Human papillomavirus genotype distribution in Ethiopia: an updated systematic review

Distribution of HPV genotypes in Mashhad, Iran: insights from a 2022-2023 study

BACKGROUND

Human papillomavirus (HPV), is one of the main causes of cervical cancer and also one of the most common sexually transmitted infections (STIs). HPV is responsible for almost all cases of cervical cancer and plays a principal role in causing other cancers including oropharynx, penis, larynx, oral cavity, anus, vulva, and vagina. The study aims to investigate the prevalence and distribution of HPV genotypes among patients referred to private laboratories in Mashhad, located in the northeast of Iran.

METHODS AND MATERIALS

428 samples including 382 females (89.3%) and 46 males (10.7%) between January 10, 2022, and February 11, 2023, in Mashhad, Iran were evaluated to detect HPV and determine its genotypes. Cervical swabs and urine samples were collected from females and males, respectively. Viral DNA was extracted by using a CedExtra purification kit (cedbio, Iran) and viral genotypes were identified with a High + Low Papillomastrip kit (Operon, Spain). Mann Whitney U test and Chi-square test were accomplished for statistical analysis.

RESULT

From the total of 428 participants analyzed, the HPV test result was positive for 129 patients (30.1%) and negative for 299 people (69.9%). Among the participants, 115 female (30.1%) and 14 male (30.4%) were positive for HPV infection. The prevalence of HPV infection among the referring people was about 30%. The most common genotype identified was HPV-6 (10.3%), followed by HPV-16 (8.7%) and HPV-51 (7.7%), the second and third most common genotypes, respectively. Additionally, HPV-39 was detected at a frequency of 6.70%. HPV-11, HPV-61, HPV-91, and HPV-44 with a frequency of 1% were among the least genotypes identified among the patients.

CONCLUSION

In line with the results of this study, the prevalence of HPV genotypes in both genders is 30%. The results likely reflect differences in the prevalence of high-risk HPV genotypes, that are less common. Also, HPV-6 and HPV-16 genotypes that are covered by the vaccine had a significant prevalence. On the other hand, with the prevalence of HPV-51 and HPV-39 genotypes in infected people who are not covered by the Gardasil (quadrivalent) vaccine, there is a risk of related cancers in the future.

Epidemiology and genotypes analysis of human papillomavirus infection in Huizhou, China

Background

Human papillomavirus (HPV) is a main pathogenic factor for cervical carcinoma. The prevalence and genotypes distribution of HPV vary in different regions. Thus, our study aimed to investigate the epidemiology of HPV in Huizhou, China.

Methods

HPV tests were detected in 5,325 female outpatients, we focused on the overall HPV prevalence, genotypes distribution, and the correlation of HPV genotypes with cervical cytology.

Results

The overall HPV prevalence was 27.53%, HPV52, HPV58, HPV39, HPV16 and HPV51 were predominant genotypes with single infection rate of 70.80%. HPV infection rate showed a U-shaped age distribution, statistical differences were observed among 5 age groups (χ2 = 50.497, p < 0.01), and the higher positive rate was aged under 30 (34.42%) and above 60 (34.74%). Among high-risk HPV (hrHPV) infections, 60.69% involved NILM, 0.99% HSIL. The degrees of cervical lesions in multiple hrHPV infections were worse than those in single infection (p < 0.01).

Conclusion

The HPV infection rate is high in Huizhou, Guangdong, single infection was predominant. HPV infection presented with a U-shaped age distribution. Multiple hrHPV infection was worrying since it may aggravate cervical lesions. Women should pay more attention to HPV detection and choose a more appropriate HPV vaccine according to local HPV type distribution.

Human Papillomaviruses Genotype Distribution and Replacement by Year from 2014 to 2020 in Beijing, China

Background

Cervical cancer is one of the most common gynecological malignancies worldwide. The incidence of cervical cancer ranks second for female malignancies in China. However, human papillomavirus (HPV) prevalence and genotype replacement for a long time in Beijing were not yet evaluated.

Methods

Women patients who visited clinical departments, especially the gynecology department, were included in this study from 2014 to 2020. They suffered from different kinds of cervical abnormalities even cervical cancer. Thirteen types of HPV were detected in cervical samples by using multiple fluorescence polymerase chain reactions. All patients were divided into four groups according to age (15-30, 31-45, 46-60, and >60 years old).

Results

The study included data from four certain years (2014, 2016, 2018, and 2020). Overall HPV prevalence was 18.0%, 16.7%, 21.9%, and 19.1%, respectively. Of the 13 genotypes, the top one infection type was HPV52, followed by HPV58 and HPV16 or HPV16 and HPV58 in different years. HPV56 prevalence raised from 2018, which replaced HPV39 into the top five list. Only HPV prevalence of 46-60 years age group declined, mainly resulting from the reduced prevalence of HPV39 and HPV58 (p < 0.001 and p = 0.020). The proportions of HPV dual-infection across the four years varied significantly in statistics (p = 0.001), whereas the most common dual-infection HPV39/68 disappeared after 2018.

Conclusion

The prevalence of two HPV genotypes (HPV39 and HPV58) and dual-infection HPV39/68 showed a declining trend, especially in the 46-60 years age group. The trends need to be observed continuously.

Prevailing of HPV-16 and 52 genotype in 2022-2023 in Sanandaj, Iran

INTRODUCTION

Human papillomavirus (HPV) presents a potential threat to the onset of carcinogenesis in the cervix, anogenital regions, and oropharynx. HPV encompasses over 200 types, with at least 12 having the potential to cause cancer, impacting the majority of sexually active individuals. In this current research, we explore the occurrence and spread of HPV genotypes.

MATERIAL AND METHODS

During this cross-sectional study conducted in Sanandaj, Iran from Feb 2022 to Aug 2023, diverse samples including oral, vaginal, and genital were collected from individuals referred to private laboratories in Sanandaj, Iran. After sample collection and DNA extraction (FAVORGEN, Taiwan), they were subjected to PCR and genotyping (MehrViru, Iran). The subsequent statistical analysis unveiled infection rates across different demographics and age groups. STATA (version 17) were used for statistical analysis. We examined infection rates across demographics using t-tests and Odds Ratio.

RESULTS

Overall, 26% (249) out of 950 cases tested positive for HPV, with 69% of these classified as high-risk. Among the examined population, 98% (933) were female, and 2% (17) were male. Females aged 31-40 exhibited the highest percentage of HPV prevalence (115/460) in the study with the majority of positive cases belonging to HR genotypes. The overall most frequent genotypes identified were 6, 16, 52, 53, 51, 58, and 56. HPV-16 exhibited the highest frequency among HR genotypes, accounting for 42 (17%) occurrences, followed by HPV-52 with a frequency of 32 (13%).

CONCLUSION

Our findings emphasize the significant prevalence of HPV among females, particularly in the 21-30 age group. The identification of high-risk genotypes, underscores the importance of targeted interventions for specific age cohorts. The age-stratified analysis highlights a consistent predominance of high-risk HPV across age groups, indicating the need for age-specific preventive measures. These results contribute valuable information for designing effective screening and vaccination strategies, to alleviate the impact of diseases associated with HPV.

Clinical applications and utility of ctDNA in cervical cancer and its precursor lesions: from screening to predictive biomarker

Cervical cancer is a leading cause of gynecological cancer death in the world. Human papillomavirus (HPV) is the most causative factor of cervical cancer. In addition, many genetic factors are involved in cervical cancer development. Most studies focus on cervical samples to do research work about cervical cancer and precancerous lesions, but no sensitive or specific biomarkers were found. High-throughput genomic technologies are able to capture information from tumors and precancerous lesions in blood, thus providing a new way for the early diagnosis of cervical precancer and cervical cancer. Blood is an ideal specimen for detecting cancer biomarkers because it contains a lot of information, such as circulating tumor cells and circulating tumor DNA (ctDNA). This article reviews the clinical use and challenges of blood ctDNA testing in patients with cervical precancer and cervical cancer.

Acceptance of human papillomavirus vaccination and parents' willingness to vaccinate their adolescents in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

Despite the global vaccination campaign to prevent HPV-related morbidity, HPV vaccination uptake remains unacceptably low in the developing world, like Ethiopia. For strong interventional measures, compiled data in the field is required which is otherwise missed in the Ethiopian context. Therefore, this systematic review aimed to provide an estimate of the HPV vaccination uptake, mothers' willingness to vaccinate their adolescent girls, and associated factors in Ethiopia.

METHODS

Articles were systematically searched using comprehensive search strings from PubMed/Medline, SCOPUS, and grey literature from Google Scholar. Two reviewers assessed study eligibility, extracted data, and assessed the risk of bias independently. Meta-analysis was performed using STATA v 14 to pool the vaccination uptake and mothers' willingness toward HPV vaccination in Ethiopia.

RESULTS

We included 10 articles published between 2019 and 2022 covering reports of 3,388 adolescent girls and 2,741 parents. All the included articles had good methodological quality. The pooled estimate of the proportion of good knowledge about HPV vaccination and the agreement of girls to get the vaccine was 60% (95%CI: 59-62) and 65% (95%CI: 64-67), respectively. The pooled estimate of vaccination uptake of at least one dose of HPV vaccine among girls was 55% (95%CI: 53-57). Positive attitudes to the vaccine, higher maternal education, and having knowledge about HPV and its vaccine were reported as statistically significant predictors. On the contrary, not having adequate information about the vaccine and concerns about possible side effects were reported as reasons to reject the vaccine. Likewise, the pooled estimate of mothers who were knowledgeable about HPV vaccination, who had a positive attitude, and willing to vaccinate their children were 38% (95%CI: 36-40) 58% (95%CI: 56-60), and 74% (95%CI: 72-75), respectively.

CONCLUSIONS

Knowledge about the HPV vaccine among girls and their vaccination uptake is suboptimal that falls short of the 2030 WHO targets. Therefore, stakeholders need major efforts in rolling out vaccination programs and monitoring their uptake. Social mobilization towards primary prevention of HPV infection should focus on adolescents. The existing strategies need to address the predictors of uptake by educating girls and parents.

The Prognostic Role of Human Papillomavirus and p16 Status in Penile Squamous Cell Carcinoma-A Systematic Review

PSCC is a rare cancer, with approximately half of all cases related to HPV. While HPV and p16 IHC testing have proven their prognostic value for oropharyngeal cancer, this is not yet established for PSCC. The current level of evidence exploring the relation between PSCC and HPV is moderate, so we conducted a systematic review following PRISMA guidelines to evaluate the prognostic role of HPV and p16 IHC in PSCC clinical outcomes. We searched the PubMed, Embase, and Cochrane databases and identified 34 relevant studies that met our inclusion criteria. Of these, 33 were retrospective cohort studies, and one was a cross-sectional study. Nine studies reported that HPV-positive and p16-positive PSCC had better overall survival (OS) and disease-free survival (DFS). This study highlights the need for a meta-analysis to determine the role of routine HPV status or p16 staining testing as part of the initial diagnosis and staging of PSCC patients worldwide.

Exploring computer-aided health decision-making on cervical cancer interventions through deliberative interviews in Ethiopia

Cervical cancer is a significant disease burden in Ethiopia. Mathematical models and computer simulations on disease dynamics can support effective resource allocation. The objectives of this work are (i) to explore the perspectives of health decision-makers on computer-aided predictions supporting cervical cancer interventions, (ii) to identify their information needs from these predictions, and (iii) their willingness to apply the results in their work. We conducted deliberative interviews with 15 health decision-makers and advisors in Ethiopia in autumn 2019. We analyze the data using a five steps framework approach drawing on thematic analysis and find that Ethiopian health decision-makers are willing to use computer-aided predictions in their decisions. Data on HPV prevalence and the cervical cancer burden are scarce but valued highly and decision-makers are particularly interested in the identification of local HPV hotspots. Data-driven mathematical models and computer simulations may increasingly influence health decision-making in Ethiopia.

High-risk human papillomavirus genotype distribution among women with gynecology complaints in northwest Ethiopia

BACKGROUND

Human papillomavirus (HPV) genotypes differ by geographic location. With the advent of HPV vaccination and HPV-based cervical screening tests in Ethiopia, a nationwide dataset on the genotype distribution of HPV among women has paramount importance in the fight against cervical cancer. However, there is limited data in this regard in the northwest part of the country. Therefore, this study aimed to identify the genotype distribution of high-risk HPVs among women presenting with cervical abnormalities.

METHODS

A health facility-based cross-sectional study was conducted at Felege Hiwot Comprehensive Specialized Hospital (FHCSH), Bahir Dar-Ethiopia. Women aged ≥ 30 years who visited the hospital gynecology unit from 01 March 2019 to 30 October 2021 were included. Following general and pelvic examinations, a senior gynecologist collected cervical punch biopsies for histopathological examinations and cervical swabs for HR-HPV detection using the Abbott Alinity m system (Abbott Molecular, Des Plaines, IL, USA). Extended genotyping was carried out with the INNO-LiPA HPV Genotyping Extra II assay (INNO-LiPA; Fujirebio Europe, Ghent, Belgium) as per the manufacturer protocols at the Institute of Virology, Leipzig University Hospital, Germany.

RESULTS

We included 355 women with a mean age of 46.4 ± 11.4 years. The majority of the participants, 277 (79.4%) were sexually active before the age of 18 years and 180 (51.6%) had multiple sexual partners. Forty-eight (13.5%) of the participants were HIV positive. The proportion of HR-HPV was 53.0% (n = 188; 95%CI: 47.8-58.1%). From these samples, 13 different HR-HPV types with a total of 258 sequences were identified. The detection of HR-HPV increased significantly with an increase in the age of the participants. The predominant identified HR-HPV was HPV16, 50.4% followed by HPV31 (9.7%), HPV33 (8.5%), HPV39, and HPV68 each (5.8%) and HPV18 (4.7%). Of the total HR-HPV-positive women, 23.9% (45/188) were infected with multiple HR-HPV types. All HPV16, HPV18, HPV35, and HPV45 genotypes (as a single or in coinfections) were found to be associated with either high-grade lesions or cervical cancer.

CONCLUSIONS

HR-HPV infection was reportedly higher among women in the present study area. Based on our findings, we strongly recommend the nonavalent HPV vaccine for immunization and any HPV-based screening method to take into consideration the predominant genotypes circulating in the country. The role of multiple HPV infections in high-grade cervical lesions entails further study in Ethiopia.

One-year results of the national breast and cervical cancer screening program: Giresun province in the black sea region

Background/Aim: Increasing the survival rate of patients with breast and cervical cancers is possible by early diagnosis through screening individuals for cancer in the asymptomatic period. Especially during the COVID-19 pandemic period, the possibility of early diagnosis in breast and cervical cancers has decreased due to the decrease in cancer screening applications. The aim of cancer screening is to increase the survival of patients by detecting precancerous lesions early. The purpose of our study is to evaluate the application and results of breast and cervical cancer screening in the Black Sea region’s Giresun province. Methods: This is a cross-sectional and descriptive study. The results of patients who were admitted to the Giresun Early Diagnosis Cancer Screening and Education Center between July 1, 2021, and June 28, 2022, were examined. The mammography report results of women aged 40–69 years who applied to the cancer screening center for breast cancer screening, and the HPV and Pap smear results of the patients aged 30–65 years who applied for cervical cancer screening, were evaluated retrospectively through the public health management system. Mammography results were evaluated with BIRADS (Breast Imaging Reporting and Dated System) scoring. The type of HPV and the cytology results from cervical swab samples were analyzed for cervical cancer screening. Results: A total of 3567 people underwent mammography. Per the mammography results, the percentage of those with BIRADS 0 was 7.7% (n=278), the percentage of those with BIRADS 1–2 was 91% (n=3256), the percentage of those with BIRADS 4 was 0.7% (n=25), and the percentage of those with BIRADS 5 was 0.14% (n=5). HPV-DNA and cervical cytology examinations were performed for cervical cancer screening in 2326 patients. As a result of cervical cancer screening, HPV positivity was found in 6.44% (n=150) patients, and 14 different HPV types were found in the positive samples. When HPV types were examined, the two most common types were HPV type 16 (13.6%) and type 56 (11.9%). When the HPV types were examined in the positive samples, the two most common types were HPV type 16 (13.6%) and type 56 (11.9%). HPV type 18 was the least detected HPV type in patients (3.7%). When the Pap smear screening results of the 150 cases with positive screening results were examined, 3.33% were ASC-US (atypical squamous cells of undetermined significance), 22% were reported as infection, and 62.6% were normal. Conclusion: The role of primary care physicians directing patients registered in their coverage area to cancer screening programs is especially effective in raising society’s awareness and education on the issue. As a result, it is important that primary care physicians and related specialist physicians, together with cancer early detection and screening centers, adopt a supportive stance towards these programs in order for them to be implemented effectively.