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Suvanasuthi R, Therasakvichya S, Kanchanapiboon P, Promptmas C, Chimnaronk S. Analysis of precancerous lesion-related microRNAs for early diagnosis of cervical cancer in the Thai population. Sci Rep 2025; 15:142. [PMID: 39747449 PMCID: PMC11696073 DOI: 10.1038/s41598-024-84080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 12/19/2024] [Indexed: 01/04/2025] Open
Abstract
The incidence rate of cervical cancer (CC) is three times greater in Southeast Asia (SEA), where screening tests are less common than in Northern America, underlining a need for convenient self-diagnostic methods. The expression pattern of microRNAs (miRNAs) has been considered a molecular tool for non-invasive cancer diagnosis and prognosis. This study aimed at the development of the first miRNA biomarker panel for early detection of CC in Thai women. Genome-wide miRNA expression profiling was performed on cervical tissue and discharge samples from high-grade squamous intraepithelial lesion (HSIL) and adenocarcinoma in situ (AIS) subjects. Machine learning was used for handling imbalanced data and feature selection before differential expression analysis to identify significantly dysregulated miRNA panels. Pathway analysis was conducted to provide the cellular functions involved in CC progression. The study identified a shared 18-miRNA panel for both tissue and discharge, with which the prediction model distinguished HSIL and AIS from normal samples with an accuracy of 90.9%. Three dysregulated miRNAs comprised of miR-125b-1-3p, miR-487b-3p, and miR-1180-3p in CC were first described. Most of the miRNAs in the panel were down-regulated, whereas merely miR-142-3p was significantly up-regulated in HSIL and AIS, suggesting a convenient biomarker for detecting precancerous conditions. Moreover, our miRNA panel highlighted important roles played by the cell-cell interaction pathways in CC. Together, our miRNA panel hold promise as a biomarker for the early detection of cervical cancer with cervical discharge, offering the possibility for developing non-invasive diagnostic tools.
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Affiliation(s)
- Rooge Suvanasuthi
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom, 73170, Thailand
- Faculty of Science, Chulabhorn Royal Academy, Bangkok, 10210, Thailand
| | - Suwanit Therasakvichya
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Potjanee Kanchanapiboon
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Chamras Promptmas
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Sarin Chimnaronk
- Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, 73170, Thailand.
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Zhu Z, Nie X, Deng L, Ding J, Chen J, Zhu J, Yin X, Guo B, Zhang F. Regulation of cervical cancer via G15-mediated inhibition of G protein-coupled estrogen receptor. Anticancer Drugs 2024; 35:817-829. [PMID: 39018257 DOI: 10.1097/cad.0000000000001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
Cervical cancer is among the most common gynecological malignancies. G protein-coupled estrogen receptor (GPER) is involved in the development of various tumors; however, its role in cervical cancer remains unclear. We investigated whether G15, an inhibitor of GPER, can regulate its expression and affect cervical cancer progression. We examined the biological behaviors of G15-treated SiHa and HeLa cells using Cell Counting Kit-8, monoclonal proliferation, plate scratching, and Transwell invasion experiments. Western blotting was used to detect the expression of GPER, E-cadherin, N-cadherin, vimentin, Bcl-2, Bax, phosphatidylinositol-3-kinase (PI3K)/AKT, and programmed death ligand 1 (PD-L1). The expression of GPER, E-cadherin, vimentin, and PD-L1 in cervical cancer and adjacent tissues was detected using immunohistochemistry. The correlation between GPER expression and clinicopathological characteristics was analyzed. The expression of GPER in cervical cancer tissues was significantly higher than that in paracancerous tissues, and it was detected in the membrane and cytoplasm of SiHa and HeLa cells. The proliferation, migration, and invasion abilities of SiHa and HeLa cells were reduced after G15 treatment. The G15-treated groups exhibited higher expression of E-cadherin and Bax and lower expression of N-cadherin, vimentin, Bcl-2, GPER, p-PI3K, p-AKT, and PD-L1 than the control group. The expression of E-cadherin was lower and that of vimentin was higher in cancer tissues than in paracancerous tissues; PD-L1 was highly expressed in tumor and stromal cells in cancer tissues but not in paracancerous tissues. G15 functions by regulating the GPER/PI3K/AKT/PD-L1 signaling pathway and may serve as a new immunotherapy for treating patients with cervical cancer.
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Affiliation(s)
- Ziyan Zhu
- Graduate School, Hebei North University, Departments of
| | - Xinyi Nie
- Graduate School, Hebei North University, Departments of
| | - Lexiu Deng
- Graduate School, Hebei North University, Departments of
| | - Jia Ding
- Graduate School, Hebei North University, Departments of
| | | | - Jingyi Zhu
- Graduate School, Hebei North University, Departments of
| | - Xiaoxia Yin
- Pathology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Bowei Guo
- Pathology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
| | - Fan Zhang
- Pathology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China
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Teklehaimanot DA, Mekuria AD, Dadi AF, Derseh BT. Precancerous lesion determinants in women attending cervical cancer screening at public health facilities in North Shoa Zone, Amhara, Ethiopia: an unmatched case-control study. BMC Womens Health 2024; 24:271. [PMID: 38702683 PMCID: PMC11067165 DOI: 10.1186/s12905-024-03113-z] [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: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Precancerous cervical lesions develop in the transformation zone of the cervix and progress through stages known as cervical intraepithelial neoplasia (CIN) 1, 2, and 3. If untreated, CIN2 or CIN3 can lead to cervical cancer. The determinants of cervical precancerous lesions are not well documented in Ethiopia. Therefore, this study aims to find the determinants of cervical precancerous lesions among women screened for cervical cancer at public health facilities. METHODS A study conducted from January to April 2020 involved 216 women, consisting of 54 cases (positive for VIA during cervical cancer screening) and 162 controls (negative for VIA). It focused on women aged 30 to 49 undergoing cervical cancer screening. Multivariable logistic regression analysis assessed the link between precancerous lesions and different risk factors, considering a significance level of p < 0.05. RESULTS Women who used oral contraceptives for a duration exceeding five years showed a nearly fivefold increase in the likelihood of developing precancerous lesions (Adjusted Odds Ratio (AOR) = 4.75; 95% CI: 1.48, 15.30). Additionally, early age at first sexual intercourse (below 15 years) elevated the odds of developing precancerous lesions fourfold (AOR = 3.77; 95% CI: 1.46, 9.69). Furthermore, women with HIV seropositive results and a prior history of sexually transmitted infections (STIs) had 3.4 times (AOR = 3.45; 95% CI: 1.29, 9.25) and 2.5 times (AOR = 2.58; 95% CI: 1.10, 6.09) higher odds of developing cervical precancerous lesions compared to their counterparts. CONCLUSION In conclusion, women who have used oral contraceptives for over five years, started sexual activity before the age of 15 and have a history of sexually transmitted infections, including HIV, are at higher risk of developing precancerous cervical lesions. Targeted intervention strategies aimed at promoting behavioural change to prevent early sexual activity and STIs are crucial for avoiding cervical precancerous lesions. It is crucial to introduce life-course principles for female adolescents early on, acknowledging the potential to prevent and control precancerous lesions at critical stages in life, from early adolescence to adulthood, encompassing all developmental phases.
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Affiliation(s)
| | - Abinet Dagnaw Mekuria
- Department of Public Health, Asrat Woldeyes Health Sciences Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abel Fekadu Dadi
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Behailu Tariku Derseh
- Department of Public Health, Asrat Woldeyes Health Sciences Campus, Debre Berhan University, Debre Berhan, Ethiopia.
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
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Supindham T, Tangmunkongvorakul A, Aurpibul L, Sripan P, Utaipat U, Hongjaisee S, Srithanaviboonchai K. Prevalence and Genotypic Diversity of Human Papillomavirus Infection Among Male and Female Sex Workers in Thailand. Sex Transm Dis 2023; 50:827-833. [PMID: 37824263 DOI: 10.1097/olq.0000000000001875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) is associated with cancer. Female sex workers (FSWs) are known to be at risk for HPV, but little is known about male sex workers (MSWs). METHODS We examined HPV prevalence and associated risk factors in both populations. During 2022, HPV testing using vaginal or penile samples, HIV testing, and interviews were performed among 100 MSWs and 100 FSWs in Chiang Mai, Thailand. RESULTS The prevalence of all HPV types was 63.5% (66% in MSW, 61% in FSW), HPV-16 prevalence was 14%, HPV-52 was 13%, and HPV-18 was 4%. There was no difference between MSW and FSW for these subtypes. The prevalence of HPV-16 or HPV-18 was 17%, and for HPV-16, HPV-18, or HPV-52, it was 26%. HIV-positive participants had a higher prevalence of all HPV types (94% vs. 60%, P = 0.004), HPV-16 or HPV-18 (39% vs. 15%, P = 0.018), and HPV-16, HPV-18, or HPV-52 (50% vs. 23%, P = 0.017). CONCLUSIONS We demonstrated an equally high HPV prevalence across the sexes. Further studies are needed to determine if this indicates an equal risk for cancer. Increased HPV awareness, screening, and vaccination should be considered, regardless of gender.
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Hurtado-Salgado E, Ortiz-Panozo E, Salmerón J, Luna-Gordillo R, Allen-Leigh B, Saavedra-Lara N, Franco EL, Lazcano-Ponce E. Prevalence of cervical human papillomavirus in Mexico, 2010-2017: analysis of 2.7 million women. Cancer Causes Control 2023; 34:123-132. [PMID: 36273050 DOI: 10.1007/s10552-022-01642-2] [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: 02/05/2021] [Accepted: 09/29/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Prevalence of cervical high-risk human papillomavirus (hrHPV) infection varies greatly. Data on distribution of hrHPV infection constitute important evidence for decision-making when implementing HPV testing into cervical cancer screening programs. We estimate the prevalence of cervical hrHPV infection in a large sample of women in a middle-income country and explore variation by age, community marginalization and region in women using public cervical cancer screening services. METHODS Records covering 2010-2017 from a registry of hrHPV test results (Hybrid Capture 2 and polymerase chain reaction) in 2,737,022 women 35-64 years were analyzed. In this observational study, 32 states were categorized into five geographical regions and classified by degree of marginalization. We stratified by test type and estimated crude and adjusted prevalence and rate ratios and used Poisson models and joinpoint regression analysis. RESULTS Prevalence was higher in women 35-39 years, at 10.4% (95% CI 10.3-10.5) and women 60-64 years, at 10.1% (95% CI 10.0-10.3). Prevalence was higher in the southeast, at 10.5% (95% CI 10.4-10.6). Women living in less marginalized areas had a significantly higher prevalence, at 10.3% (95% CI 10.2-10.4) compared to those in highly marginalized areas, at 8.7% (95% CI 8.5-8.7). HPV16 infection was detected in 0.92% (2,293/23,854) of women and HPV18 infection was detected in 0.39% (978/23,854) of women. CONCLUSION Understanding the distribution of HPV prevalence has value as evidence for developing policy in order to improve cervical cancer screening strategies. These results will constitute evidence to allow decision makers to better choose where to focus those resources that they do have.
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Affiliation(s)
- Erika Hurtado-Salgado
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Jorge Salmerón
- Political, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Betania Allen-Leigh
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | | | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
| | - Eduardo Lazcano-Ponce
- National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
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Dub T, Le Cœur S, Ngo-Giang-Huong N, Matanasarawut W, Suriyachai P, Saisawat K, Putiyanun C, Buranabanjasatean S, Leenasirimakul P, Randaeng S, Delory T. Prevalence of High-Risk Human Papillomavirus Infections before and after Cervical Lesion Treatment, among Women Living with HIV. J Clin Med 2021; 10:jcm10143133. [PMID: 34300302 PMCID: PMC8305309 DOI: 10.3390/jcm10143133] [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: 04/02/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 12/29/2022] Open
Abstract
Even when receiving combination antiretroviral therapy, women living with HIV are at high risk of human papillomavirus (HPV) infection and/or cervical lesions, including cancer. Using data from the PapilloV prospective cohort, we evaluated the prevalence of high-risk HPV (HR-HPV) infections after cervical lesion treatment and investigated factors associated with their carriage. Women were followed up for three years with annual Pap smear and HPV genotyping. We offered treatment to women presenting either a Pap smear with high-grade squamous intraepithelial lesion or higher, and/or a biopsy showing cervical intraepithelial neoplasia II or III. We compared the prevalence of HR-HPV infection at the time of first treatment indication and at the end of follow-up among women who received treatment and those who did not. Overall, 46 women had treatment indication. HR-HPV prevalence significantly decreased from 67% to 27% (p value = 0.001) in the 30 women who received treatment, while it did not significantly decrease (from 56% to 38%) in the 16 women who did not (p value = 0.257). Due to lack of statistical power, the 40% relative difference in HR-HPV carriage between treated and untreated women was not significant. In women living with HIV, the treatment of a cervical lesion may be beneficial for clearing HR-HPV infections.
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Affiliation(s)
- Timothée Dub
- Department of Health Security, Finnish Institute for Health and Welfare, 00160 Helsinki, Finland
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (S.L.C.); (N.N.-G.-H.); (T.D.)
- Correspondence: ; Tel.: +358-29-524-6177
| | - Sophie Le Cœur
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (S.L.C.); (N.N.-G.-H.); (T.D.)
- Institut National d’Etudes Démographiques (INED), 93322 Aubervilliers, France
| | - Nicole Ngo-Giang-Huong
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (S.L.C.); (N.N.-G.-H.); (T.D.)
- Institut de Recherche pour le Développement (IRD) UMI 174-PHPT, 13002 Marseille, France
| | | | - Pornnapa Suriyachai
- Ministry of Public Health, Phayao Provincial Hospital, Phayao 56000, Thailand;
| | - Kannikar Saisawat
- Ministry of Public Health, Chiangrai Prachanukroh Hospital, ChiangRai 57000, Thailand;
| | - Chaiwat Putiyanun
- Ministry of Public Health, Chiang Kham Hospital, Chiang Kham 56110, Thailand;
| | | | | | - Samreung Randaeng
- Faculty of Medicine, Department of Pathology, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Tristan Delory
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand; (S.L.C.); (N.N.-G.-H.); (T.D.)
- Institut National d’Etudes Démographiques (INED), 93322 Aubervilliers, France
- Institut de Recherche pour le Développement (IRD) UMI 174-PHPT, 13002 Marseille, France
- Délégation à la Recherche Clinique et à l’Innovation (DRCI), Centre Hospitalier Annecy-Genevois, 74370 Epargny Mets-Tessy, France
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Ramachandran B, Murhekar K, Sundersingh S. SERMs suppresses the growth of ERα positive cervical cancer xenografts through predominant inhibition of extra-nuclear ERα expression. Am J Cancer Res 2021; 11:3335-3353. [PMID: 34249466 PMCID: PMC8263693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023] Open
Abstract
The role of estrogens and estrogen receptors (ER) in cervical cancer (CC) is not well established. However, epidemiological studies and abundant evidence from genetically engineered mouse models support such hypothesis. In this study, we have addressed estrogen responsiveness in a human CC cell line xenograft mouse model. We assessed the sensitivity of Ethynyl Estradiol (EE), SERMs (fulvestrant, MPP) and a non-SERM (EGCG) to competitively modulate the growth of ERα+ve MS751 CC xenografts. We also checked the agonistic-antagonistic propensity of the above treatments to alter the histology of ovariectomised mouse uterine cervix. Chronic EE treatment encouraged the growth of ERα+ve MS751 CC xenografts, while SERMs and EGCG significantly decreased tumor formation. SERMs were found to inhibit ERα expression, localized within cytoplasmic and membrane compartments. Conversely, ERα was not inducible and EE administration suppressed the growth of ERα-ve HeLa CC xenografts. SERMs competitively induced atrophic features to uterine cervix, with MPP giving rise to mucinous metaplasia in the ectocervix. We have demonstrated that, estrogen sensitivity mediated through ERα has promoted CC tumorigenesis. This in turn was modulated by SERMs, predominantly through inhibition of extra-nuclear ERα expression. Though, induction of hyper-estrogenic status in the ectocervix, might underrate the utility of SERMs in ERα+ve CC.
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Affiliation(s)
- Balaji Ramachandran
- Department of Molecular Oncology, Cancer Institute (W.I.A)No. 38, Sardar Patel Road, Adyar, Chennai 600 036, India
| | - Kanchan Murhekar
- Department of Oncopathology, Cancer Institute (W.I.A)No. 38, Sardar Patel Road, Adyar, Chennai 600 036, India
| | - Shirley Sundersingh
- Department of Oncopathology, Cancer Institute (W.I.A)No. 38, Sardar Patel Road, Adyar, Chennai 600 036, India
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Current Updates on Cancer-Causing Types of Human Papillomaviruses (HPVs) in East, Southeast, and South Asia. Cancers (Basel) 2021; 13:cancers13112691. [PMID: 34070706 PMCID: PMC8198295 DOI: 10.3390/cancers13112691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Among the over 200 human papillomavirus (HPV) genotypes identified, approximately 15 of them can cause human cancers. In this review, we provided an updated overview of the distribution of cancer-causing HPV genotypes by countries in East, Southeast and South Asia. Besides the standard screening and treatment methods employed in these regions, we unravel HPV detection methods and therapeutics utilised in certain countries that differ from other part of the world. The discrepancies may be partly due to health infrastructure, socio-economy and cultural diversities. Additionally, we highlighted the area lack of study, particularly on the oncogenicity of HPV genotype variants of high prevalence in these regions. Abstract Human papillomavirus (HPV) infection remains one of the most prominent cancer-causing DNA viruses, contributing to approximately 5% of human cancers. While association between HPV and cervical cancers has been well-established, evidence on the attribution of head and neck cancers (HNC) to HPV have been increasing in recent years. Among the cancer-causing HPV genotypes, HPV16 and 18 remain the major contributors to cancers across the globe. Nonetheless, the distribution of HPV genotypes in ethnically, geographically, and socio-economically diverse East, Southeast, and South Asia may differ from other parts of the world. In this review, we garner and provide updated insight into various aspects of HPV reported in recent years (2015–2021) in these regions. We included: (i) the HPV genotypes detected in normal cancers of the uterine cervix and head and neck, as well as the distribution of the HPV genotypes by geography and age groups; (ii) the laboratory diagnostic methods and treatment regimens used within these regions; and (iii) the oncogenic properties of HPV prototypes and their variants contributing to carcinogenesis. More importantly, we also unveil the similarities and discrepancies between these aspects, the areas lacking study, and the challenges faced in HPV studies.
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Liang Y, Chen M, Qin L, Wan B, Wang H. A meta-analysis of the relationship between vaginal microecology, human papillomavirus infection and cervical intraepithelial neoplasia. Infect Agent Cancer 2019; 14:29. [PMID: 31673281 PMCID: PMC6815368 DOI: 10.1186/s13027-019-0243-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/05/2019] [Indexed: 01/08/2023] Open
Abstract
Microecology is an emerging discipline in recent years. The female reproductive tract is an important microecological region, and its microecological environment can directly affect women's cervical health. This meta-analysis aimed to analyze the effects of vaginal microecology on Human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN). PubMed and Web of Science were systematically searched for eligible publications from January 2000 to December 2017. Articles were selected on the basis of specific inclusion and exclusion criteria. The design and quality of all studies were evaluated using the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) with a 95% confidence interval (95% CI) were calculated. Thirteen eligible studies were selected to evaluate the association of vaginal microecology with HPV infection and CIN. The factors related to HPV infection were bacterial vaginosis (BV) (OR 2.57, 95% CI 1.78-3.71, P<0.05), Candida albicans (VVC) (OR 0.63, 95% CI 0.49-0.82, P < 0.05), Chlamydia trachomatis (CT) (OR 3.16, 95% CI 2.55-3.90, P < 0.05), and Ureaplasma urealyticum (UU) (OR 1.35, 95% CI 1.20-1.51, P < 0.05). BV was also related to CIN (OR 1.56, 95% CI 1.21-2.00, P < 0.05). This meta-analysis of available literature suggested an intimate association of vaginal microecology and HPV infection with CIN. BV, CT and UU were associated to increased HPV infection, VVC was associated to decreased HPV infection, Lactobacillus is not associated to increased HPV infection, BV was associated to increased CIN development risk. Further large-scale studies are needed to confirm our findings.
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Affiliation(s)
- Yuejuan Liang
- The Department of Gynecological of Guangxi Medical University Cancer Hospital, Nanning City, 530021 Guangxi Zhuang Autonomous Region China
| | - Mengjie Chen
- The Department of Gynecological of Guangxi Medical University Cancer Hospital, Nanning City, 530021 Guangxi Zhuang Autonomous Region China
| | - Lu Qin
- The Department of Gynecological of Guangxi Medical University Cancer Hospital, Nanning City, 530021 Guangxi Zhuang Autonomous Region China
| | - Bing Wan
- The Department of Gynecological of Guangxi Medical University Cancer Hospital, Nanning City, 530021 Guangxi Zhuang Autonomous Region China
| | - He Wang
- The Department of Gynecological of Guangxi Medical University Cancer Hospital, Nanning City, 530021 Guangxi Zhuang Autonomous Region China
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Brusselaers N, Shrestha S, van de Wijgert J, Verstraelen H. Vaginal dysbiosis and the risk of human papillomavirus and cervical cancer: systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221:9-18.e8. [PMID: 30550767 DOI: 10.1016/j.ajog.2018.12.011] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The vaginal microbiota proposedly influence the association between human papillomavirus and cervical cancer. Our aim was to assess whether vaginal dysbiosis affects human papilloma virus acquisition, persistence, and progression to related cervical premalignancy. DATA SORUCES MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science (inception until June 2018) were used for this study. The study protocol was registered at PROSPERO (CRD42016035620). STUDY ELIGIBILITY CRITERIA This systematic review included all observational studies reporting on incident human papilloma virus, persistent human papilloma virus, and/or related cervical disease in women with or without vaginal dysbiosis prior to outcome assessment. STUDY APPRAISAL AND SYNTHESIS METHODS We used random-effects models for meta-analyses and report pooled relative risks with 95% confidence intervals. The risk for incident and/or persistent human papilloma virus or related cervical disease based on longitudinal results was determined. RESULTS Of 1645 unique articles, 15 mainly prospective cohort studies were included, published between 2003 and 2017, including a total of 101,049 women. Vaginal dysbiosis was associated with an increased risk of incident human papilloma virus (overall relative risk, 1.33, 1.18-1.50, I2 = 0%; among young women relative risk, 1.43, 1.10-1.85, I2 = 0%), human papilloma virus persistence (overall relative risk, 1.14, 1.01-1.28, I2 = 44.2%; for oncogenic types relative risk, 1.18, 1.01-1.38, I2 = 0%), and high-grade lesions and cancer (relative risk, 2.01, 1.40-3.01, I2 = 0%), but women with lesions/cancer were compared with those without, regardless of their oncogenic human papilloma virus status. Overall, comparable results were found in the molecular vaginal microbiota studies. CONCLUSION This study supports a causal link between vaginal dysbiosis and cervical cancer along the oncogenic human papillomavirus acquisition, persistence, and cervicovaginal dysplasia development pathway.
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Fowotade A, Osisanwo DA, Bakare RA. Human papillomavirus infection among women attending family planning clinic in Nigeria: prevalence, correlates, and co-infection with Chlamydia trachomatis. J Immunoassay Immunochem 2018; 39:390-402. [PMID: 29995572 DOI: 10.1080/15321819.2018.1493999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Infection with high-risk genotypes of human papillomavirus (HPV) is considered the main cause of invasive cervical. A number of epidemiologic studies have suggested that HPV and Chlamydia trachomatis (CT) play a synergistic role in the etiology of cervical intraepithelial neoplasia and subsequent cervical cancer. The current study aimed to evaluate the HPV prevalence and the risk factors for co-infection with CT among women attending family planning clinic in Nigeria. Following enrolment, 90 patients were screened for IgG antibodies to virus-like proteins of HPV types 6, 8, 16, and 18. CT seropositivity was tested by enzyme-linked immunosorbent assay for the detection of IgG and IgM antibodies. The prevalence of HPV IgG was 20%. Seropositivity for CT IgM was 77.8% while the IgG was 0%. A total of 10 women (11.1%) were seropositive for both CT IgM and HPV IgG antibodies. Seropositivity for HPV IgG was significantly associated with age at marriage (P < 0.001), current Chlamydia infection (P < 0.011), and number of children (P < 0.025), while seropositivty for HPV IgG and Chlamydia trahomatis IgM was significantly associated with age at coitarche (P < 0.028), number of life sex partners (P < 0.033), and history of multiple sexual partners (P < 0.002).
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Affiliation(s)
- Adeola Fowotade
- a Clinical Virology Unit, Department of Medical Microbiology, College of Medicine , University of Ibadan , Ibadan , Nigeria.,b Department of Medical Microbiology and Parasitology , University College Hospital , Ibadan, Nigeria
| | - Deborah Afekelu Osisanwo
- b Department of Medical Microbiology and Parasitology , University College Hospital , Ibadan, Nigeria
| | - Rasheed Ajani Bakare
- b Department of Medical Microbiology and Parasitology , University College Hospital , Ibadan, Nigeria
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Thorsteinsson K, Storgaard M, Katzenstein TL, Ladelund S, Rönsholt FF, Johansen IS, Pedersen G, Gaardsting A, Nielsen LN, Bonde J, Lebech AM. Prevalence of cervical, oral, and anal human papillomavirus infection in women living with HIV in Denmark - The SHADE cohort study. J Clin Virol 2018; 105:64-71. [PMID: 29906660 DOI: 10.1016/j.jcv.2018.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/20/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Women living with HIV (WLWH) have elevated risk of human papillomavirus (HPV) related cancers. OBJECTIVES To assess prevalence, distribution and concordance of cervical, oral, and anal HPV infection, and predictors of oral and anal HPV in WLWH in Denmark. STUDY DESIGN WLWH followed in the Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) were enrolled and examined for cervical, oral, and anal HPV infection. Logistic regression models were used to identify predictors of anal and oral HPV. RESULTS A total of 214 of 334 WLWH had sufficient DNA for analysis at all three anatomical sites and were included in analyses. Cervical, oral, and anal high-risk (hr) HPV prevalence were 28.0%, 3.7% and 39.3%. Most frequent i) cervical, ii) oral and iii) anal hrHPV genotypes were i) hrHPV58 (8.4%), 52 (5.1%), 16 (5.1%) and 51 (5.1%); ii) 52 (1.4%) and iii) 51 (9.3%), 58 (8.9%), 16 (7.0%) and 18 (7.0%). Among present cervical, oral, and anal hrHPV genotypes, 6.7%, 12.5% and 17.9% were targeted by the 2-or 4-valent HPV vaccines, whereas 50.0%, 50.0% and 42.9% of hrHPV genotypes were covered by the 9-valent HPV vaccine. Anal HPV infection was predicted by cervical HPV infection (adjusted OR 4.47 (95%CI 2.25-8.89)). CONCLUSION Cervical and anal HPV infection were highly prevalent in WLWH. Non-16/18 hrHPV genotypes were predominant at all anatomical sites. Almost half of all hrHPV infections at the three anatomical sites could have been prevented by childhood/adolescent vaccination with the 9-valent HPV vaccine.
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Affiliation(s)
| | - Merete Storgaard
- Department of Infectious Diseases, Skejby, Aarhus University Hospital, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Steen Ladelund
- Clinical Research Center, Hvidovre, Copenhagen University Hospital, Denmark
| | - Frederikke F Rönsholt
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Anne Gaardsting
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lars Nørregård Nielsen
- Department of Infectious Diseases, Nordsjællands Hospital, Copenhagen University Hospital, Denmark
| | - Jesper Bonde
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
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Ratanasiripong NT, Sri-Umporn S, Kathalae D, Hanklang S, Ratanasiripong P. Human papillomavirus (HPV) vaccination and factors related to intention to obtain the vaccine among young college women in Thailand. JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.1108/jhr-01-2018-018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Most cervical cancers are caused by genital human papillomavirus (HPV). However, it can be prevented if females receive an HPV vaccine. Nevertheless, there is limited evidence of HPV vaccination and predictors of intention to obtain the vaccine among young women in Thailand. The paper aims to discuss this issue.
Design/methodology/approach
This cross-sectional study examined HPV vaccination and factors influencing intention to vaccinate among a convenient sample of college women in Thailand. The data collection was conducted via a self-administered “HPV and HPV vaccine-related knowledge, attitudes, and behaviors” questionnaire.
Findings
Out of 1,030 participants, 309 (30.0 percent) were aware of HPV and the HPV vaccine. Out of these, 257 participants reported that they had not obtained the vaccine and 18 participants were unsure if they had already obtained the vaccine or not. Only 34 participants confirmed that they had received the vaccine. Among those who were aware of HPV and the HPV vaccine, 56.4 percent of them did not know that most HPV-infected persons do not show any signs or symptoms, and 53.3 percent thought that the vaccine provided protection against other sexually transmitted infections as well. Most had positive attitudes toward vaccination and subjective norms. Among the participants who had not received the vaccine, the intention to obtain the vaccine was predicted by age, knowledge, attitudes toward vaccination, and subjective norms. The reasons for not being vaccinated included the cost of the vaccine, lack of knowledge, and perception of themselves being at low risk.
Originality/value
This study found low HPV vaccination among college women. However, those who had not received the vaccine intended to obtain the vaccine at some point in the future. An HPV vaccination campaign may be well tailored in order to increase the intention to obtain the vaccine which, in turn, may increase the HPV vaccination. Vaccination cost sharing should be discussed among Thai policy makers in order to alleviate the financial burden for women.
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Phoolcharoen N, Kantathavorn N, Krisorakun W, Sricharunrat T, Teerayathanakul N, Taepisitpong C, Sornsamdang G, Krongthong W, Saeloo S. Agreement of self- and physician-collected samples for detection of high-risk human papillomavirus infections in women attending a colposcopy clinic in Thailand. BMC Res Notes 2018; 11:136. [PMID: 29458440 PMCID: PMC5819229 DOI: 10.1186/s13104-018-3241-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/09/2018] [Indexed: 11/10/2022] Open
Abstract
Objective To study the concordance between vaginal self- and endocervical physician-collected high-risk (hr) HPV testing in Thai women who attended a colposcopy clinic. Vaginal samples were obtained by self-sampling with a dry brush before endocervical samples were obtained by physicians. Both specimens were analyzed for hrHPV by Cobas4800 HPV test. Results Of the 247 pairs of samples, overall hrHPV prevalence from self- and physician-collected samples was 41.3 and 36.0%, respectively. The overall agreement between the methods was 74.5% with κ 0.46 (P < 0.001). Our study revealed moderate agreement between self- and physician-collected methods for hrHPV testing.
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Affiliation(s)
- Natacha Phoolcharoen
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand. .,Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathum Wan, Bangkok, 10330, Thailand.
| | - Nuttavut Kantathavorn
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Wasanai Krisorakun
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Thaniya Sricharunrat
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Narongchai Teerayathanakul
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chantanee Taepisitpong
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Gaidganok Sornsamdang
- Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Waraphorn Krongthong
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Siriporn Saeloo
- Data Management Unit, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Nascimento MDDSB, Vidal FCB, Silva MACND, Batista JE, Lacerda Barbosa MDC, Muniz Filho WE, Bezerra GFDB, Castro Viana GMD, Branco RCC, Brito LMO. Prevalence of human papillomavirus infection among women from quilombo communities in northeastern Brazil. BMC WOMENS HEALTH 2018; 18:1. [PMID: 29291721 PMCID: PMC5748955 DOI: 10.1186/s12905-017-0499-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/15/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) is a member of the Papillomaviridae family. The prevalence of HPV genotypes may vary according to the region and the population studied. Quilombo communities are ethnic and racial groups with difficult access to health services compared to the general population in Brazil. The aim of this study was to identify specific HPV types correlating with sociodemographic/behavioral characteristics and cervical smear cytological abnormalities in Quilombola women. METHODS This cross-sectional study included 395 Quilombola women users of the Unified Health System of the Municipalities of Maranhão for the screening of cervical cancer. The samples were analyzed for the presence of cytological abnormalities by conventional methods and tested for 37 HPV genotypes using polymerase chain reaction with primers PGMY09/11 followed by reverse line blot hybridization performed with the Linear Array HPV Genotyping Test kit by Roche Molecular System®. The association between HPV types and cytological diagnosis was investigated according to the different age groups. RESULTS HPV infection was detected in 12.6% (50/395) of the women. Infections by high-risk HPV types were more frequent. Genotypes 68 (26.0%); 58 and 52 (20.0%); 31 (10.0%) and 62 (8.0%) were the most prevalent. The highest prevalence (42.0%) of HPV infection occurred in women diagnosed with high-grade squamous intraepithelial lesion. There was a statistically significant association between HPV infection and the detection of cytological abnormalities in all age groups except in women over 60 years. There was a statistically significant association between the municipality of origin and the number of partners with HPV infection. CONCLUSIONS It is important to incorporate new cervical cancer screening techniques incorporating the cervical-vaginal cytology. For further studies, it is necessary to determine the level of knowledge of Quilombola population on health-related issues including HPV infection and cervical cancer. This will contribute to the continuous improvement of healthcare coverage among the population and enhance the implementation of cancer care in the state of Maranhão.
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Affiliation(s)
- Maria do Desterro Soares Brandão Nascimento
- Department of Pathology, Center of Biological and Health Sciences, Federal University of Maranhão, São Luís, Brazil. .,Post-graduate Program in Adult and Child Health, Federal University of Maranhão, São Luís, Brazil. .,Núcleo de Imunologia Básica e Aplicada, Avenida dos Portugueses, 1966, Bacanga. Prédio do CCBS, Bloco 3, Sala 3A, São Luís - MA, CEP, 65080-805, Brazil.
| | - Flávia Castello Branco Vidal
- Department of Morphology, Center of Biological and Health Sciences, Federal University of Maranhão, São Luís, Brazil.,Post-graduate Program in Adult and Child Health, Federal University of Maranhão, São Luís, Brazil
| | | | - José Eduardo Batista
- Department of Pathology, Center of Biological and Health Sciences, Federal University of Maranhão, São Luís, Brazil
| | | | - Walbert Edson Muniz Filho
- Department of Pathology, Center of Biological and Health Sciences, Federal University of Maranhão, São Luís, Brazil
| | | | - Graça Maria de Castro Viana
- Department of Pathology, Center of Biological and Health Sciences, Federal University of Maranhão, São Luís, Brazil
| | | | - Luciane Maria Oliveira Brito
- Post-graduate Program in Adult and Child Health, Federal University of Maranhão, São Luís, Brazil.,Department of Medicine III, Center of Biological and Health Sciences, Federal University of Maranhão, São Luís, Brazil
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Ramachandran B. Functional association of oestrogen receptors with HPV infection in cervical carcinogenesis. Endocr Relat Cancer 2017; 24:R99-R108. [PMID: 28283546 DOI: 10.1530/erc-16-0571] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 02/14/2017] [Indexed: 01/11/2023]
Abstract
Repeated parity and usage of oral contraceptives have demonstrated an increased risk of cervical cancer (CC) in HPV-infected women. These lifestyle observations raise the likelihood that oestrogens and HPV infection might act synergistically to affect cancers of the cervix. In vivo studies have indicated the requirement of oestrogens and ERα in the development of atypical squamous metaplasia followed by cervical intraepithelial neoplasia (CIN) I, II and III. CIN II and III are precancerous cervical lesions that can progress over time to CC as an invasive carcinoma. Recently, there has been evidence suggesting that ERα signalling in the tumour epithelium is a preliminary requisite during cancer initiation that is subsequently lost during tumorigenic progression. Conversely, continued expression of stromal ERα gains control over tumour maintenance. This review summarises the current information on the association between oestrogens and HPV infection in contributing to CC and the possibility of SERMs as a therapeutic option.
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Affiliation(s)
- Balaji Ramachandran
- Department of Molecular OncologyCancer Institute (W.I.A.), Adyar, Chennai, India
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17
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Delory T, Ngo-Giang-Huong N, Rangdaeng S, Chotivanich N, Limtrakul A, Putiyanun C, Suriyachai P, Matanasarawut W, Jarupanich T, Liampongsabuddhi P, Heard I, Jourdain G, Lallemant M, Le Coeur S. Human Papillomavirus infection and cervical lesions in HIV infected women on antiretroviral treatment in Thailand. J Infect 2017; 74:501-511. [PMID: 28254419 DOI: 10.1016/j.jinf.2017.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 02/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To estimate the prevalence and factors associated with Human Papillomavirus (HPV) infection, HPV genotypes and cytological/histological high-grade (HSIL+/CIN2+) lesions. METHODS We conducted a cross-sectional study within a prospective cohort of HIV-infected women on combination antiretroviral therapy (cART). Cervical specimens were collected for cytology and HPV genotyping (Papillocheck®). Any women with High-Risk-HPV (HR-HPV), and/or potentially HR-HPV (pHR-HPV) and/or ASC-US or higher (ASC-US+) lesions were referred for colposcopy. Factors associated with HR-HPV infection and with HSIL+/CIN2+ lesions were investigated using mixed-effects logistic regression models. RESULTS 829 women were enrolled: median age 40.4 years, on cART for a median of 6.9 years, median CD4 cell-count 536 cells/mm3, and 788 (96%) with HIV-viral load<50copies/mL. Of 214 (26%) infected with HPV: 159 (19%) had ≥1 HR-HPV, of whom 38 (5%) HPV52, 22 (3%) HPV16, 9 (1%) HPV18; 21 (3%) had pHR-HPV, 34 (4%) low risk-HPV infection, and 56 (26%) had multiple genotypes. Younger age, low CD4 cell-counts and low education were independently associated with HR-HPV infection. 72 women (9%) had ASC-US+ and 28 (3%) HSIL+/CIN2+ lesions. HR-HPV infection was independently associated with HSIL+/CIN2+ lesions. CONCLUSION The prevalence of HPV infection and of cervical lesions was low. The HPV genotype distribution supports the use of 9-valent vaccine in Thailand.
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Affiliation(s)
- Tristan Delory
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; APHP, Service de maladies infectieuses et tropicales, hôpital Saint Louis, F-75010, Paris, France; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France.
| | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Samreung Rangdaeng
- Faculty of Medicine, Department of Pathology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Aram Limtrakul
- Ministry of Public Health, Nakornping Hospital, Chiang Mai, Thailand
| | - Chaiwat Putiyanun
- Ministry of Public Health, Chiang Kham Hospital, Chiang Kham, Thailand
| | | | | | | | | | - Isabelle Heard
- HPV National Reference Center, Pasteur Institute, Paris, France; APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Marc Lallemant
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Institut National d'Etudes Démographiques (Ined), UR-5, Paris, France; Harvard T.H. Chan School of Public Health, Boston, MA, United States
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18
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Grąt K, Grąt M, Wronka KM, Pietrzak B, Suchońska B, Walter de Walthoffen S, Młynarczyk G, Krawczyk M, Wielgoś M. Cervical human papillomavirus infection in the early postoperative period after liver transplantation: Prevalence, risk factors, and concordance with anal infections. Clin Transplant 2017; 31. [PMID: 27988990 DOI: 10.1111/ctr.12894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 11/29/2022]
Abstract
Solid organ transplant recipients are at increased risk of developing several human papillomavirus (HPV)-related malignancies, including cervical and anal cancers. The purpose of this prospective study was to assess the initial prevalence and risk factors for high-risk HPV (HR-HPV) cervical infections in liver transplant recipients, as well as their concordance with anal infections. A total of 50 female patients were enrolled in the Department of General, Transplant and Liver Surgery at the Medical University of Warsaw (center with >1600 liver transplantations). The initial prevalence of cervical HR-HPV infection was 10.0% (5/50). The only significant risk factor for cervical HR-HPV infection was ≥4 lifetime sexual partners (P=.037). Statistical tendencies toward higher prevalence of cervical HR-HPV infections were found for patients with hepatitis B virus (HBV, P=.082) and with model for end-stage liver disease (MELD) score ≤8 (P=.064). Cervical cytology was abnormal in 10 patients, including three with HR-HPV. Out of 12 patients with available data on anal HR-HPV, one had concordant HPV 16 infection. In conclusion, the initial prevalence of high-risk HPV infection is relatively low, except for patients with ≥4 previous sexual partners and potentially in those with HBV and/or low MELD score.
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Affiliation(s)
- Karolina Grąt
- Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Grąt
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Karolina M Wronka
- Department of General, Transplant and Liver Surgery, Student Scientific Group, Medical University of Warsaw, Warsaw, Poland
| | - Bronisława Pietrzak
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Barbara Suchońska
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Grażyna Młynarczyk
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Mirosław Wielgoś
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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Mongsawaeng C, Kokorn N, Kujapun J, Norkaew J, Kootanavanichpong N, Chavenkun W, Ponphimai S, Kaewpitoon SJ, Tongtawee T, Padchasuwan N, Pengsaa P, Kompor P, Kaewpitoon N. Knowledge, Attitude, and Practice Regarding Cervical Cancer among Rural Community Women in Northeast Thailand. Asian Pac J Cancer Prev 2016; 17:85-8. [PMID: 26838259 DOI: 10.7314/apjcp.2016.17.1.85] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer is the second most common malignancy among women worldwide, and women of reproductive age in Thailand. However, information on the behavior regarding cervical cancer in rural community Thailand is sparse. OBJECTIVE To assess the knowledge, attitude, and practice regarding cervical cancer (CC) among rural community women in Nakhon Ratchasima, Thailand, using predesigned structured questionnaires. MATERIALS AND METHODS A cross-sectional survey was conducted in 8 villages of Non Sung district, Nakhon Ratchasima province, Thailand, during January to April 2015. Bloom's taxonomy was used as a framework for the study. 265 women aged between 30-60 years old were selected by simple random sampling. All participants completed predesigned questionnaires with 4 parts: demographic data, knowledge, attitude, and practice regarding cervical cancer. Descriptive statistics were used for analysis in this study. RESULTS The majority of participants were in the age group of 41-50 years old (42.6%) with senior secondary school level of education (32.1%), marriage status (85.0%), agricultural employment (59.6%), and family income between 6,000- 10,000 baht per month (54.3%). Some 63.4% and 68.7% participants had high knowledge and moderate level of attitudes regarding CC, while 41.1%, 48.7%, and 10.2% had neem regularly, irregularly or never screened for CC, respectively. The main reasons for not screening were were shyness (44.4%) and no time (55.6%). Vaginal discharge and itching were the common signs and symptoms of participants who were screened at a health promotion hospital of sub-district. CONCLUSIONS CC is still a health problem in the rural community. Therefore, health education is required, particularly for those who have never undergone screening.
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Affiliation(s)
- Cholticha Mongsawaeng
- Department of Public Health, Faculty of Public Health, Vongchavalitkul University, Nakhon Ratchasima, Thailand E-mail : natthawut.k@hotmail. com,
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20
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Ghedira R, Mahfoudh W, Hadhri S, Gabbouj S, Bouanene I, Khairi H, Chaieb A, Khelifa R, Bouaouina N, Remadi S, Elmi AA, Bansal D, Sultan AA, Faleh R, Zakhama A, Chouchane L, Hassen E. Human papillomavirus genotypes and HPV-16 variants distribution among Tunisian women with normal cytology and squamous intraepithelial lesions. Infect Agent Cancer 2016; 11:61. [PMID: 27980608 PMCID: PMC5133751 DOI: 10.1186/s13027-016-0109-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries. Herein, we conducted a molecular epidemiological study to investigate prevalence of HPV type and HPV-16 variants among cervical-screened unvaccinated Tunisian women. METHODS Cross-sectional study was performed on 494 Tunisian women visiting Women's Healthcare Centers. HPV-DNA detection was carried out on cervical samples using real-time polymerase chain reaction. HPV genotyping and HPV-16 variants were characterized by direct sequencing of L1 viral capsid gene. RESULTS The overall HPV prevalence was 34% (95% CI: 30-38%) with significantly higher prevalence among women with squamous intraepithelial lesions (SIL) than those with no intraepithelial lesions (NIL) 84% (95% CI: 76-92%) and 24.5% (95% CI: 20-29%) respectively. The distribution of HPV prevalence according to women's age shows a U-shaped curve and the highest HPV prevalence rates were observed among the youngest (≤25 years; 51.2%, 95% CI: 37-67%) and the oldest women (>55 years; 41.7%, 95% The HPV-16 prevalence was 32.8% (95% CI: 22-45%) among women with SIL and 9.2% (95% CI: 6-12%) among women with NIL. Whereas, the HPV-18 prevalence was 1.3% (95% CI: 0-5%) among women with SIL and 0.3% (95% CI: 0-1%) among women with NIL. Among HPV-16 positive women, European lineage (E) was identified as the predominant HPV-16 variant (85.7%, 95% CI: 76-95%). The frequency of E variant was lower among SIL than among NIL women (81%, 95% CI: 64-99%, and 88%, 95% CI: 77-100%, respectively). Conversely, the African-2 variant frequency was higher among SIL than among NIL women (18%, 95% CI: 1-36% and 6%, 95% CI: 2-14%, respectively). In multivariate analysis, young age was the only risk factor that is independently associated with HPV infection. Moreover, HPV infection and menopause were both found to be independently associated with SIL and HSIL. CONCLUSION HPV DNA testing should be proposed to young and menopausal Tunisian women. Considering HPV prevalence, only 13% of the Tunisian women could be protected by the bivalent HPV vaccine. These results may be helpful for designing an adapted HPV testing and vaccination program in Tunisia.
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Affiliation(s)
- R. Ghedira
- Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia
- Faculty of Sciences, Carthage University, Bizerte, Tunisia
| | - W. Mahfoudh
- Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia
| | - S. Hadhri
- National Office of Family and Population, Monastir, Tunisia
| | - S. Gabbouj
- Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia
| | - I. Bouanene
- Department of Epidemiology and preventive medicine, Faculty of Medicine, Monastir University, Monastir, Tunisia
| | - H. Khairi
- Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia
- Department of Gynecology Obstetrics, Farhat Hached University Hospital, Sousse, Tunisia
| | - A. Chaieb
- Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia
- Department of Gynecology Obstetrics, Farhat Hached University Hospital, Sousse, Tunisia
| | - R. Khelifa
- Unit of Viral and Molecular Tumor Diagnostics, Habib Thameur Hospital, Tunis, Tunisia
| | - N. Bouaouina
- Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia
- Department of Cancerology Radiotherapy, Farhat Hached University Hospital, Sousse, Tunisia
| | - S. Remadi
- Laboratory of Anatomy and Pathologic cytology, Sousse, Tunisia
| | - A. A. Elmi
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - D. Bansal
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - A. A. Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - R. Faleh
- Department of Gynecology and Obstetrics, University Hospital of Monastir, Monastir, Tunisia
| | - A. Zakhama
- Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia
| | - L. Chouchane
- Laboratory of Genetic Medicine and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - E. Hassen
- Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia
- Higher Institute of Biotechnology of Monastir, Monastir University, Monastir, Tunisia
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Shakya S, Syversen U, Åsvold BO, Bofin AM, Aune G, Nordbø SA, Vaidya KM, Karmacharya BM, Afset JE, Tingulstad S. Prevalence of human papillomavirus infection among women in rural Nepal. Acta Obstet Gynecol Scand 2016; 96:29-38. [PMID: 27714759 DOI: 10.1111/aogs.13036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In this study we aimed to determine the overall and type-specific prevalence of cervical human papillomavirus (HPV) infection and risk factors for such infection among women in rural Nepal, and to investigate the distribution of HPV infection by cervical cytology. MATERIAL AND METHODS The study was conducted among women aged ≥15 years in five rural villages within Kavre District in Nepal. Sociodemographic data and information on risk factors for cervical cancer were obtained through an interview, and a cervical specimen was collected for HPV DNA detection and typing using the Anyplex™ ll HPV28 Detection system, and for Papanicolaou test. RESULTS Among the 1289 women in whom a valid HPV result was obtained the median age was 40 years (range 17-86 years). Overall, the HPV prevalence was 14.4%, 7.9% for high-risk and 6.5% for low-risk HPV types, and was similar between age groups. The five most common HR types were HPV-18 (2.3%), HPV-51 (1.2%), HPV-59 (1.1%), HPV-31 (0.9%), and HPV-16 (0.8%). The prevalence of high-risk types in women with and without abnormal cytology was 8.3 and 7.7%, respectively. HPV infection was associated with current smoking, formal education, and being married to a husband with at least one previous marriage. CONCLUSIONS This is the first population-based study to report the prevalence of a broad range of HPV types among women from rural Nepal. These data are crucial for development of preventive strategies to reduce cervical cancer burden in the country.
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Affiliation(s)
- Sunila Shakya
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Gynecology and Obstetrics, Dhulikhel Hospital/Kathmandu University School of Medical Sciences, Kavre, Nepal
| | - Unni Syversen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St Olav's Hospital, Trondheim, Norway
| | - Bjørn O Åsvold
- Department of Endocrinology, St Olav's Hospital, Trondheim, Norway.,Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna M Bofin
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Guro Aune
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim, Norway
| | - Svein A Nordbø
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Microbiology, St Olav's Hospital, Trondheim, Norway
| | | | - Biraj M Karmacharya
- Department of Community Medicine, Dhulikhel Hospital/Kathmandu University School of Medical Sciences, Kavre, Nepal
| | - Jan E Afset
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Microbiology, St Olav's Hospital, Trondheim, Norway
| | - Solveig Tingulstad
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim, Norway
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Thorsteinsson K, Storgaard M, Katzenstein TL, Ladelund S, Rønsholt FF, Johansen IS, Pedersen G, Hashemi L, Nielsen LN, Nilas L, Obel N, Bonde J, Lebech AM. Prevalence and distribution of cervical high-risk human papillomavirus and cytological abnormalities in women living with HIV in Denmark - the SHADE. BMC Cancer 2016; 16:866. [PMID: 27821088 PMCID: PMC5100104 DOI: 10.1186/s12885-016-2881-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023] Open
Abstract
Background Women living with HIV (WLWH) are at increased risk of persistent human papillomavirus (HPV) infection, cervical dysplasia and cervical cancer compared with women from the general population (WGP). We assessed the prevalence and distribution of cervical high-risk (hr) HPV infection and cytological abnormalities in WLWH compared with WGP in Denmark. Predictors of HPV and cytological abnormalities were estimated in WLWH. Methods WLWH consecutively enrolled in the Study on HIV, cervical Abnormalities and infections in women in Denmark (SHADE) in 2011 and were examined for cervical HPV and cytological abnormalities. WLWH were matched on age and prior cytological findings with WGP from an earlier study. HIV demographics were retrieved from the nationwide Danish HIV Cohort Study. Logistic regression was used to estimate predictors of hrHPV and cytological abnormalities. Results Of 334 included WLWH 26.4 % were positive for hrHPV as opposed to 16.6 % WGP (p < 0.0001). WLWH had a higher number of multiple infections (>1 h genotype present) (38.5 % versus 25.7 %, p = 0.030). Hr genotypes in descending order of frequency were HPV58 (7.1 %), 52 (5.4 %), and 16 (4.8 %) in WLWH versus HPV16 (4.1 %), 52 (2.8 %) and 58 (2.4 %) in WGP. Predictors of hrHPV in WLWH were short duration of HAART (adjusted OR per year 0.90 (95 % CI 0.84-0.96)), AIDS prior to inclusion (adjusted OR 3.61 (95 % CI 1.75-7.46)), ≥5 lifetime sexual partners (adjusted OR 2.20 (95 % CI 1.08-4.49)), sexual debut <16 years of age (adjusted OR 2.05 (95 % CI 1.03-4.10)) and CD4 < 350 cells/μL (adjusted OR 2.53 (95 % CI 1.20-5.40)). Cytological abnormalities were prevalent in 10.4 % vs. 5.2 % (p = 0.0003) of WLWH and WGP. In WLWH with hrHPV, short duration of HAART predicted cervical dysplasia (adjusted OR per year 0.83 (95 % CI 0.71-0.97)). Conclusions WLWH presented with more cervical hrHPV infections and cytological abnormalities, and a different distribution of hrHPV genotypes compared with WGP. Cervical hrHPV and cytological abnormalities were predicted by short duration of HAART. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2881-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kristina Thorsteinsson
- Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Infectious Diseases, Hvidovre Hospital, Kettegaards Allé 30, 2650, Hvidovre, Denmark.
| | - Merete Storgaard
- Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steen Ladelund
- Clinical Research Center, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Lailoma Hashemi
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lisbeth Nilas
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynaecology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Bonde
- Molecular Pathology Laboratory, Department of Pathology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Capo-Chichi CD, Aguida B, Chabi NW, Acapko-Ezin J, Sossah-Hiffo J, Agossou VK, Anagbla T, Zannou M, Houngbé F, Sanni A. Diversity of high risk human papilloma viruses in women treated with antiretroviral and in healthy controls and discordance with cervical dysplasia in the South of Benin. Infect Agent Cancer 2016; 11:43. [PMID: 27528886 PMCID: PMC4983786 DOI: 10.1186/s13027-016-0090-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/28/2016] [Indexed: 11/14/2022] Open
Abstract
Background High risk oncologic Human Papilloma Virus (HPV) is one of the leading causes of cervical cancer worldwide. We investigated HPV genotypes among women living or not with Human Immuno-deficiency Virus (HIV) in two major hospitals in the south of the republic of BENIN in the city of Cotonou. Our objective is to investigate the association of high risk-HPV to cervical dysplasia among women under stringent anti-retroviral (ARV) treatment and in controls without HIV. Methods The investigation was carried out within 1 year period in two groups of adult women: one group with HIV1 infection and under ARV therapy in the National University Hospital (CNHU-HKM) designated as CH group (n = 86); and one control group without HIV infection and attending the hospital Mènontin for routine gynecologic checkup and designated as ME group (n = 86). Cells derived from cervical uterine smears (CUS) were used for this investigation. The samples in ME group were selected to have similar lamin A/C profile with CH group. HPV genotypes were assessed by polymerase chain reaction (PCR) while lamin A/C expression profile was assessed by western blotting to corroborate the risk of cervical dysplasia. Results HPV56 is dominant in CH group while HPV66 is dominant in ME group. 31 % of women in CH group are infected with HPV compared to 23 % in ME group. Quadruple and quintuple HPV infections are more observed among CH group but not in ME group making HPV counts of 43 in CH group and 27 in ME group. Cervical dysplasia are present in 5 % (4/86) of women in CH group and in 1 % (1/86) of women in ME group at the time of CUS collection. The adjustment of the risk to develop cervical cancer in the future related to HPV infection and the total loss of lamin A/C is not significantly different in both groups. Conclusion Women living with HIV are more sensitive to multiple HPV infection but not all HPV infections generated cervical dysplasia. The effectiveness of antiretroviral therapy in CH group may reduce significantly the frequency of cervical dysplasia.
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Affiliation(s)
- Callinice D Capo-Chichi
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
| | - Blanche Aguida
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
| | - Nicodème W Chabi
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
| | | | - Jonas Sossah-Hiffo
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
| | | | | | - Marcel Zannou
- National University Hospital (CNHU-HKM), Cotonou, Benin
| | | | - Ambaliou Sanni
- Molecular Biomarkers in Cancer and Nutrition (BMCN), Unit of Biochemistry and Molecular Biology (UBBM), Institute of Biomedical Sciences and Applications (ISBA), Faculty of Sciences and Technologies (FAST), University Abomey-Calavi (UAC), 04BP488, Cotonou, Benin
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