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Seven years prevalence and distribution of high and low risk HPV genotypes in women living in the metropolitan area of Naples. Cancer Epidemiol 2019; 63:101625. [DOI: 10.1016/j.canep.2019.101625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/15/2019] [Accepted: 10/18/2019] [Indexed: 11/24/2022]
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Mennini FS, Fabiano G, Marcellusi A, Sciattella P, Saia M, Cocchio S, Baldo V. Burden of Disease of Human Papillomavirus (HPV): Hospitalizations in the Marche and Veneto Regions. An observational study. Clin Drug Investig 2018; 38:173-180. [PMID: 29081028 DOI: 10.1007/s40261-017-0597-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES HPV (human papillomavirus) is the virus most often responsible for sexually transmitted infections. The burden of HPV-related diseases on hospital resources represents a major public health problem. The aim of this study was to assess the economic burden of HPV-related diseases (anal cancer, genital cancer, genital warts, oropharyngeal cancer) on hospital resources in two Italian regions. METHODS A retrospective, non-randomized, observational study was developed in the Marche and Veneto Regions, based on patients receiving hospitalization between 2008 and 2011. All hospitalizations were identified through administrative archives, according to the International Classification of Diseases (ICD-9 CM) to which a defined tariff was assigned. RESULTS We identified 5299 hospitalized patients in Veneto and 1735 in the Marche Region. The mean annual hospitalization rate was 49.44 per 100,000 individuals in Veneto and 48.41 in Marche. The total mean annual cost attributable to HPV-related diseases was €5.78 (SD 0.80) million in Veneto and €2.24 (SD 0.17) million in Marche. Costs associated with genital cancer amounted to €1.61 million in Veneto and €1.06 million in Marche (28% and 47% of the total mean annual cost, respectively). Oropharyngeal cancer accounted for 36% in Veneto (€2.08 million) and 28% in Marche (€632,645). Hospitalization costs related to anal cancer were €882,567 in Veneto and €377,719 in Marche; genital warts accounted for €1.19 million in Veneto and €171,406 in Marche. Finally, the mean cost per patient was €4364 in Veneto and €5176 in Marche. CONCLUSIONS The present work estimated the cost of HPV-related diseases for hospitalized patients in two Italian regions. The considerable estimated annual economic burden is a powerful driver for the governance of the public health sector.
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Affiliation(s)
- Francesco Saverio Mennini
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome 'Tor Vergata', Via Columbia, 2, Roma, RM, Italy.,Institute of Leadership and Management in Health, Kingston University, London, UK
| | - Gianluca Fabiano
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome 'Tor Vergata', Via Columbia, 2, Roma, RM, Italy.,Institute of Leadership and Management in Health, Kingston University, London, UK
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome 'Tor Vergata', Via Columbia, 2, Roma, RM, Italy. .,Institute of Leadership and Management in Health, Kingston University, London, UK. .,Consiglio Nazionale delle Ricerche (CNR), Istituto di Richerche sulla Popolazione e le Politiche Sociali (IRPPS), Rome, Italy.
| | - Paolo Sciattella
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome 'Tor Vergata', Via Columbia, 2, Roma, RM, Italy
| | - Mario Saia
- Net, Veneto Region Health Directorate, Venezia, Italy
| | - Silvia Cocchio
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, Institute of Hygiene, University of Padua, Via Loredan, 18, 35121, Padova, Italy
| | - Vincenzo Baldo
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, Institute of Hygiene, University of Padua, Via Loredan, 18, 35121, Padova, Italy
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Puerto D, Reyes V, Lozano C, Buitrago L, Garcia D, Murillo RH, Muñoz N, Hernandez GA, Sanchez L, Wiesner C, Combita AL. Detection and Genotyping of HPV DNA in a Group of Unvaccinated Young Women from Colombia: Baseline Measures Prior to Future Monitoring Program. Cancer Prev Res (Phila) 2018; 11:581-592. [PMID: 29991579 DOI: 10.1158/1940-6207.capr-17-0439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/12/2018] [Accepted: 06/22/2018] [Indexed: 11/16/2022]
Abstract
In 2012, Colombia launched human papillomavirus (HPV) vaccination program for girls ages 9 to 12, and in 2013, the target age was expanded to 9 to 17 years. Monitoring the changes of HPV infection prevalence among young women has been proposed as an endpoint for early assessment of HPV vaccination programs. However, the data on HPV prevalence in young ages are very limited. The purpose of this study was to determine the prevalence of HPV infection and the distribution of genotypes in a group of nonvaccinated women ages 18 to 25 years old in three Colombian cities as baseline for the monitoring of the HPV national vaccination program. A total of 1,782 sexually active women were included. Cervical smear samples were collected to perform the Pap smear and HPV DNA detection using a Linear Array HPV assay. Of the 1,782 specimens analyzed, 60.3% were positive for any HPV type; 42.2% were positive for high-risk HPV (HR-HVP) types, and 44.4% for low-risk HPV (LR-HPV) types. Multiple and single infections were identified in 37.1% and 23.2% of samples, respectively. HR-HPV types -16, -52, and -51 were the most predominant with proportions of 11.3%, 7.92%, and 7.9%, correspondingly. The prevalence for HR-HPV 16/18 was 14.4%. HR-HPV prevalence in women with abnormal cytology (75.16%) was higher than in women with normal cytology (38.6%). In conclusion, a high prevalence of HR-HPV was observed among younger women. This HPV type-specific prevalence baseline may be used to monitor postvaccination longitudinal changes and to determine its impact on HPV-related disease incidence in Colombia population. Cancer Prev Res; 11(9); 581-92. ©2018 AACR.
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Affiliation(s)
- Devi Puerto
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Viviana Reyes
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Cristina Lozano
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Lina Buitrago
- Unidad de Análisis, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Diego Garcia
- Grupo Enfermedades Transmisibles-PAI, Ministerio de Salud y Protección Social, Colombia
| | - Raúl H Murillo
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Nubia Muñoz
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Gustavo A Hernandez
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Laura Sanchez
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Carolina Wiesner
- Grupo de Investigación en Salud Pública y Epidemiología, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Alba L Combita
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia. .,Departamento de Microbiología. Facultad de Medicina. Universidad Nacional de Colombia. Bogotá, Colombia
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Prevalence of human papillomavirus infection and genotyping for population-based cervical screening in developed regions in China. Oncotarget 2018; 7:62411-62424. [PMID: 27566561 PMCID: PMC5308736 DOI: 10.18632/oncotarget.11498] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/28/2016] [Indexed: 01/06/2023] Open
Abstract
We conducted a cross-sectional analysis to assess the distribution of human papillomavirus (HPV) types and explored an acceptable strategy for cervical screening in Shenzhen, China. A total of 2717 individuals ranging in age from 30–59 years were recruited. Clinical sensitivity and specificity as well as positive (PPV) and negative (NPV) predictive values were estimated. A triage strategy was regarded as acceptable when the NPV was at least 98.0%. 432 (15.9%) participants presented HPV positive. The five most prevalent HPV types were HPV52 (22.9%), HPV16 (12.7%), HPV53 (10.0%), HPV51 (8.6%), and HPV58 (8.1%). The CIN2+ risks for each HPV type were 40.0% for HPV33, 32.4% for HPV16, 18.2% for HPV58, 13.3% for HPV56, and 11.1% for HPV68 in descending order. Baseline cytology testing combined with HPV16/33/52/58 genotyping met the NPV thresholds at 98.6% with a PPV of 17.9%, demonstrating excellent clinical performance for detecting HPV types in CIN2+ patients. In conclusion, triaging HPV-positive women by baseline cytology combined with HPV16/58/33/52 genotyping is an acceptable strategy for cervical cancer screening in Shenzhen, China.
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Carozzi F, Puliti D, Ocello C, Anastasio PS, Moliterni EA, Perinetti E, Serradell L, Burroni E, Confortini M, Mantellini P, Zappa M, Dominiak-Felden G. Monitoring vaccine and non-vaccine HPV type prevalence in the post-vaccination era in women living in the Basilicata region, Italy. BMC Infect Dis 2018; 18:38. [PMID: 29334901 PMCID: PMC5769466 DOI: 10.1186/s12879-018-2945-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/04/2018] [Indexed: 11/15/2022] Open
Abstract
Background A large free-of-charge quadrivalent HPV (qHPV) vaccination program, covering four cohorts annually (women 11, 14, 17 and 24 years), has been implemented in Basilicata since 2007. This study evaluated vaccine and non-vaccine HPV prevalence 5-7 years post-vaccination program implementation in vaccinated and unvaccinated women. Methods This population-based, cross-sectional study was conducted in the public screening centers of the Local Health Unit in Matera between 2012 and 2014. Cervical samples were obtained for Pap and HPV testing (HC2, LiPA Extra® assay) and participants completed a sociodemographic and behavioral questionnaire. Detailed HPV vaccination status was retrieved from the official HPV vaccine registry. HPV prevalence was described overall, by type and vaccination status. The association between HPV type-detection and risk/protective factors was studied. Direct vaccine protection (qHPV vaccine effectiveness [VE]), cross-protection, and type-replacement were evaluated in cohorts eligible for vaccination, by analyzing HPV prevalence of vaccine and non-vaccine types according to vaccination status. Results Overall, 2793 women (18-50 years) were included, 1314 of them having been in birth cohorts eligible for the HPV vaccination program (18- to 30-year-old women at enrolment). Among the latter, qHPV vaccine uptake was 59% (at least one dose), with 94% completing the schedule; standardized qHPV type prevalence was 0.6% in vaccinated versus 5.5% in unvaccinated women (P <0.001); adjusted VE against vaccine type infections was 90% (95% CI: 73%-96%) for all fully vaccinated women and 100% (95% CI not calculable) in women vaccinated before sexual debut. No statistically significant difference in overall high-risk HPV, high-risk non-vaccine HPV, or any single non-vaccine type prevalence was observed between vaccinated and unvaccinated women. Conclusions These results, conducted in a post-vaccine era, suggest a high qHPV VE and that a well-implemented catch-up vaccination program may be efficient in reducing vaccine-type infections in a real-world setting. No cross-protective effect or evidence of type-replacement was observed a few years after HPV vaccine introduction. Electronic supplementary material The online version of this article (10.1186/s12879-018-2945-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesca Carozzi
- Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | - Donella Puliti
- Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | - Cristina Ocello
- Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | | | | | - Emilia Perinetti
- Medical and Scientific Department, Sanofi-Pasteur MSD, Rome, Italy
| | - Laurence Serradell
- Franchise Development, Sanofi-Pasteur MSD, 162 avenue Jean-Jaurès, CS 50712 69367, Cedex 07, Lyon, France
| | - Elena Burroni
- Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | - Massimo Confortini
- Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | - Paola Mantellini
- Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | - Marco Zappa
- Istituto per lo Studio e la Prevenzione Oncologica (ISPO), Florence, Italy
| | - Géraldine Dominiak-Felden
- Franchise Development, Sanofi-Pasteur MSD, 162 avenue Jean-Jaurès, CS 50712 69367, Cedex 07, Lyon, France.
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Moga MA, Irimie M, Oanta A, Pascu A, Burtea V. Type-specific prevalence of human papillomavirus by cervical cytology among women in Brasov, Romania. Asian Pac J Cancer Prev 2015; 15:6887-92. [PMID: 25169541 DOI: 10.7314/apjcp.2014.15.16.6887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The oncogenic role of human papillomavirus (HPV) in triggering cervical cancer, the second most common cancer in women worldwide, is well established. Romania ranks in first place in Europe in terms of the incidence of cervical cancer. Geographical widespread data on HPV type-distribution are essential for estimating the impact of HPV vaccines and cervical cancer screening programmes. In this study we aimed to identify the prevalence of HPV genotypes and to establish correlations with abnormal cervical cytology among the female population of Brasov County, Romania. A total of 1,000 women aged 17.3-57 years, attending routine cervical examination in the Obstetrics and Gynecology Hospital of Brasov, Romania, and undergoing both cytological examination and HPV genotyping were screened. Infection with 35 different HPV genotypes was detected in 39.6% of cytological specimens. Overall HPV infections were highest in young women under 25 years (p<0.0001), in which cervical cytological abnormalities also reached the highest prevalence. Patients infected by HPV-16 or HPV-18 showed the highest prevalence of cervical cytological abnormalities. Some 48.2% of women with abnormal cytology were infected with high-risk HPV types whereas less than 3% of them were infected only with low-risk HPV types. Our study showed that the prevalence of high-risk HPV infection among Romanian women is higher compared to other studies in other geographic areas. Thus, we consider that in areas where there is an increased prevalence of high-risk HPV infections, HPV genotyping should be performed in all women aged between 18 and 45 years, and Pap test should be performed every 6 months in women with high-risk HPV infection, even those with previous normal cervical cytology.
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Meloni A, Pilia R, Campagna M, Usai A, Masia G, Caredda V, Coppola RC. Prevalence and molecular epidemiology of human papillomavirus infection in italian women with cervical cytological abnormalities. J Public Health Res 2014; 3:157. [PMID: 25170506 PMCID: PMC4140382 DOI: 10.4081/jphr.2014.157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/24/2013] [Accepted: 10/02/2013] [Indexed: 01/01/2023] Open
Abstract
Background Human papillomavirus (HPV) infection is the most common sexually transmitted infection and high-risk HPV types are a necessary cause for the development of cervical cancer. The present study investigated the HPV-type specific prevalence in 650 women, aged 15-76 years, with cytological abnormalities and the association between HPV infection and cervical disease in a subset of 160 women for whom cytological results for Pap-Test were available, during the period 2008-2011 in Cagliari (Southern Italy). Design and Methods HPV-DNA extraction was performed by lysis and digestion with proteinase K and it was typed by using the INNOLiPA HPV Genotyping Assay. Results Overall the HPV prevalence was 52.6%; high-risk genotypes were found in 68.9% of women and multiple-type infection in 36.1% of HPV-positive women. The commonest types were HPV-52 (23.4%), HPV-53 (15.7%), HPV-16 (15.4%) and HPV-6 (12.4%). Among the women with cytological diagnosis, any-type of HPV DNA was found in 49.4% of the samples and out of these 93.7% were high-risk genotypes. Genotype HPV 53 was the commonest type among women affected by ASCUS lesions (21.4%), genotype 52 in positive L-SIL cases (22.5%), genotype 16 H-SIL (27.3%). Conclusions This study confirmed the high prevalence of HPV infection and high-risk genotypes among women with cervical abnormalities while, unlike previously published data, genotype HPV-52 was the most common type in our series. These data may contribute to increase the knowledge of HPV epidemiology and designing adequate vaccination strategies. Significance for public health Human papillomavirus (HPV) is the most common sexually-transmitted agent, which can cause cervical lesions and cancer in females. Efforts to reduce the burden of cervical cancer with cytology screening in the last years have had limited success. HPV infection and disease imposes a substantial burden of direct costs on the Italian National Health Service that have never been fully quantified. Monitoring HPV prevalence could represent a tool to follow the evolution of the infection in the vaccination and post-vaccination era, to understand the impact of HPV types in cervical diseases in Italy. Our survey shows an high frequency of infections sustained by HPV 52. Given the recent implementation of a widespread immunization program with vaccines not containing HPV 52, it has been relevant to prove the high prevalence of this HPV genotype from the beginning of the vaccination campaign, to avoid ascribing to the vaccination program a possible selection effect and the importance of non-vaccine HPV types in the burden of cervical disease, in order to assess the opportunity to realize new vaccine including other types.
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Affiliation(s)
- Angelo Meloni
- Section of Hygiene, Department of Public Health, Molecular and Clinical Medicine, Cagliari University , Italy
| | - Roberta Pilia
- Section of Hygiene, Department of Public Health, Molecular and Clinical Medicine, Cagliari University , Italy
| | - Marcello Campagna
- Section of Hygiene, Department of Public Health, Molecular and Clinical Medicine, Cagliari University , Italy
| | - Antonella Usai
- Section of Hygiene, Department of Public Health, Molecular and Clinical Medicine, Cagliari University , Italy
| | - Giuseppina Masia
- Section of Hygiene, Department of Public Health, Molecular and Clinical Medicine, Cagliari University , Italy
| | - Valeria Caredda
- Centre for Women Health, Local Health District of Cagliari , Italy
| | - Rosa Cristina Coppola
- Section of Hygiene, Department of Public Health, Molecular and Clinical Medicine, Cagliari University , Italy
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Baudu A, Prétet JL, Riethmuller D, Chotard M, Mougin C, Mercier M. Prevalence and risk factors of human papillomavirus infection types 16/18/45 in a cohort of French females aged 15-23 years. J Epidemiol Glob Health 2014; 4:35-43. [PMID: 24534334 PMCID: PMC7320404 DOI: 10.1016/j.jegh.2013.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 10/19/2013] [Accepted: 11/29/2013] [Indexed: 11/18/2022] Open
Abstract
Investigation of the prevalence and risk factors of human papillomavirus (HPV) infection is the basis for developing prophylactic strategies against cervical cancer, especially for young women. This study aimed to assess the prevalence and risk factors of HPV infection among a cohort of sexually active young French women eligible for catch-up vaccination. Between 1997 and 2007, 2163 women aged 15-23 years attending consultations at the department of gynecology in the Hospital of Besançon (France) were screened for high risk HPV (HR HPV) infection. Risk factors were investigated through a questionnaire sent to all participants in 2010. HPV DNA was detected by HC2 and Probe Set assays. The overall prevalence for HR HPV and HPV16, 18 and/or HPV45 was 44.6% (95% CI, 42.5-46.7%) and 19% (95% CI, 17.3-20.7%), respectively. The response rate to the questionnaire was 22.6%. The prevalence of independent risk factors (age older than 19, smoking, and oral contraception) for HPV 16/18/45 infection in this population was less than 20%. Based on this study, HPV vaccination should be offered not only to teenage girls, but also to young women, regardless of their sexual activity.
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Affiliation(s)
- Ariane Baudu
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France
| | - Jean-Luc Prétet
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France
| | - Didier Riethmuller
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France
| | - Morgane Chotard
- EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France
| | - Christiane Mougin
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France.
| | - Mariette Mercier
- Univ Franche-Comte, F-25000 Besancon, France; EA 3181, FED4234, F-25000 Besancon, France; CHU Besancon, F-25000, France
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Prevalence of human papillomavirus in young Italian women with normal cytology: how should we adapt the national vaccination policy? BMC Infect Dis 2013; 13:575. [PMID: 24313984 PMCID: PMC4029487 DOI: 10.1186/1471-2334-13-575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 12/02/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) is the most common sexually transmitted infection. In Italy, HPV vaccination is now offered free of charge to 12-year-old females. However, some regional health authorities have extended free vaccination to other age-groups, especially to girls under 18 years of age. We conducted a multicentre epidemiological study to ascertain the prevalence of different genotypes of HPV in young Italian women with normal cytology, with the aim of evaluating the possibility of extending vaccination to older females. METHODS The study was performed in 2010. Women aged 16-26 years with normal cytology were studied. Cervical samples were analyzed to identify the presence of HPV by PCR amplification of a segment of ORF L1 (450 bp). All positive HPV-DNA samples underwent viral genotype analysis by means of a restriction fragment length polymorphism assay. RESULTS Positivity for at least one HPV genotype was found in 18.2% of the 566 women recruited: 48.1% in the 16-17 age-class, 15.4 in the 18-20 age-class, 21.9% in the 21-23 age-class, and 15.5% in the 24-26 age-class; 10.1% of women were infected by at least one high-risk HPV genotype. HPV-16 was the most prevalent genotype. Only 4 (0.7%), 4 (0.7%) and 3 (0.5%) women were infected by HPV-18, HPV-6 and HPV-11, respectively. Of the HPV-DNA-positive women, 64.1% presented only one viral genotype, while 24.3% had multiple infections. The HPV genotypes most often involved in multiple infections were high-risk. A high prevalence was noted in the first years of sexual activity (48.1% of HPV-DNA-positive women aged 16-17 years); HPV prevalence subsequently declined and stabilized.The estimate of cumulative proportions of young women free from any HPV infection at each age was evaluated; 93.3% and 97.1% of 26 year-old women proved free from HPV-16 and/or HPV-18 and from HPV-6 and/or HPV-11, respectively. CONCLUSIONS Our findings confirm the crucial importance of conducting studies on women without cytological damage, in order to optimise and up-date preventive interventions against HPV infection, and suggest that vaccinating 26-year-old females at the time of their first pap-test is to be recommend, though this issue should be further explored.
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Piana A, Sotgiu G, Cocuzza C, Musumeci R, Marras V, Pischedda S, Deidda S, Muresu E, Castiglia P. High HPV-51 prevalence in invasive cervical cancers: results of a pre-immunization survey in North Sardinia, Italy. PLoS One 2013; 8:e63395. [PMID: 23717420 PMCID: PMC3661560 DOI: 10.1371/journal.pone.0063395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/30/2013] [Indexed: 11/19/2022] Open
Abstract
Background Human Papilloma virus (HPV) is recognized as the etiological agent of benign and malignant ano-genital lesions. The most prevalent genotypes associated with cervical carcinoma are HPV-16 and -18 worldwide. However, recent studies have emphasized the role of other genotypes, such as HPV-51, in the pathogenesis of cervical dysplasia. The aim of the study was to estimate the burden of HPV-51 infection in invasive cervical malignant lesions in Northern Sardinia, Italy. Methods/Principal Findings An observational, retrospective, prevalence, mono-center study was carried out to evaluate the presence of HPV genotypes in tissues biopsies of cervical lesions (CIN-1, CIN-2, CIN-3 and invasive carcinoma) gathered from 1996 to 2009. Biological samples were collected from women admitted consecutively to a tertiary university hospital situated in Sassari, Italy. Molecular methods were used to identify 28 oncogenic HPV types. A total of 155 formalin-fixed and paraffin-embedded cervical tissue samples were analyzed. Approximately half of the cervical lesions were classified as invasive carcinoma. HPV-DNA was detected in 71% of the samples, with a higher frequency (100%) in those categorized as invasive neoplasia. Mono- or co-infections were demonstrated in 45.8% and 25.8% of the cervical samples, respectively. Overall, the most prevalent HPV types were -16 (49%) and -51 (19.4%), with an increased frequency of detection associated with the severity of the cervical lesions. Conclusions/Significance This survey highlights for the first time the relevant role of HPV-51 infection in the pathogenesis of invasive cervical cancer prior to the introduction of a vaccination program. Although a selection bias could have influenced the results, other recent studies have described the impact of HPV-51. This remarkable epidemiological element should be carefully evaluated, particularly in the view of opting for preventive vaccines, whose cross-protection patterns determine their efficacy in protecting against infection from HPV types that are not included in the vaccine itself.
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Affiliation(s)
- Andrea Piana
- Department of Biomedical Sciences, Hygiene and Preventive Medicine Unit, University of Sassari – AOU Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Department of Biomedical Sciences, Hygiene and Preventive Medicine Unit, University of Sassari – AOU Sassari, Sassari, Italy
| | - Clementina Cocuzza
- Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Milan, Italy
| | - Rosario Musumeci
- Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Milan, Italy
| | - Vincenzo Marras
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Stefania Pischedda
- Department of Biomedical Sciences, Hygiene and Preventive Medicine Unit, University of Sassari – AOU Sassari, Sassari, Italy
| | - Silvia Deidda
- Department of Biomedical Sciences, Hygiene and Preventive Medicine Unit, University of Sassari – AOU Sassari, Sassari, Italy
| | - Elena Muresu
- Department of Biomedical Sciences, Hygiene and Preventive Medicine Unit, University of Sassari – AOU Sassari, Sassari, Italy
| | - Paolo Castiglia
- Department of Biomedical Sciences, Hygiene and Preventive Medicine Unit, University of Sassari – AOU Sassari, Sassari, Italy
- * E-mail:
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Giambi C, Donati S, Carozzi F, Salmaso S, Declich S, Atti MLCD, Ronco G, Alibrandi MP, Brezzi S, Collina N, Franchi D, Lattanzi A, Minna MC, Nannini R, Barretta E, Burroni E, Gillio-Tos A, Macallini V, Pierotti P, Bella A. A cross-sectional study to estimate high-risk human papillomavirus prevalence and type distribution in Italian women aged 18-26 years. BMC Infect Dis 2013; 13:74. [PMID: 23390953 PMCID: PMC3599585 DOI: 10.1186/1471-2334-13-74] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/29/2013] [Indexed: 12/22/2022] Open
Abstract
Background Pre-vaccination information on HPV type-specific prevalence in target populations is essential for designing and monitoring immunization strategies for cervical cancer (CC) prevention. Data on HPV prevalence in Italy are available for women over the age of 24 years, target of the population-based CC screening programmes; while data of HPV prevalence in younger ages are very limited. The present study enrolled Italian women aged 18–26 years in order to assess the prevalence and distribution of high-risk (HR) HPV types. Risk-factors correlated with HR-HPV positivity were also described. Methods A sample of 2,289 women was randomly selected from the resident population lists of ten Local Health Units (LHUs) located in six Italian Regions scattered across the country; both rural and urban LHUs were involved. Women aged between 18 and 26 years and living in the selected LHUs were included in the study; pregnant women and women who did not speak Italian were excluded. A total of 1,102 women met the inclusion criteria and agreed to participate. Participants were offered pap test and Hybrid-Capture 2 (HC2) test for HR-HPV types and genotyping was performed on positive smears. Results Out of 1,094 valid samples, 205 (18.7%) were HR-HPV positive. Women with 2–4 (ORadj = 4.15, 95%CI: 2.56-6.72) and ≥5 lifetime partners (ORadj = 10.63, 95%CI: 6.16-18.36) and women who have used any contraceptive in the last six months (ORadj = 1.67, 95%CI: 1.09-2.54) had a higher risk to be infected; women living with their partner had a lower risk (ORadj = 0.56, 95%CI: 0.34-0.92) to acquire infection than women living with parents/friends/alone. Among HC2 positive women, HPV16 was the most prevalent type (30.9%), followed by 31 (19.6%), 66 (12.9%), 51 (11.3%), 18 (8.8%), 56 (8.8%). Co-infections of HR-HC2 targeted types were found in 20.4% of positive samples. The HR-HPV prevalence in women with abnormal cytology (52.4%) was significantly higher than in women with normal cytology (14.6%); however 33.0% of HR-HPV infected women had an abnormal cytology. Conclusion HR-HPV prevalence in Italian women aged 18–26 years was 19%, higher than what detected for older women, by other studies using the same molecular method and laboratory network; this result supports the choice of electing girls before the sexual debut as the primary target of HPV vaccination. The HPV type distribution found in this study may represent a baseline picture; an accurate post-vaccine surveillance is necessary to early detect a possible genotype replacement. The high prevalence of viral types other than vaccine-HPV types supports the necessity to guarantee the progression of CC screening programmes in vaccinated women.
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Affiliation(s)
- Cristina Giambi
- Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion; Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
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Castellsagué X, Iftner T, Roura E, Vidart JA, Kjaer SK, Bosch FX, Muñoz N, Palacios S, Rodriguez MSM, Serradell L, Torcel-Pagnon L, Cortes J. Prevalence and genotype distribution of human papillomavirus infection of the cervix in Spain: The CLEOPATRE study. J Med Virol 2012; 84:947-56. [DOI: 10.1002/jmv.23282] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Piana A, Sotgiu G, Castiglia P, Pischedda S, Cocuzza C, Capobianco G, Marras V, Dessole S, Muresu E. Prevalence and type distribution of human papillomavirus infection in women from North Sardinia, Italy. BMC Public Health 2011; 11:785. [PMID: 21989375 PMCID: PMC3208589 DOI: 10.1186/1471-2458-11-785] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 10/11/2011] [Indexed: 12/04/2022] Open
Abstract
Background Human papillomavirus (HPV) has been associated with several disorders of the genital tract, skin and oropharynx. The aims of our study were to evaluate the prevalence of HPV infection in women between 15 and 54 years of age in North Sardinia, Italy, to identify the prevalence of High Risk - Human papillomaviruses (HR-HPV) genotypes and to establish a correlation between molecular and cytological results. Methods From 2007 to 2009 we consecutively enrolled women aged 15-54 years admitted to public and private outpatient settings. All the participants filled in a questionnaire about the socio-cultural state, sexual activity and awareness about HPV. 323 cervical specimens were tested for HPV-DNA and HPV genotypes with INNO-LiPA HPV Genotyping CE Amp kit. Samples showing positivity to some HPV genotypes were re-tested using "in house" quantitative Real-Time PCR assays. Results Overall HPV-DNA positivity was detected in 35.9% of the women. The prevalence of HR-HPV infection among HPV positive samples was 93.1% with a specific prevalence of HPV 16, 51, 31, 53 and 18 of 54.3%, 37.9%, 10.3%, 6.9% and 5.2%, respectively. Co-infection with any HPV, HR-HPV, LR-HPV and HR/LR-HPV type was 18.3%, 14.9%, 0.9% and 2.5%, respectively; HPV 16/51 co-infection was detected in 64.6% of the HR-HPV co-infection group. The most frequent HPV-genotypes detected were 16 (32.5%) and 51 (22.7%). Among the 57 patients harboring mono-infection the most prevalent HPV genotypes were 16 (38.6%) and 31(10.5%). A multivariate analysis identified a statistical significant association between HPV infection and age and between HPV infection and previous sexual transmitted diseases. A statistically significant association between cytological cervical lesions and generic HPV exposure was identified. Conclusions To our knowledge, this is the first survey evaluating the prevalence of HPV infection in Northern Sardinia and drawing attention to the unusual high proportion of genotype HPV 51. Given the recent implementation of a widespread immunization program with vaccines not containing HPV 51, it has been relevant to prove the high prevalence of this HPV genotype from the start of the vaccination campaign, in order to avoid in the future attributing to the vaccination program a possible selection effect (HPV replacement).
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Affiliation(s)
- Andrea Piana
- Department of Biomedical Science, Hygiene and Preventive Medicine, University of Sassari, Sassari, Italy.
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Giorgi Rossi P, Bisanzi S, Paganini I, Di Iasi A, Angeloni C, Scalisi A, Macis R, Pini MT, Chini F, Carozzi FM. Prevalence of HPV high and low risk types in cervical samples from the Italian general population: a population based study. BMC Infect Dis 2010; 10:214. [PMID: 20646310 PMCID: PMC2916912 DOI: 10.1186/1471-2334-10-214] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 07/20/2010] [Indexed: 11/17/2022] Open
Abstract
Background This multicenter study describes the type-specific prevalence of HPV infection in the general population from central and southern Italy, comparing the data with previously published Italian studies. Methods Women aged from 25 to 65 who attended cervical cancer screening in five different Italian regions were tested for HPV infection with Hybrid Capture II (HCII) low and high risk probes. Women repeating Pap-test upon unsatisfactory or positive results, or as a post-treatment and post-colposcopy follow-up analysis, were excluded from our study. High risk (HR) HPV positive samples were typed using GP5+/GP6+ primed PCR, followed by Reverse Line Blot for 18 high/intermediate risk HPV types, while low risk (LR) HPV positive samples were tested with type specific primers for HPV6 and HPV11. Results 3817 women had a valid HCII test: 350 of them (9.2%) were positive for HR probes, 160 (4.2%) for LR probes, while 57 women were positive for both. Multiple infections were detected in 97 HR HPV positive women. The most common types were HPV 16 (3%), 31 (1.2%), 51 (1%). HPV6 ranked fifth (0.6%), HPV18 ranked tenth (0.5%) and HPV11 sixteenth (0.3%). In Sardinia the prevalence of high-risk infection was 13%, significantly higher than the mean value (p < 0.00005). The distribution of the most frequent types did not significantly differ by centre (p = 0.187) and age (p = 0.085). Conclusions Because cervical cancer incidence and Pap test coverage is lower in southern than in northern Italy, a lower prevalence of high-risk infections in the general population was expected in the south. However, prevalence detected in this study for the south of the country is slightly but significantly higher than the rest of Italy. The consequence may be an epidemic of cervical cancer in the next decades if adequate screening programs are not implemented there.
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Affiliation(s)
- Paolo Giorgi Rossi
- Laziosanità-Agency for Public Health, Lazio Region, Via di S, Costanza 53, 00198-Rome, Italy.
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