1
|
Mayeri DG, Kahasha PM, Kibalama IB, Mongane J, Louguè M, Birindwa EK, Mwimangire SC, Kikuru CK, Materanya JM, Bisimwa YK, Kasago B, Mukengeshai LEM. Cervical precancerous and cancerous lesions screening using Pap smear test at Provincial Referral Hospital of Bukavu, Eastern DR Congo: profile and recommendations to stakeholders. Pan Afr Med J 2024; 47:57. [PMID: 38646136 PMCID: PMC11032072 DOI: 10.11604/pamj.2024.47.57.39090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 12/28/2023] [Indexed: 04/23/2024] Open
Abstract
Introduction cervical cancer is a health concern worldwide. The South Kivu Province in the Eastern DR Congo is facing many cases of this disease but poorly screened and reported. The objective of this was to determine the prevalence of cell abnormalities at cervical cytology in a tertiary teaching hospital in Bukavu and their association with common risk factors of cervical cancer. Methods a cross-sectional study was conducted on 142 women attending the Provincial Referral Hospital of Bukavu (HPGRB) from February to December 2021. Quantitative variables were described by their median following their asymmetric distributions and the qualitative variables in absolute and relative frequencies. Then the Chi-square test was used for the comparison of proportion. Results forty-five percent of the participants had between three and five children. Twenty-two (15.5%) of the 142 patients reported to have two or more sexual partners and 17.5% reported the use of hormonal contraception. The prevalence of cell abnormalities at cervical cytology was 17% of which Low- Grade Squamous Intraepithelial Lesion (LSIL) was the most representative (12.9%). There was no statistically significant association between the common cervical risk factors and the occurrence of cell abnormalities. Conclusion cervical pre-cancerous lesions are frequent in South Kivu province. The Pap smear test remains an early and affordable screening method and constitutes a secondary prevention strategy in women of 18 years and older in a low-income country such as DR Congo where vaccination against HPV is still hypothetic.
Collapse
Affiliation(s)
- Daniel Garhalangwanamuntu Mayeri
- Department of Pathology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Department of Pathology, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Pierre Mulumeoderhwa Kahasha
- Department of Pathology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Isaac Barhishindi Kibalama
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Jules Mongane
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Medina Louguè
- Department of Pathology, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Etienne Kajibwami Birindwa
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Serge Chentwali Mwimangire
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Claude Kalegamire Kikuru
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Jeanne Maningo Materanya
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Yvette Kujirakwinja Bisimwa
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Benjamin Kasago
- Department of Gynaecology, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Léon-Emmanuel Mubenga Mukengeshai
- Department of Surgery, Faculty of Medicine, Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| |
Collapse
|
2
|
Shaffi AF, Odongo EB, Itsura PM, Tonui PK, Mburu AW, Hassan AR, Rosen BP, Covens AL. Cervical cancer management in a low resource setting: A 10-year review in a tertiary care hospital in Kenya. Gynecol Oncol Rep 2024; 51:101331. [PMID: 38379666 PMCID: PMC10876584 DOI: 10.1016/j.gore.2024.101331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/12/2023] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
Background Cervical cancer is one of the leading causes of cancer mortality among women in Kenya due to late presentations, poor access to health care, and limited resources. Across many low- and middle-income countries infrastructure and human resources for cervical cancer management are currently insufficient to meet the high population needs therefore patients are not able to get appropriate treatment. Objective This study aimed to describe the clinicopathological characteristics and the treatment profiles of cervical cancer cases seen at Moi Teaching and Referral Hospital (MTRH). Methods This was a retrospective cross-sectional study conducted at MTRH involving the review of the electronic database and medical charts of 1541 patients with a histologically confirmed diagnosis of cervical cancer between January 2012 and December 2021. Results Of the 1541 cases analyzed, 91% were squamous cell carcinomas, 8% were adenocarcinomas, and 1% were other histological types. Thirty-eight percent of the patients were HIV infected and less than 30% of the women had health insurance. A majority (75%) of the patients presented with advanced-stage disease (stage IIB-IV). Only 13.9% received chemoradiotherapy with curative intent; of which 33.8% received suboptimal treatment. Of the 13% who received surgical treatment, 45.3% required adjuvant therapy, of which only 27.5% received treatment. Over 40% of the women were lost to follow-up. Conclusion Most of the patients with cervical cancer in Kenya present at advanced stages with only a third receiving the necessary treatment while the majority receive only palliative treatment or supportive care.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Allan L. Covens
- University of Toronto, Sunnybrook Health Sciences Center, Toronto, Canada
| |
Collapse
|
3
|
The role of infections in the causation of cancer in Kenya. Cancer Causes Control 2022; 33:1391-1400. [PMID: 36087193 DOI: 10.1007/s10552-022-01625-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/31/2022] [Indexed: 12/09/2022]
Abstract
Cancer constitutes a major health care burden in the world today with the situation worsening in resource poor settings as seen in most Sub-Saharan African (SSA) countries. Infections constitute by far the most common risk factors for cancer in SSA and being a typical country in this region, Kenya has experienced an upsurge in the incidence of various types of cancers in the last few decades. Although there is limited population-based data in Kenya of infections-associated cancers, this review provides an up-to-date literature-based discussion on infections-associated cancers, their pathogenesis, and preventive approaches in the country. The primary infectious agents identified are largely viral (human immunodeficiency virus, human papillomavirus (HPV), Kaposi's sarcoma-associated herpes virus, Epstein-Barr virus, hepatitis B virus (HBV), hepatitis C virus), and also bacterial: Helicobacter pylori and parasitic: Schistosomiasis haematobium. Cancers associated with infections in Kenya are varied but the predominant ones are Non-Hodgkin lymphoma, Kaposi's sarcoma, Hodgkin lymphoma, Burkitt's lymphoma, cervical, liver, and gastric cancers. The mechanisms of infections-induced carcinogenesis are varied but they mainly seem to stem from disruption of signaling, chronic inflammation, and immunosuppression. Based on our findings, actionable cancer-preventive measures that are economically feasible and aligned with existing infrastructure in Kenya include screening and treatment of infections, implementation of cancer awareness and screening, and vaccination against infections primarily HBV and HPV. The development of vaccines against other infectious agents associated with causation of cancer remains also as an important goal in cancer prevention.
Collapse
|
4
|
Seyoum A, Assefa N, Gure T, Seyoum B, Mulu A, Mihret A. Prevalence and Genotype Distribution of High-Risk Human Papillomavirus Infection Among Sub-Saharan African Women: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:890880. [PMID: 35875040 PMCID: PMC9304908 DOI: 10.3389/fpubh.2022.890880] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Among sub-Saharan African women, cervical cancer is steadily increasing with more than 75,000 new cases and 50,000 deaths annually. Due to the vast ethno geography variation, Africa harbors heterogeneous genotypes of HPV. High-risk HPV [hr HPV] genotypes such as hr HPV-16,−18,-35, and−52 are abundantly reported in sub-Saharan Africa. The purpose of this systematic review and meta-analysis is to generate an evidence on the prevalence and the genotype distribution of hr HPV among sub-Saharan African countries. Methods The review was conducted by following the preferred reporting items for systematic reviews and Meta-analysis. PubMed/Medline, Embase, Scopus, Google Scholar, Heath Technology assessment and Cochrane Library databases were used to retrieve published original studies between 2001 and 2021. It included studies that used PCR-based or hybrid testing to assess the presence of HPV DNA in a cervical biopsy, cervical swelling, and vaginal swelling. Statistical software for data science (STATA V16) software using a random-effects model was used to determine the pooled prevalence and type-specific distribution of HPV with 95% confidence intervals (CI). The I-squared statistic was used to describe the level of heterogeneity. The study protocol is registered on PROSPERO with reference number CRD42022311157. Results The review included 27 studies conducted in 19 sub-Saharan countries. A total of 16,506 study participants from 27 studies were included in a systematic review and 5,303 of them were infected with the hr HPV infection. Out these, only 3,075 of them were eligible for meta-analysis. The incidence proportion of estimatesof hr HPV infection among study participants with different health conditions ranges from 10.7 to 97.2% while the pooled incidence proportion of estimates is 34% (95%CI: 29–39). Among 3,075 women, 424 (13.8%), 305 (9.9%) and 279 (9%) were infected with HPV-16,−52 and−18, respectively. HPV-16 and−52 are the main genotypes causing the hr HPV infection in the Eastern and Southern African sub-contents, whereas HPV-16 and−35 are the main genotypes in the Western African countries. Conclusions Depending on several factors, especially women's health conditions, the high rate of hr HPV infection with inconsistent genotype distribution shows that it is a growing public health challenge in sub-Saharan African countries. Therefore, to implement a vaccination-based prevention strategy and be effective, considering factors associated with hr HPV infection is crucial.
Collapse
Affiliation(s)
- Ayichew Seyoum
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- *Correspondence: Ayichew Seyoum
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Gure
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| |
Collapse
|
5
|
Cancer stages and demographical study of HPV16 in gene L2 isolated from cervical cancer in Dhi-Qar province, Iraq. APPLIED NANOSCIENCE 2021. [DOI: 10.1007/s13204-021-01947-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
6
|
Volpini LPB, Dias JA, de Freitas LB, Silva MCLF, Miranda AE, Spano LC. Viral load and high prevalence of HR-HPV52 and 58 types in black women from rural communities. BMC Infect Dis 2021; 21:362. [PMID: 33865316 PMCID: PMC8052640 DOI: 10.1186/s12879-021-06042-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background The high-risk human papillomavirus (HR-HPV) infection is the main cause of cervical cancer development, and the most common types were included in the last approved nonavalent vaccine (9vHPV). Geographical, socioeconomic and ethnic barriers in developing countries challenge primary and secondary prevention measures of cervical cancer. We aimed to determine the prevalence of HPV infection and the viral load of HR-HPV 9vHPV-related types black women resident in rural semi-isolated communities. Methods A descriptive study was conducted with 273 cervical samples of women from rural communities of Southeastern Brazil. Viral DNA was amplified by PCR, the genotype was identified by Reverse Line Blot (RLB) and Restriction Fragment Length Polymorphism (RFLP), and real-time PCR was applied to determine the viral load. Results HPV frequency was 11.4% (31/273), associated with the presence of cytological abnormalities (32.3%; p < 0.001). Thirty-one distinct genotypes were detected; HR-HPV occurred in 64.5% (20/31) of the samples and the most prevalent type were HPV52 > 58, 59. Multiple infections occurred with up to nine different genotypes. The viral load of HR-HPV 9vHPV-related types was higher in lesions than in normal cytology cases (p = 0.04); “high” and “very high” viral load occurred in HSIL and LSIL, respectively (p = 0.04). Conclusions We highlight that despite the low HPV frequency in the black rural women population, the frequency of HR-HPV was high, particularly by the HR-HPV52 and 58 types. Moreover, the HR-HPV viral load increased according to the progression from normal to lesion, being a potential biomarker to identify those women at higher risk of developing cervical lesions in this population.
Collapse
Affiliation(s)
- Lays Paula Bondi Volpini
- Infectious Diseases Post-Graduate Program, Federal University of Espírito Santo, Vitória, Brazil.
| | - Jerusa Araújo Dias
- Department of Nursing, University Center of Northern Espírito Santo, Federal University of Espírito Santo, São Mateus, Brazil
| | | | | | - Angélica Espinosa Miranda
- Infectious Diseases Post-Graduate Program, Federal University of Espírito Santo, Vitória, Brazil.,Department of Social Medicine, Center of Health Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Liliana Cruz Spano
- Infectious Diseases Post-Graduate Program, Federal University of Espírito Santo, Vitória, Brazil.,Department of Pathology, Center of Health Sciences, Federal University of Espírito Santo, Vitória, Brazil
| |
Collapse
|
7
|
Temesgen MM, Alemu T, Shiferaw B, Legesse S, Zeru T, Haile M, Gelanew T. Prevalence of oncogenic human papillomavirus (HPV 16/18) infection, cervical lesions and its associated factors among women aged 21-49 years in Amhara region, Northern Ethiopia. PLoS One 2021; 16:e0248949. [PMID: 33760866 PMCID: PMC7990306 DOI: 10.1371/journal.pone.0248949] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection is considered as the major risk factor for the development of cervical cancer, second most frequent cancer in Ethiopia. However, the magnitude of the problem and the associated factors remain unrevealed in the Amhara region. This study aimed to determine the prevalence of HPV infection and factors contributing to the progression of HPV infection to cervical cancer. METHODS Facility-based cross-sectional study design was employed among women aged 21 to 49 years of age who came for routine cervical cancer screening to 4 randomly selected hospitals (2 general and 2 referral) of Amhara region from May to October, 2019. The sample size was calculated by using the single population proportion formula, proportionated to hospitals, and women were recruited consecutively. Socio demographic and clinical data were collected using a pretested questionnaire and detection of HPV infection was done using HPV test (OncoE6TM Cervical Test) specific to HPV16/18 in cervical swabs. Visual inspection with acetic acid (VIA) was used to determine cervical lesions (precancerous and cancerous). Descriptive statistics and bivariate and multivariate logistic regression were used to describe HR-HPV and cervical lesions burden and association between HR-HPV, and cervical lesions and potential risk factors. RESULTS Among 337 women 21 to 49 years (median age of 35 years ±SD = 7.1 years) of age enrolled in the study, The overall prevalence of oncogenic HPVs (HPV16/18) and the VIA-positivity rate, possible an indicative of cervical lesions, were 7.1% and 13.1%, respectively. Logistic regression analysis showed a significant association between early age of first sexual intercourse (COR = 2.26; 95% CI: 1.0-5.05) and level of education (COR = 0.31; 95% CI: 0.12-0.78) with cervical lesions. Higher odds of HPV positivity (COR = 1.56; 95% CI: 0.59-4.11, p = 0.36) and VIA positivity (COR = 1.39; 95% CI: 0.64-3.00, p = 0.39) were observed among participants who had a history of sexually transmitted illnesses (STIs). CONCLUSIONS There was a relatively low prevalence of oncogenic HPV 16/18 and VIA-positivity in women attending four hospitals in the Amhara Region. Early age sexual contact, high parity, and being uneducated/low level of education were independently associated factors with HR-HPV infection and development of cervical lesions, highlighting the importance of prioritizing the limited HPV testing to those risk groups.
Collapse
Affiliation(s)
| | - Tefera Alemu
- Amhara Public Health Institute Dessie Branch, Dessie, Ethiopia
| | | | - Seid Legesse
- Amhara Public Health Institute Dessie Branch, Dessie, Ethiopia
| | - Taye Zeru
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | | | | |
Collapse
|
8
|
Smit M, Perez-Guzman PN, Mutai KK, Cassidy R, Kibachio J, Kilonzo N, Hallett TB. Mapping the Current and Future Noncommunicable Disease Burden in Kenya by Human Immunodeficiency Virus Status: A Modeling Study. Clin Infect Dis 2020; 71:1864-1873. [PMID: 31734688 PMCID: PMC8240998 DOI: 10.1093/cid/ciz1103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The noncommunicable disease (NCD) burden in Kenya is not well characterized, despite estimates needed to identify future health priorities. We aimed to quantify current and future NCD burden in Kenya by human immunodeficiency virus (HIV) status. METHODS Original systematic reviews and meta-analyses of prevalence/incidence of cardiovascular disease (CVD), chronic kidney disease, depression, diabetes, high total cholesterol, hypertension, human papillomavirus infection, and related precancerous stages in Kenya were carried out. An individual-based model was developed, simulating births, deaths, HIV disease and treatment, aforementioned NCDs, and cancers. The model was parameterized using systematic reviews and epidemiological national and regional surveillance data. NCD burden was quantified for 2018-2035 by HIV status among adults. RESULTS Systematic reviews identified prevalence/incidence data for each NCD except ischemic heart disease. The model estimates that 51% of Kenyan adults currently suffer from ≥1 NCD, with a higher burden in people living with HIV (PLWH) compared to persons not living with HIV (62% vs 51%), driven by their higher age profile and partly by HIV-related risk for NCDs. Hypertension and high total cholesterol are the main NCD drivers (adult prevalence of 20.5% [5.3 million] and 9.0% [2.3 million]), with CVD and cancers the main causes of death. The burden is projected to increase by 2035 (56% in persons not living with HIV; 71% in PLWH), with population growth doubling the number of people needing services (15.4 million to 28.1 million) by 2035. CONCLUSIONS NCD services will need to be expanded in Kenya. Guidelines in Kenya already support provision of these among both the general and populations living with HIV; however, coverage remains low.
Collapse
Affiliation(s)
- Mikaela Smit
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Pablo N Perez-Guzman
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | | | - Rachel Cassidy
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joseph Kibachio
- Division of Noncommunicable Diseases, Ministry of Health, Nairobi, Kenya
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Timothy B Hallett
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| |
Collapse
|
9
|
Baena A, De Vuyst H, Mesher D, Kasubi M, Yuma S, Mwaiselage J, Zouiouich S, Mlay P, Kahesa C, Landoulsi S, de la Luz Hernandez M, Lucas E, Herrero R, Almonte M, Broutet N. Reproducibility of a Rapid Human Papillomavirus Test at Different Levels of the Healthcare System in Tanzania: The AISHA Study. Cancer Epidemiol Biomarkers Prev 2020; 29:2261-2268. [PMID: 32856600 DOI: 10.1158/1055-9965.epi-20-0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/23/2020] [Accepted: 08/14/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To inform policy makers in Tanzania if and how best to implement rapid HPV testing, we assessed the interobserver reproducibility of careHPV test at three different levels of the healthcare system in an urban and a rural region of Tanzania. METHODS Women aged 30 to 50 years were screened by careHPV testing in two primary healthcare centers (PHC), two district hospitals (DiH), and two regional hospitals (ReH). Aliquots were retested at regional (ReH) and national referral laboratories (NRL). Reproducibility was evaluated using agreement and kappa index measures. Intralaboratory reproducibility was also evaluated in a set of 10 positive and 10 negative samples. RESULTS Samples from 1,134 women were locally tested and retested at ReH and/or NRL. Test results from Dar es Salaam ReH and Kilimanjaro PHC showed clear quality problems including suspicion of contamination during testing or aliquoting. After excluding these samples, 18.8% of 743 women were HPV positive at clinic level. The resulting careHPV reproducibility at different levels of the healthcare system was very good [agreement 95.7%, 95% confidence interval (CI), 94.0-96.9; kappa, 0.86, 95% CI, 0.81-0.91]. Intralaboratory agreement was also very good across four different experiments, with Fleiss' kappa between 0.87 (95% CI, 0.61-1.00) and 1.00 (0.75-1.00). CONCLUSIONS Rapid HPV testing was highly reproducible between lower and higher levels of the healthcare system in Tanzania; however, performance seems to be operator dependent. IMPACT The careHPV test seems to be a feasible option for cervical cancer screening in an organized, decentralized system and in limited-resource settings if quality assurance measures are in place.
Collapse
Affiliation(s)
- Armando Baena
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Hugo De Vuyst
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France.
| | - David Mesher
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France.,Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, United Kingdom
| | - Mabula Kasubi
- Department of Microbiology/Immunology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Safina Yuma
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Julius Mwaiselage
- Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Semi Zouiouich
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Pendo Mlay
- Department of Gynecology and Obstetrics, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Crispin Kahesa
- Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Sihem Landoulsi
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
| | - Maria de la Luz Hernandez
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Eric Lucas
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Rolando Herrero
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Maribel Almonte
- Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer (IARC), Lyon, France
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
10
|
Human Papillomavirus Infection and Cervical Cancer: Epidemiology, Screening, and Vaccination-Review of Current Perspectives. JOURNAL OF ONCOLOGY 2019; 2019:3257939. [PMID: 31687023 PMCID: PMC6811952 DOI: 10.1155/2019/3257939] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 02/07/2023]
Abstract
Viral infections contribute as a cause of 15–20% of all human cancers. Infection by oncogenic viruses can promote different stages of carcinogenesis. Among many types of HPV, around 15 are linked to cancer. In spite of effective screening methods, cervical cancer continues to be a major public health problem. There are wide differences in cervical cancer incidence and mortality by geographic region. In addition, the age-specific HPV prevalence varies widely across different populations and showed two peaks of HPV positivity in younger and older women. There have been many studies worldwide on the epidemiology of HPV infection and oncogenic properties due to different HPV genotypes. However, there are still many countries where the population-based prevalence has not yet been identified. Moreover, cervical cancer screening strategies are different between countries. Organized cervical screening programs are potentially more effective than opportunistic screening programs. Nevertheless, screening programs have consistently been associated with a reduction in cervical cancer incidence and mortality. Developed countries have achieved such reduced incidence and mortality from cervical cancer over the past 40 years. This is largely due to the implementation of organized cytological screening and vaccination programs. HPV vaccines are very effective at preventing infection and diseases related to the vaccine-specific genotypes in women with no evidence of past or current HPV infection. In spite of the successful implementation of the HPV vaccination program in many countries all over the world, problems related to HPV prevention and treatment of the related diseases will continue to persist in developing and underdeveloped countries.
Collapse
|
11
|
Prevalence and genotype-specific distribution of human papillomavirus in Burundi according to HIV status and urban or rural residence and its implications for control. PLoS One 2019; 14:e0209303. [PMID: 31237894 PMCID: PMC6592514 DOI: 10.1371/journal.pone.0209303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human papillomaviruses are the most important causative agents for invasive cervical cancer development. HPV type-specific vaccination and HPV cervical cancer screening methods are being widely recommended to control the disease but the epidemiology of the circulating HPV types may vary locally. The circulating HPV-strains have never been assessed in Burundi. This study determined the prevalence and genotype-specific distribution of HPV in four different strata in Burundi: HIV-infected or non-infected and women living in rural or urban areas. Implications for HPV diagnosis and vaccine implementation was discussed. METHODS Four cross-sectional surveys were conducted in Burundi (2013 in a rural area and 2016 in urban area) among HIV-infected and uninfected women living in rural and urban areas. Liquid-Based Cytology (LBC) and HPV genotyping were performed and risk factors for HPV infection and cervical pre-cancer lesions were determined using logistic regression model. RESULTS HPV prevalence was very high in urban area with significant differences between HIV-positive and negative women (p<0.0001). In fact, 45.7% of HIV-positive participants were infected with any HPV type and all were infected with at least one HR/pHR-HPV type. Among the HIV-negative participants, 13.4% were HPV-infected, of whom, only four women (2.7%) were infected with HR/pHR-HPV types. In rural area, HPV infection did not significantly differ between HIV-positive and negative women (30.0% and 31.3% respectively; p = 0.80). In urban area, multiple infections with HR/pHR-HPV types were detected in 13.9% and 2.7% among HIV-positive and negative women respectively (p<0.0001), whereas in rural area, multiple infections with HR/pHR-HPV types were detected in 4.7% and 3.3% of HIV-positive and negative women respectively (p = 0.56). The most prevalent HR/pHR-HPV types in HIV-positive women living in urban area were HPV 52, 51, 56, 18 and 16 types. In HIV-negative women living in urban area, the most prevalent HR/pHR-HPV types were HPV 66, 67, 18, 45 and 39 types. In HIV-positive women living in rural area, the most prevalent HR/pHR-HPV types were HPV 66, 16, 18 and 33 types. In HIV-negative women living in rural area, the most prevalent HR/pHR-HPV types were HPV 16, 66, 18, 35 and 45 types. Independent risk factors associated with cervical lesions were HPV and HIV infections. CONCLUSIONS There is a high burden of HR and pHR-HPV infections, in particular among HIV-infected women living in urban area. The study points out the need to introduce a comprehensive cervical cancer control programme adapted to the context. This study shows that the nonavalent vaccine covers most of the HR/pHR-HPV infections in rural and urban areas among HIV-infected and uninfected women.
Collapse
|
12
|
Damião PDA, Oliveira-Silva M, Moreira MÂ, Poliakova N, de Lima MER, Chiovo J, Nicol AF. Human Papillomavirus types distribution among women with cervical preneoplastic, lesions and cancer in Luanda, Angola. Pan Afr Med J 2017; 24:268. [PMID: 28154623 PMCID: PMC5267858 DOI: 10.11604/pamj.2016.24.268.9678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/10/2016] [Indexed: 11/12/2022] Open
Abstract
Introduction Cervical cancer is the leading cause of cancer deaths among females in Angola and human papillomavirus (HPV) is the main risk factor for the development of pre-cancerous squamous intraepithelial lesions. The diversity and frequency of HPV types in Angola has yet to be reported. Aim To determine the frequency of HPV among women with squamous intraepithelial lesions from women in Luanda, Angola. Methods Study participants included women diagnosed with cytological abnormalities that voluntarily provided Pap smears (n = 64). Genomic DNA was extracted from the samples for use as templates in the PCR amplification of HPV sequences. PCR products were sequenced to determine HPV type. Results HPV DNA was detected in 71.9% (46/64) in the samples. A higher diversity of HPV types was found in the cytological lesions, such as ASCUS and LSIL (HPV16, 6, 18, 31, 58, 66, 70 and 82, in order of frequency) than that detected for HSIL and SSC (HPV16, 18, 6 and 33). The most prevalent HPV type were: HPV16, HPV6 and HPV18. Conclusion This is the first report on HPV type diversity and frequency in woman of Angola. The results suggest that large-scale studies across Africa would improve our understanding of interrelationship between HPV infections and cervical cancer. More directly, the identification of the HPV types most prevalent suggests that women in Angola would benefit from currently available HPV vaccines.
Collapse
Affiliation(s)
| | - Michelle Oliveira-Silva
- Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil; Division of Genetic, National Institute of Cancer, Rio de Janeiro, Brazil
| | | | - Natalia Poliakova
- Departamento de Anatomia Patológica do Hospital Militar Principal, Instituto Superior, Luanda, Angola
| | - Maria Emilia Rt de Lima
- Departamento de Anatomia Patológica do Hospital Militar Principal, Instituto Superior, Luanda, Angola
| | - José Chiovo
- Departamento de Anatomia Patológica do Hospital Militar Principal, Instituto Superior, Luanda, Angola
| | - Alcina Frederica Nicol
- Laboratory of Interdisciplinary Medical Research, LIPMED, IOC, Fiocruz, Rio de Janeiro, Brazil
| |
Collapse
|
13
|
Zoa Assoumou S, Ndjoyi Mbiguino A, Mabika Mabika B, Nguizi Ogoula S, El Mzibri M, Khattabi A, Ennaji MM. Human papillomavirus genotypes distribution among Gabonese women with normal cytology and cervical abnormalities. Infect Agent Cancer 2016; 11:2. [PMID: 26779280 PMCID: PMC4714494 DOI: 10.1186/s13027-016-0046-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 01/05/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cervical cancer is one of the most common tumors affecting women with a disproportionate mortality occurring in developing countries. Despite the high prevalence of cervical cancer and cervical neoplasia in Gabon, few studies have been performed to evaluate the prevalence and determinants of HPV infection in this country. The aim of this study was to determine the HPV prevalence and distribution in a population of Gabonese women with normal cytology and cervical abnormalities. METHODS A total of 200 cervical samples collected in the "Departement d'Anatomie et de Cytologie Pathologiques" of the "Faculté de Medecine et des Sciences de la Santé" in Libreville, Gabonwere analyzed. Cytological status was classified according to Bethesda 2001. Nested polymerase chain reaction (PCR) using consensus degenerate PCR primers (MY09/11 and GP5+/6+) was performed for the detection of HPV DNA and HPV typing was done by DNA sequencing. RESULTS Cytological analysis showed that 87 % of women had normal cytology (n = 174/200). Among the 26 women with cytological abnormalities, predominance (61.5 %; 16/26) of low grade squamous intraepithelial lesion (LSIL) was found and no cervical cancer case was detected. Overall, HPV DNA was detected in 60 % of women (120/200). With respect to the cytological status, HPV DNA was found in 57.5 % of women with normal cervix and 76.9 % of women with abnormal cytology. HPV genotyping was performed on 114 HPV positive cases and revealed the presence of 11 distinct genotypes: 16, 18, 33, 31, 56, 6, 66, 70, 35, 45 and 81. The high risk type HPV 16 was the most common genotype found in all cytological categories. Six HPV positive samples could not be typed by DNA sequencing, probably due to multiple HPV infection. Evaluation of possible risk factors showed that HPV infection was related positively with number of sexual partners (≥3, OR = 2.3; 95 % CI, 1.3-4.3), history of sexually transmitted infection (Chlamydia, OR = 1.9; 95 % CI, 1.01-3.4) and marital status (single, OR = 2.0; 95 % CI, 1.1-3.5). CONCLUSION The prevalence of HPV infection among Gabonese women is high. Our findings highlight the need to set up a national program to fight cervical cancer, combining Pap smear test and HPV testing, to improve cervical cancer prevention in Gabon.
Collapse
Affiliation(s)
- Samira Zoa Assoumou
- />Laboratoire de Virologie, Microbiologie et Qualité/ Eco-toxicologie et Biodiversité, Faculté des Sciences et Techniques, Université Hassan II, Mohammedia, Maroc
- />Département de biologie, Laboratoire d’Agroalimentaire et Santé, Faculté des Sciences et Techniques, Université Hassan I, Settat, Maroc
- />Département de Bactériologie et Virologie, Laboratoire de référence MST/Sida, Laboratoire de Référence Rougeole, Rubéole et Fièvre Jaune, Faculté de Médecine et des Sciences de la Santé, Université des Sciences de la Santé, Libreville, Gabon
| | - Angelique Ndjoyi Mbiguino
- />Département de Bactériologie et Virologie, Laboratoire de référence MST/Sida, Laboratoire de Référence Rougeole, Rubéole et Fièvre Jaune, Faculté de Médecine et des Sciences de la Santé, Université des Sciences de la Santé, Libreville, Gabon
| | - Barthelemy Mabika Mabika
- />Département d’Anatomie et de Cytologie Pathologiques, Faculté de Médecine et des Sciences de la Santé, Université des Sciences de la Santé, Libreville, Gabon
| | - Sidonie Nguizi Ogoula
- />Département d’Anatomie et de Cytologie Pathologiques, Faculté de Médecine et des Sciences de la Santé, Université des Sciences de la Santé, Libreville, Gabon
| | - Mohammed El Mzibri
- />Unité de Biologie et Recherche Médicale, Centre National de l’Energie, des Sciences et Techniques Nucléaires (CNESTEN), Rabat, Maroc
| | - Abdelkrim Khattabi
- />Département de biologie, Laboratoire d’Agroalimentaire et Santé, Faculté des Sciences et Techniques, Université Hassan I, Settat, Maroc
| | - My Mustapha Ennaji
- />Laboratoire de Virologie, Microbiologie et Qualité/ Eco-toxicologie et Biodiversité, Faculté des Sciences et Techniques, Université Hassan II, Mohammedia, Maroc
| |
Collapse
|
14
|
Ali-Risasi C, Verdonck K, Padalko E, Vanden Broeck D, Praet M. Prevalence and risk factors for cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of the Congo: a cross-sectional study. Infect Agent Cancer 2015; 10:20. [PMID: 26180542 PMCID: PMC4502934 DOI: 10.1186/s13027-015-0015-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 06/25/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cancer of the uterine cervix is the leading cause of cancer-related death among women in Sub-Saharan Africa, but information from the Democratic Republic of the Congo (DRC) is scarce. The study objectives were to: 1/ assess prevalence of (pre)cancerous cervical lesions in adult women in Kinshasa, 2/ identify associated socio-demographic and behavioural factors and 3/ describe human papillomavirus (HPV) types in cervical lesions. METHODS A cross-sectional study was conducted in Kinshasa. Between 2006 and 2013, four groups of women were recruited. The first two groups were included at HIV screening centres. Group 1 consisted of HIV-positive and group 2 of HIV-negative women. Group 3 was included in large hospitals and group 4 in primary health centres. Pap smears were studied by monolayer technique (Bethesda classification). Low- or high-grade squamous intraepithelial lesions or carcinoma were classified as LSIL+. HPV types were determined by INNO-LiPA®. Bivariate and multivariable analyses (logistic regression and generalised estimating equations (GEE)) were used to assess associations between explanatory variables and LSIL+. RESULTS LSIL+ lesions were found in 76 out of 1018 participants. The prevalence was 31.3 % in group 1 (n = 131 HIV-positive women), 3.9 % in group 2 (n = 128 HIV-negative women), 3.9 % in group 3 (n = 539) and 4.1 % in group 4 (n = 220). The following variables were included in the GEE model but did not reach statistical significance: history of abortion, ≥3 sexual partners and use of chemical products for vaginal care. In groups 3 and 4 where this information was available, the use of plants for vaginal care was associated with LSIL+ (adjusted OR 2.70 (95 % confidence interval 1.04 - 7.01). The most common HPV types among HIV-positive women with ASCUS+ cytology (ASCUS or worse) were HPV68 (12 out of 50 samples tested), HPV35 (12/50), HPV52 (12/50) and HPV16 (10/50). Among women with negative/unknown HIV status, the most common types were HPV52 (10/40), HPV35, (6/40) and HPV18 (5/40). CONCLUSION LSIL+ lesions are frequent among women in Kinshasa. The use of plants for vaginal care deserves attention as a possible risk factor for LSIL+. In this setting, HPV16 is not the most frequent genotype in samples of LSIL+ lesions.
Collapse
Affiliation(s)
- Catherine Ali-Risasi
- />Laboratory of Anatomopathology, General Reference Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
- />N.Goormaghtigh Institute of Pathology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - Kristien Verdonck
- />Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium
| | - Elizaveta Padalko
- />Department of Microbiology, Clinical Chemistry and Immunology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
- />Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building D, Diepenbeek, Belgium
| | - Davy Vanden Broeck
- />International Centre for Reproductive Health, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - Marleen Praet
- />N.Goormaghtigh Institute of Pathology, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
| |
Collapse
|
15
|
Ogembo RK, Gona PN, Seymour AJ, Park HSM, Bain PA, Maranda L, Ogembo JG. Prevalence of human papillomavirus genotypes among African women with normal cervical cytology and neoplasia: a systematic review and meta-analysis. PLoS One 2015; 10:e0122488. [PMID: 25875167 PMCID: PMC4396854 DOI: 10.1371/journal.pone.0122488] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/22/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several meta-analyses confirmed the five most prevalent human papillomavirus (HPV) strains in women with and without cervical neoplastic diseases are HPV16, 18, 31, 52, and 58. HPV16/18 are the predominant oncogenic genotypes, causing approximately 70% of global cervical cancer cases. The vast majority of the women studied in previous analyses were from Europe, North America, Asia, and most recently Latin America and the Caribbean. Despite the high burden of cervical cancer morbidity and mortality in Africa, a robust meta-analysis of HPV genotype prevalence and distribution in African women is lacking. METHODS AND FINDINGS We systematically searched 14 major databases from inception to August 2013 without language restriction, following the Meta-Analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-one studies from 23 African countries were identified after screening 1162 citations and data abstracted and study quality appraised from 195 articles. HPV type-specific prevalence and distribution was estimated from 17,273 cases of women with normal cervical cytology; 1019 women with atypical squamous cells of undetermined significance (ASCUS); 1444 women with low-grade squamous intraepithelial lesion (LSIL); 1571 women with high-grade squamous intraepithelial lesion (HSIL); and 4,067 cases of invasive cervical carcinoma (ICC). Overall prevalence of HPV16/18 were 4.4% and 2.8% of women with normal cytology, 12.0% and 4.4% with ASCUS, 14.5% and 10.0% with LSIL, 31.2% and 13.9% with HSIL, and 49.7% and 18.0% with ICC, respectively. Study limitations include the lack of adequate data from Middle and Northern African regions, and variations in the HPV type-specific sensitivity of different genotyping protocols. CONCLUSIONS To our knowledge, this study is the most comprehensive assessment of the overall prevalence and distribution of HPV genotypes in African women with and without different cervical neoplasias. We have established that HPV16/18 account for 67.7% of ICC cases among African women. Based on our findings, we highly recommend the administration of existing prophylactic vaccines to younger women not infected with HPV16/18 and an increase in HPV screening efforts for high-risk genotypes to prevent cervical cancer. REVIEW REGISTRATION International Prospective Register of Systematic Reviews CRD42013006558.
Collapse
Affiliation(s)
- Rebecca Kemunto Ogembo
- Northeastern University, Boston, MA, United States of America
- University of Massachusetts Medical School, Worcester, MA, United States of America
| | | | | | - Henry Soo-Min Park
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Paul A. Bain
- Countway Library of Harvard Medical School, Boston, MA, United States of America
| | - Louise Maranda
- University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Javier Gordon Ogembo
- University of Massachusetts Medical School, Worcester, MA, United States of America
- * E-mail:
| |
Collapse
|
16
|
De Vuyst H, Alemany L, Lacey C, Chibwesha CJ, Sahasrabuddhe V, Banura C, Denny L, Parham GP. The burden of human papillomavirus infections and related diseases in sub-saharan Africa. Vaccine 2014; 31 Suppl 5:F32-46. [PMID: 24331746 DOI: 10.1016/j.vaccine.2012.07.092] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/06/2012] [Accepted: 07/10/2012] [Indexed: 11/17/2022]
Abstract
Despite the scarcity of high quality cancer registries and lack of reliable mortality data, it is clear that human papillomavirus (HPV)-associated diseases, particularly cervical cancer, are major causes of morbidity and mortality in sub-Saharan Africa (SSA). Cervical cancer incidence rates in SSA are the highest in the world and the disease is the most common cause of cancer death among women in the region. The high incidence of cervical cancer is a consequence of the inability of most countries to either initiate or sustain cervical cancer prevention services. In addition, it appears that the prevalence of HPV in women with normal cytology is higher than in more developed areas of the world, at an average of 24%. There is, however, significant regional variation in SSA, with the highest incidence of HPV infection and cervical cancer found in Eastern and Western Africa. It is expected that, due to aging and growth of the population, but also to lack of access to appropriate prevention services and the concomitant human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic, cervical cancer incidence and mortality rates in SSA will rise over the next 20 years. HPV16 and 18 are the most common genotypes in cervical cancer in SSA, although other carcinogenic HPV types, such as HPV45 and 35, are also relatively more frequent compared with other world regions. Data on other HPV-related anogenital cancers including those of the vulva, vagina, anus, and penis, are limited. Genital warts are common and associated with HPV types 6 and 11. HIV infection increases incidence and prevalence of all HPV-associated diseases. Sociocultural determinants of HPV-related disease, as well as the impact of forces that result in social destabilization, demand further study. Strategies to reduce the excessive burden of HPV-related diseases in SSA include age-appropriate prophylactic HPV vaccination, cervical cancer prevention services for women of the reproductive ages, and control of HIV/AIDS. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Sub-Saharan Africa Region" Vaccine Volume 31, Supplement 5, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
Collapse
Affiliation(s)
- Hugo De Vuyst
- Infection and Cancer Epidemiology Group, International Agency for Research on Cancer (WHO-IARC), Lyon, France
| | - Laia Alemany
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Institut Català d'Oncologia - Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Charles Lacey
- Centre for Immunology and Infection, Hull York Medical School, University of York, York, UK
| | - Carla J Chibwesha
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A and Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Vikrant Sahasrabuddhe
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cecily Banura
- Department of Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lynette Denny
- Department of Obstetrics and Gynaecology and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, UNC Global Women's Health, University of North Carolina - Chapel Hill, North Carolina, USA.
| |
Collapse
|
17
|
Padalko E, Van Renterghem L, Bamelis M, De Mey A, Sturtewagen Y, Vastenavond H, Weyers S, Praet M. Prospective evaluation of E6/E7 mRNA detection by the NucliSENS Easy Q HPV assay in a stepwise protocol. J Med Virol 2013; 85:1242-9. [PMID: 23918543 DOI: 10.1002/jmv.23591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 11/05/2022]
Abstract
The objective of the study was to evaluate prospectively the added value of E6/E7 mRNA detection in a stepwise protocol. A total of 1,422 samples were collected over a period of 17 months. The samples were referred for human papillomavirus (HPV) genotyping if they showed cytological evidence of atypical squamous cells of undetermined significance, low- or high-grade squamous intraepithelial lesion. If one or more of HPV types 16, 18, 31, 33, or 45 were present, mRNA was analyzed by the NucliSENS EasyQ HPV assay. The genotypical distribution of high-risk HPV was very heterogeneous; HPV 16, 18, 31, 33, and 45 represented 20.2%, 3.4%, 10.8%, 3.4%, and 3.8% of HPV-positive samples, respectively. Follow-up data were available for 35 patients. Although over the half (51.4%) of follow-up samples showing HPV DNA/mRNA consensus evolved to cervical intraepithelial neoplastic lesions, 25.7% showed no progression to neoplasia despite mRNA positivity. However, the major concern was the group (14.3%) that showed progression to cervical intraepithelial neoplasia despite mRNA negativity: all but one of these cases had a high-risk HPV genotype other than the five included in the NucliSENS EasyQ HPV assay. Markedly, 66.7% of the discordant samples between colposcopy and histology that underestimated the degree of cervical dysplasia were found in this group. Close monitoring of high-risk HPV DNA-positive/mRNA-negative cases remains necessary, which leads to questions about the added value of the evaluated protocol.
Collapse
Affiliation(s)
- Elizaveta Padalko
- Laboratory of Clinical Biology, Ghent University Hospital, Ghent, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Malisic E, Jankovic R, Brotto K, Radulovic S. TP53 codon 72 polymorphism and risk of cervical carcinoma in Serbian women. Arch Gynecol Obstet 2013; 288:621-5. [PMID: 23483183 DOI: 10.1007/s00404-013-2783-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 02/28/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE It was shown that individuals homozygous for the Arg-encoding allele of codon 72 TP53 gene may have an increased risk to human papillomavirus (HPV)-related cervical carcinomas. However, many studies have failed to confirm this hypothesis. The aim of this study was to investigate a role of the TP53 codon 72 polymorphism in cervical carcinoma development in Serbian women. METHODS In comparative, prospective study, we analyzed 49 wild type TP53 gene cervical carcinomas samples and 74 cervical smears of gynecologically healthy women. DNA was extracted by salting-out procedure. Codon 72 polymorphism was assessed by Restriction Fragment-Length Polymorphism method. Presence of HPV infection was detected through amplification of one part of L1 viral gene. χ(2) and odds ratio were used for statistical analysis. RESULTS The distribution of Arg/Arg, Arg/Pro, and Pro/Pro genotypes of codon 72 of TP53 gene was: 63.3, 34.7, and 2.0 % in the cervical carcinomas and 58.1, 33.8, and 8.1 % in the control group. We observed an increased risk for the development of cervical carcinoma for Arg homozygotes in relation to heterozygotes plus Pro homozygotes (OR 1.24; 95 % CI 0.59-2.61) and higher one for Arg/Arg plus Arg/Pro genotype in relation to Pro homozygotes (OR 4.24; 95 % CI 0.49-36.32). CONCLUSIONS The results indicate that carriers of Arg allele of codon 72 TP53 gene have an increased risk for development of cervical carcinoma in Serbian women. However, the influence is not statistically significant and requires analysis of larger case-control group.
Collapse
Affiliation(s)
- Emina Malisic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
| | | | | | | |
Collapse
|
19
|
De Vuyst H, Mugo NR, Chung MH, McKenzie KP, Nyongesa-Malava E, Tenet V, Njoroge JW, Sakr SR, Meijer CM, Snijders PJF, Rana FS, Franceschi S. Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya. Br J Cancer 2012; 107:1624-30. [PMID: 23033006 PMCID: PMC3493776 DOI: 10.1038/bjc.2012.441] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women. Methods: Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy. Results: In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). CD4 count was negatively associated with prevalence of hrHPV (P<0.001) and CIN2/3 among non-users of cART (P=0.013). Combination antiretroviral therapies users (⩾2 year) had lower hrHPV prevalence (prevalence ratio (PR) vs non-users=0.77, 95% confidence interval (CI): 0.61–0.96) and multiple infections (PR=0.68, 95% CI: 0.53–0.88), but not fewer CIN2/3. The positive predictive value of hrHPV-positivity for CIN2/3 increased from 28.9% at age <35 years to 53.3% in ⩾45 years. Conclusion: The burden of hrHPV and CIN2/3 was high and it was related to immunosuppression level. Combination antiretroviral therapies ( ⩾2 year) use had a favourable effect on hrHPV prevalence but cART in our population may have been started too late to prevent CIN2/3.
Collapse
Affiliation(s)
- H De Vuyst
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, Lyon, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|