The role of antioxidants and the risk of human papillomavirus infection and cervical intraepithelial neoplasia: A systematic review

Introduction: Cervical cancer is one of the most common cancers in women and the HPV is an important factor to induce it. According to the contradictory findings about the role of antioxidants in cancer control, the present study was conducted with the aim of a systematic review of the existing studies on the role of these elements and the risk of HPV infection and cervical intraepithelial neoplasia (CIN). Methods: This systematic review was performed by a search in the reliable databases of PubMed, Web of Science, Google Scholar, Embase, Scopus, Magiran and SID by two researchers, based on the PICO guidelines and the use of Mesh terms including antioxidants, vitamins, nutritional status, diet, uterine cervical neoplasms, papillomavirus Infection, and Human papillomavirus and their combination using AND and OR operators that included observational studies and clinical trial and were published in English or Persian in the recent ten years (2012-2022). NOS checklist was used to evaluate the quality of articles. Results: Finally, 7 articles with13211 participants included in this study. Antioxidants included zinc, selenium, carotenoids, flavonoids, manganese, and vitamins B12, C, A, D, B2, E, and folate. The results showed that antioxidants by neutralizing the effect of oxidative stress and cellular DNA damage following a virus attack reduce the incidence of persistent HPV and neoplastic changes. In women with higher serum levels of antioxidants, the risk of infection and the chance of progression to CIN is significantly reduced compared to the control group. Conclusion: According to various evidence about the role of antioxidants in reducing HPV infection and cervical intraepithelial neoplasia, concurrently with other care and treatment, diets or supplements containing these elements can be used to prevent infection in women at risk.