers in HPV positive patients. Diet and nutrition play a critical role in maintaining overall health and preventing various diseases. A healthy diet can strengthen the immune system, which is essential for fghting off infections, including HPV infections, and preventing the growth and spread of cancer cells. Therefore, following a healthy diet and maintaining a healthy weight are important components of HPV and cancer prevention. This article explores the current scientifc evidence on the relationship between nutrition and HPV, including the impact of specifc nutrients, dietary patterns, and sup- plements on HPV infection toward cancer progression. 1. Introduction Papillomaviruses are a family of DNA viruses that infect keratino- cytes and induce both benign and malignant tumors [1,2]. Cancers linked to the human papillomavirus (HPV) encompass malignancies affecting the cervix, vulva, vagina, penis, anus, and oropharynx. Cervi- cal cancer is the most common HPV-related cancer worldwide, with the majority of cases and deaths occurring in low-income countries where cervical cancer screening and treatment are limited. Each year, approximately 630,000 cancer cases worldwide are attributed to HPV, out of which 570,000 affect women [3]. The virus can infect squamous epithelial cells by entering through cuts or scraped areas, where it es- tablishes an infection in the basal layer [1,2]. Although HPV is considered a crucial factor in the cell trans- formation toward cancer, its presence alone is insuffcient to induce malignancy. Therefore, other cofactors are required for the progression of HPV infection to cancer. Long-term use of hormonal contraceptives, unhealthy diet, smoking, and HIV co-infection have been identifed as co-factors. Several studies have shown protective effect of fruits, antioxidant-rich nutrients, vegetables, vitamins C and E, α and β-caro- tene, lycopene, lutein/zeaxanthin, and cryptoxanthin against HPV infection. There is strong evidence that certain nutrients and compounds offer protection against cervical cancer. Notably, folate, retinol, and vitamin E have shown a high likelihood of exerting a protective effect against this disease. Additionally, vegetables, vitamin C, vitamin B12, α-carotene, β-carotene, lycopene, lutein/zeaxanthin, and cryptoxanthin may also offer some degree of protection against cervical cancer. Also, Elevated levels of homocysteine in the blood have been found to be associated with an increased risk of cervical cancer. Recent studies have shown other factors such as tobacco usage leads to a higher risk of cancer progression and The International Agency for Research on Cancer (IARC) has classifed tobacco as a known cause of cervical cancer [4–7]. While smoking is linked to poorer outcomes in cases of oropharyngeal squamous cell carcinoma (OPSCC) associated with HPV, it also nega- tively affects the function of the aviation route epithelial boundary and increases oxidative stress. This, in turn, accelerates senescence and * Corresponding author.Medical Virology, Tehran University of Medical Sciences, Tehran, Iran: E-mail addresses: arashletafati@yahoo.com (A. Letafati), tannaz.sakhavarz@khu.ac.ir (T. Sakhavarz), dr.mahdi.co@gmail.com (M.M. Khosravinia), omid. salahi23@gmail.com (O.S. Ardekani), samira.sadeghifar@gmail.com (S. Sadeghifar), mnorouzi@tums.ac.ir (M. Norouzi), mona.naseri1374@gmail.com (M. Naseri), ghaziasadi@gmail.com (A. Ghaziasadi), jazayeri42@gmail.com (S.M. Jazayeri). Contents lists available at ScienceDirect Microbial Pathogenesis journal homepage: www.elsevier.com/locate/micpath https://doi.org/10.1016/j.micpath.2023.106302 Received 3 July 2023; Received in revised form 7 August 2023; Accepted 9 August 2023