Type-specific HPV prevalence in cervical cancer and high-grade lesions in Latin America and the Caribbean: systematic review and meta-analysis

Prevalence of human papillomavirus genotypes in women of different ethnicity from rural northwestern Ecuador

BACKGROUND

In Ecuador, cervical cancer is the third most common cancer among women and the second most common cause of cancer-related death in women. Although HPV represents a serious public health problem worldwide, the information about its prevalence and genotypes in remote communities of Ecuador is limited. The aim of this study was to determine the distribution of HPV genotypes among ethnic minority women from two remote communities of the northwestern region of Ecuador: Afro-Ecuadorians and Chachis (Amerindian group).

METHODS

We included 291 women who responded to a short survey and were screened for HPV by the amplification of the L1 gene and a nested multiplex PCR to detect 14 high risk (HR) genotypes. A survey collected information on ethnicity, age, community access, and sexual and gynecological history. We identified risk factors associated with HPV infection and co-infection using multivariate logistic regression to calculate odds ratio (OR) and Wald 95% confidence intervals (CI).

RESULTS

Overall, HPV prevalence in the study cohort was 56%, and the five most common HR-HPV genotypes were HPV-58, -16, -68, -39, and -43; however, the distribution of HPV genotypes varied according to ethnicity. We identified lineage A (European variant) for HPV-16 and sublineage A2 for HPV-58 in both ethnic groups. Adjusting for ethnicity, age, community access, and number of sexual partners, we found that Afro-Ecuadorian women were less likely to have an HPV infection than Chachi women (OR: 0.49, 95% CI: 0.25, 0.96), and that participants in communities only accessible by river had 64% less chances of an HPV infection when compared to women in communities accessible by road (OR: 0.36, 95% CI: 0.19, 0.71), and women with 2 to 3 sexual partners had 2.47 times the odds of HPV infection than participants with 0-1 partners (OR: 2.47, 95% CI: 1.32, 4.6). Similar associations were observed with prevalence of co-infection.

CONCLUSIONS

This study provides baseline knowledge regarding the prevalence and distribution of HPV genotypes in ethnic groups of the northwestern coastal Ecuador and essential information for the implementation of appropriate HPV testing and vaccination program to prevent cervical cancer.

Pap Cytology and Human Papillomavirus (HPV) Genotypes in Western Romania: A Retrospective Analysis

Background and objective Vigorous proactive measures are needed to combat cervical cancer, linked to the human papillomavirus (HPV). HPV genotyping aids in identifying high-risk strains, enabling targeted screening and risk assessment. This informs treatment decisions, reducing cervical cancer cases. In light of this, we conducted a retrospective analysis of Pap cytology and HPV genotypes to assess western Romania's new screening program. Understanding HPV prevalence, genotype correlations, and risk factors will help refine risk stratification models and enhance public health strategies. Methodology This retrospective study analyzed Pap smears from 195 patients with a mean age of 40 years [standard deviation (SD): 12 years], with a peak of incidence between 25 and 30 years. The patient cohort, with equal representation from urban and rural areas, comprised sexually active women of reproductive age presenting to the Gynaecology Ambulatory of the Municipal Emergency Clinical Hospital Timișoara over two years. Patients not sexually active and those in menopause were excluded. HPV genotyping was done on 67 patients. Data were analyzed using JASP, employing descriptive statistics, frequency tables, contingency tables, chi-squared test, odds ratio, and Fisher's exact test. Results Among 195 patients undergoing Pap smear tests, the most prevalent finding was negative (77.95%), indicating no abnormal cells detected. A smaller proportion of patients exhibited low-grade squamous intraepithelial lesions (LSIL, 11.28%) or atypical squamous cells of undetermined significance (ASC-US, 8.72%) findings. High-grade lesions (HSIL, ASC-H) were rare. For cytology grading, Category II (CII) was the most prevalent (75.90%), followed by Category III (CIII, 24.10%). HPV genotyping was performed on a subset of patients (n=67). Among them, Type 16 was the most frequent (28.36%), followed by Other high-risk types (20.89%), Type 16 (28.35%), and Type 18 (13.43%). HPV testing was not performed for 65.64% of the patients. Overall, the study suggests that a significant majority of the patients had normal Pap smears. However, a small proportion did have abnormal findings, including HPV infection. These findings highlight the importance of Pap smear screening for early detection of cervical abnormalities. Conclusions Our study from western Romania highlights the importance of HPV testing and Pap cytology in cervical cancer prevention. HPV testing is a potent tool for identifying high-risk women, and when combined with Pap cytology, it provides a more comprehensive screening strategy. Our research also revealed a diverse HPV genotype distribution, suggesting the need for broader-spectrum vaccines like the nonavalent vaccine. Despite our study's limitations, our findings underscore the need for including HPV testing in national screening guidelines. Future research should focus on larger studies and the cost-effectiveness of broader-spectrum vaccines. Implementing policies based on these findings could lead to more effective cervical cancer prevention in western Romania.

Cervicovaginal Gardnerella sialidase-encoding gene in persistent human papillomavirus infection

Disturbed vaginal microbiota have a role in the persistence of high-oncogenic-risk human papillomavirus (hrHPV) and Gardnerella spp. is closely related with this condition. Such bacteria are the major source of cervicovaginal sialidases, important for microbiota alterations. The sialidase-encoding gene nanH3 is account for their sialidase activity. Thus, a subset of 212 women positive for hrHPV at the first visit were included in the analysis of the current study aiming to compare the loads of nanH3 in cervicovaginal fluid (CFV) of women with persistent hrHPV infection and with those cleared the infection after a year. Participants were assigned to two study groups named "persistence" (n = 124, 53.22%) or "clearance" (n = 88, 37.77%), according to the HPV status upon enrollment and follow-up. Absolute quantification of nanH3 gene was performed using quantitative real-time PCR (qPCR). Persistence and clearance group did not show statistical difference in the load of nanH3 gene (p = 0.19). When considering the subset of women with HPV16, differences in number of copies of nanh3 gene was observed between the persistent (7.39E+08 copies/μL) and clearance group (2.85E+07 copies/μL) (p = 0.007). Therefore, baseline loads of nanH3 gene is increased in women that persist with cervical HPV16 infection after 12 months.

Novel competitive enzyme-linked immunosorbent assay for the detection of the high-risk Human Papillomavirus 18 E6 oncoprotein

Cervical cancer represents a global concern with 604,000 new cases and 342,000 deaths reported annually, with the vast majority diagnosed in low income countries. Despite high-risk Human Papillomavirus (HR HPV)-induced cervical cancer has become highly preventable through prophylactic vaccines, screening programs are critical in the control of cervical carcinogenesis in populations with limited access to vaccination and in older generations of women who have already been exposed to HR HPV infection. The surge of HPV molecular tests has provided a more sensitive and accurate diagnostic alternative to cytology screening. Given that HPV DNA testing presents a low positive predicted value, leading to unnecessary treatment, the E6 oncoprotein from HR HPV types arises as a promising diagnostic marker for its overexpression in transformed HPV-positive cancer cells. For these reasons, this study aimed at obtaining monoclonal antibodies (mAbs) against the E6 oncoprotein of one of the most prevalent HR HPV types worldwide, HPV18, in order to develop a highly specific and sensitive indirect competitive ELISA (icELISA). The production of hybridomas secreting HPV18 E6 mAbs was carried out through a combined tolerization and immunization strategy, in order to avoid cross-reactivity with the E6 protein from low-risk HPV types 6 and 11. We selected the 7D2 hybridoma clone, which recognized HPV18 E6 and showed some cross-reactivity against the HR HPV45 E6 oncoprotein. The 7D2 mAb enabled the development of a sensitive, reliable and reproducible icELISA to detect and quantify small amounts of HPV18 E6 biomarker for cervical cancer progression. The present study establishes a valid 7D2-based icELISA that constitutes a promising bioanalytical method for the early detection and quantification of HPV18 E6 oncoprotein in cervical swab samples and cancer prevention.

Human papillomavirus 16/18/45 are not the most frequent genotypes in African American women: analysis in cervical Papanicolaou smears of women in an inner-city hospital

INTRODUCTION

Cervical cancer is considered the most common human papillomavirus (HPV)-associated disease in women. Primary and secondary prevention methods have been established through Pap tests, HPV molecular testing, and vaccines. Although the most common high-risk HPV (HR-HPV) genotypes in the United States are 16, 18, and 45, there is reported ethnic disparity in the distribution of these genotypes.

MATERIALS AND METHODS

Data analysis of HPV genotype results on cervical pap tests in our institution between late 2018 and early 2020 was performed. The distribution of HPV genotypes in each Bethesda category was evaluated.

RESULTS

A total of 13,160 smears were evaluated; 75.5% were from African American women. Of those tested for HR-HPV (10,060), 1412 (14%) were HR-HPV positive. In all diagnostic categories of the Bethesda classification system, non-16/18/45 HR-HPV genotypes were more prevalent, ranging from 60.8% even in high-grade squamous intraepithelial lesion to 90.4% in negative for intraepithelial lesion or malignancy.

CONCLUSIONS

In this study with a predominantly African American population, non-16/18/45 HR-HPV genotypes were prevalent in the majority (60.8%) of high-grade squamous intraepithelial lesion cases. Ethnic variability should be considered when deciding which HPV genotypes to integrate into the HPV vaccine.

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.

hnRNP K induces HPV16 oncogene expression and promotes cervical cancerization

PURPOSE

This study aims to explore the expression of hnRNP K in cervical carcinogenesis and to investigate the regulatory role of hnRNP K on HPV16 oncogene expression as well as biological changes in cervical cancer cells.

METHODS

In total 1042 subjects, including 573 with the normal cervix and 469 with different grades of cervical lesions were enrolled in this study to explore the association between hnRNP K and HPV16 oncogene expression in cervical carcinogenesis. Additionally, the Gene Omnibus (GEO) database was used to analyze hnRNP K mRNA expression in cervical cancerization. Meanwhile, the effects of hnRNP K on cell biological functions and HPV16 oncogene expression were investigated in Siha cells. Moreover, Function analyses were conducted using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) databases after ChIP-seq.

RESULTS

hnRNP K was highly expressed in cervical cancer and precancerous lesions, and positively correlated with HPV16 E6, but negatively correlated with HPV16 E2 and HPV16 E2/E6 ratio. hnRNP K induced cell proliferation, inhibited apoptosis and caused cell cycle arrest in the S phase, and particularly increased HPV16 E6 protein expression.

CONCLUSION

This study revealed that hnRNP K overexpression has important warning significance for the malignant transformation of cervical lesions, and could be used as a potential therapeutic target for inhibiting the carcinogenicity of HPV16 and prevention of cervical carcinogenesis.

Human Papillomavirus: Challenges and Opportunities for the Control of Cervical Cancer

Viruses are the most abundant and genetically diverse entities on the planet, infect all life forms and have evolved with their hosts. To date, 263 viral species have been identified that infect humans, of which only seven are considered type I oncogenic. Human papillomavirus (HPV) is the main virus associated with cancer and is responsible for practically all cases of cervical carcinoma. Screening tests for early detection have been available since the 1960s. Undoubtedly, the entailment between knowledge of HPV biology and the natural history of cervical cancer has contributed to the significant advances that have been made for its prevention since the 21^st century, with the development of prophylactic vaccines and improved screening strategies. Therefore, it is possible to eradicate invasive cervical cancer as a worldwide public health problem, as proposed by the WHO with the 90-70-90 initiative based on vaccination coverage, screening, and treatment, respectively. In addition, the emerging knowledge of viral biology generates opportunities that will contribute to strengthening prevention and treatment strategies in HPV-associated neoplasms.

Human papillomavirus genotyping using next generation sequencing (NGS) in cervical lesions: Genotypes by histologic grade and their relative proportion in multiple infections

Sensitive and specific genotyping of human papillomaviruses (HPVs) is critical for the surveillance and monitoring of the vaccine effectiveness. Here, HPV genotypes were identified in 137 cervical samples with different histology (79 ≤CIN1 and 58 CIN3+) using Nested-PCR followed by Next-Generation sequencing (NGS) and relative proportions for each genotype in multiple infections were computed. All samples had been previously genotyped by PCR-Reverse Blotting Hybridization (PCR-RBH) thus allowing for a concordance analysis between both techniques. Multiple infections were present in 85% of ≤CIN1 cases compared to only 41% in CIN3+ cases (p<0.001). Among ≤CIN1 cases a towering genotypic diversity was observed, considering both low (LR-) and high risk (HR-) HPV genotypes; while among CIN3+, diversity was lower, HR-HPVs prevailing in most cases, especially HPV16. Furthermore, the predominance of HR-HPV genotypes in the proportions identified in each sample was higher in CIN3+ cases [(HPV16 (62.5%), followed by HPV31 and HPV58 (8.3% each)], than in ≤CIN1 cases [(HPV16 (17.7%), followed by HPV52 (14.7%) and HPV31 (10.3%)]. Agreement between PCR-RBH and NGS was higher than 90% for all genotypes (with an overall Kappa of 0.7), even though NGS identified eighty-nine positive results for HPV genotypes that had not been detected by PCR-RBH, evidencing its greater sensitivity. These results suggest that a reduction in genotypic diversity and/or an increase in the relative proportion of HR-HPVs in multiple infections can be considered as a biomarker for the potential risk of malignant progression.

Prevalence, Diversity, and Risk Factors for Cervical HPV Infection in Women Screened for Cervical Cancer in Belém, Pará, Northern Brazil

Background: Human papillomavirus (HPV) is the most common viral sexually transmitted infection of the reproductive tract, and cervical cancer is the most common HPV-related disease. This study estimated the prevalence, diversity of HPV genotypes, and associated risk factors in women screened for cervical cancer in northern Brazil. Methods: The cross-sectional study was conducted in Belém, Pará, in the Amazon region of Brazil, and it included 162 women who were spontaneously undergoing a Pap-smear routine. Epidemiological, sexual, and health-related information was collected by interviews, and cervical samples were collected for cytological examination and HPV-DNA detection. HPV genotypes were classified as low risk (LR) and high risk (HR) by nucleotide sequencing. Results: In total, 17.3% (28/162) of the participants had HPV-DNA, and LR-HPV was the most prevalent (71.4%). Among the 13 different types of HPV detected, HPV-11 was found most frequently (12/28; 42.9%), followed by HPV-31 (3/28; 10.7%). Of the participants with cytological alterations, HPV infection was detected in only four: two were diagnosed with low-grade squamous intraepithelial lesions (15.4%), one with atypical squamous cells of undetermined significance (7.7%), and one with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (7.7%). Of the 61 women who presented a normal cytology, 13 (21.3%) had positive tests for HPV infection, 4 (8.2%) of which were positive for a high-risk genotype. Conclusion: The prevalence of HPV was high in Belém, Pará, and especially in women who had normal cytology results, which suggests the need for greater screening for HPV infection in women’s primary health care.

Distribution of human papillomavirus genotypes by severity of cervical lesions in HPV screened positive women from the ESTAMPA study in Latin America

The proportion of HPV16 and 18-associated cervical cancer (CC) appears rather constant worldwide (≥70%), but the relative importance of the other HR-HPV differs slightly by geographical region. Here, we studied the HPV genotype distribution of HPV positive Latin American (LA) women by histological grade, in a sub-cohort from the ESTAMPA study; we also explored the association of age-specific HPV genotypes in severe lesions. Cervical samples from 1,252 participants (854 ≤CIN1, 121 CIN2, 194 CIN3 and 83 CC) were genotyped by two PCRs-Reverse Blotting Hybridization strategies: i) Broad-Spectrum General Primers 5+/6+ and ii) PGMY9/11 PCRs. HPV16 was the most frequently found genotype in all histological grades, and increased with the severity of lesions from 14.5% in ≤ CIN1, 19.8% in CIN2, 51.5% in CIN3 to 65.1% in CC (p < 0.001). For the remaining HR-HPVs their frequency in CC did not increase when compared to less severe categories. The nonavalent vaccine HR-types ranked at the top in CC, the dominant ones being HPV16 and HPV45. HR-HPV single infection occurs, respectively, in 57.1% and 57.0% of ≤CIN1 and CIN2, increasing to 72.2% and 91.6% in CIN3 and CC (p<0.001). No association between age and HPV type was observed in CC, although the risk of HPV16 infection in CIN3 cases increased with age. Results confirm the relevance of HPV16 in the whole clinical spectrum, with a strong rise of its proportion in CIN3 and cancer. This information will be relevant in evaluating the impact of HPV vaccination, as a baseline against which to compare genotype changes in HPV type-specific distribution as vaccinated women participate in screening in LA region. Likewise, these data may help select the best HPV testing system for HPV-based efficient, affordable, and sustainable screening programmes.

Cervical cancer specific survival in Grande Cuiabá, Mato Grosso State, Brazil

OBJECTIVE

To estimate specific five-year survival in women diagnosed with cervical cancer living in the municipalities of Cuiabá and Várzea Grande, in the state of Mato Grosso, Brazil.

METHODS

This is a retrospective cohort study with information from the Cuiabá Population-based Cancer Registry and the Mortality Information System. To estimate the probability of specific survival in five years, the Kaplan-Meier estimator and the log-rank test were used aiming at verifying if there were statistical differences in the lifetime per groups. To verify the proportionality of the failure rates, the Schoenfeld residual test was used according to the statistical significance level of 0.05.

RESULTS

Specific five-year survival and median time were 90.0% and 50.3 months, respectively, for cervical cancer. When analyzing by age, the highest specific survival was among women aged 20 to 49 years (91.7%) and median time was 53.3 months. For the histological type, the highest specific survival was among women with adenocarcinoma (92.3%) and the mean survival time was 53.5 months.

CONCLUSION

This study showed that specific survival after five years of diagnosis remained about 90% in patients with cervical cancer. Patients aged 20 to 49 years had higher specific survival and there was statistically significant difference only between age groups.

Cervicovaginal loads of Gardnerella spp. are increased in immunocompetent women with persistent high-risk human papillomavirus infection

Introduction. Two high-oncogenic-risk human papilomavirus (hrHPV) genotypes - HPV16 and HPV18 - cause most of the cases of cervical cancer worldwide. Bacterial vaginosis is associated with increased hrHPV persistence, although the mechanism underlying this association remains unclear. Gardnerella spp. are detected in nearly all cases of bacterial vaginosis and are the major source of cervicovaginal sialidases. The NanH1 gene is present in virtually all Gardnerella sialidase-producing strains and has been proposed as a potential marker for persistent hrHPV infection.Hypothesis. Gardnerella spp. load and the NanH1 gene are associated with hrHPV persistence.Aim. To compare the cervicovaginal load of Gardnerella spp. and the frequency of the NanH1 gene between women with persistent HPV16 and/or HPV18 infection and those who cleared the infection after 11 months.Methodology. Among a population of 1638 HPV screened, we detected 104 with positive HPV16 and/or HPV18 results. Samples were obtained at two time points (baseline and at a median of 11 months at follow-up) and tested using the Linear Array HPV Genotyping kit (Roche Molecular Systems, Pleasanton, CA, USA). Based on their HPV16/HPV18 status at enrolment and follow-up, participants were assigned to 'persistence' or 'clearance' groups. We used cervicovaginal fluid samples obtained upon enrolment to determine the load of the 23 s rRNA gene of Gardnerella spp. and the presence of the NanH1 gene using real-time polymerase chain reaction (PCR). We compared Gardnerella spp. loads and NanH1 frequency between the groups by, respectively, Mann-Whitney and chi-squared tests, with a P-value <0.05 considered to be significant.Results. Of the 104 participants who were positive for HPV16/HPV18, 73 (70.2 %) persisted with at least 1 of the baseline genotypes at follow-up, while 31 (29.8 %) cleared the infection in this time frame. Participants in the persistence group had significantly higher loads of Gardnerella spp. [5.8E+02 (0-3.0E+05) copies µl^-1] than those in the clearance group [9.9E+01 (0-7.7E+04) copies µl^-1] (P=0.03). The baseline frequency of NanH1 was higher in the persistence' (n=46, 63.0 %) than in the clearance (n=14, 45.2 %) group, although this was not statistically significant (P=0.09).Conclusion. These findings reinforce the negative effect of vaginal microbiota for the clearance of hrHPV and indicate a possible association between sialidase-producing species with hrHPV persistence.

Characterization of High-Risk HPV/EBV Co-Presence in Pre-Malignant Cervical Lesions and Squamous Cell Carcinomas

High-risk human papillomaviruses (HR-HPVs) are the etiological agents of cervical cancer. However, a low proportion of HR-HPV-infected women finally develop this cancer, which suggests the involvement of additional cofactors. Epstein−Barr virus (EBV) has been detected in cervical squamous cell carcinomas (SCCs) as well as in low- (LSIL) and high-grade (HSIL) squamous intraepithelial lesions, although its role is unknown. In this study, we characterized HR-HPV/EBV co-presence and viral gene expression in LSIL (n = 22), HSIL (n = 52), and SCC (n = 19) from Chilean women. Additionally, phenotypic changes were evaluated in cervical cancer cells ectopically expressing BamHI-A Rightward Frame 1 (BARF1). BARF1 is a lytic gene also expressed in EBV-positive epithelial tumors during the EBV latency program. HPV was detected in 6/22 (27.3%) LSIL, 38/52 (73.1%) HSIL, and 15/19 (78.9%) SCC cases (p < 0.001). On the other hand, EBV was detected in 16/22 (72.7%) LSIL, 27/52 (51.9%) HSIL, and 13/19 (68.4%) SCC cases (p = 0.177). HR-HPV/EBV co-presence was detected in 3/22 (13.6%) LSIL, 17/52 (32.7%) HSIL, and 11/19 (57.9%) SCC cases (p = 0.020). Additionally, BARF1 transcripts were detected in 37/55 (67.3%) of EBV positive cases and in 19/30 (63.3%) of HR-HPV/EBV positive cases. Increased proliferation, migration, and epithelial-mesenchymal transition (EMT) was observed in cervical cancer cells expressing BARF1. Thus, both EBV and BARF1 transcripts are detected in low- and high-grade cervical lesions as well as in cervical carcinomas. In addition, BARF1 can modulate the tumor behavior in cervical cancer cells, suggesting a role in increasing tumor aggressiveness.

Human papillomavirus genotype distribution in Ethiopia: an updated systematic review

BACKGROUND

Cervical cancer is caused by infection with high-risk human papillomaviruses (HR-HPVs). It is one of the leading causes of cancer-related deaths in Ethiopia and globally. To develop efficient vaccination and HPV-based cervical cancer screening approaches, data on genotype distribution of HPVs is crucial. Hence, the study was aimed to review HPV genotype distribution in Ethiopia.

METHODS

Research articles were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. Besides, Google Scholar was searched manually for grey literature. The last search was conducted on 18 August 2021. The first two authors independently appraised the studies for scientific quality and extracted the data using Excel sheet. The pooled HPV genotype distribution was presented with descriptive statistics.

RESULTS

We have included ten studies that were reported from different parts of the country during 2005 and 2019. These studies included 3633 women presented with different kinds of cervical abnormalities, from whom 29 different HPV genotypes with a sum of 1926 sequences were reported. The proportion of high-risk, possible/probable high-risk and low-risk HPVs were at 1493 (77.5%), 182 (9.4%) and 195 (10.1%), respectively. Of the reported genotypes, the top five were HPV 16 (37.3%; 95% CI 35.2.1-39.5%), HPV 52 (6.8%; 95% CI 5.8-8.0%), HPV 35 (4.8%; 95% CI 3.9-5.8%), HPV 18 (4.4%; 95% CI 3.5-5.3%) and HPV 56 (3.9%: 95% CI 3.1-4.9%). Some of other HR-HPV groups include HPV 31 (3.8%), HPV 45 (3.5%), HPV 58 (3.1%), HPV 59(2.3%), and HPV 68 (2.3%). Among the high-risk types, the combined prevalence of HPV 16/18 was at 53.7% (95% CI 51.2-56.3%). HPV 11 (2.7%: 95% CI 2.1-3.5%), HPV 42 (2.1%: 95% CI 1.5-2.8%) and HPV 6 (2.1%: 95% CI 1.4-2.7%) were the most common low-risk HPV types.

CONCLUSIONS

We noted that the proportion of HR-HPV types was higher and HPV 16 in particular, but also HPV 52, HPV 35 and HPV 18, warrant special attention in Ethiopian's vaccination and HPV based cervical screening program. Additional data from other parts of the country where there is no previous HPV genotype report are needed to better map the national HPV genotypes distribution of Ethiopia.

Prevalence and Distribution of Human Papillomavirus Genotypes (1997-2019) and Their Association With Cervical Cancer and Precursor Lesions in Women From Southern Mexico

BACKGROUND

Cervical cancer (CC) is the fourth most common malignancy of the female genital tract. Human Papillomavirus (HPV) is the main cause of precancerous lesions and CC cases worldwide.

OBJECTIVE

We assessed the prevalence and distribution of HPV types and their association with precancerous lesions and CC.

METHODS

HPV genotypes were detected by 3 methods depending on the year of in which the sample was analyzed: MY09/11 RFLPs (1997 to 2010), GP5+/6+ primer systems (2005 to 2010) and INNO-LiPA HPV Genotyping Extra (2010 to 2019) in cervical samples (No-IL: 4445; LSIL: 2464; HSILs: 151 and CC: 253) from women from southern Mexico.

RESULTS

The overall HPV prevalence was 54.17%, and hpv-16 was the most common genotype. In single infection, the high-risk HPV genotypes (group 1) were associated with squamous intraepitelial lesions (LSIL: HPV-39 (OR = 10.58, 95% CI 4.09-27.36, P < .001); HSIL: HPV-31 (OR = 14.76, 95% CI 6.56-33.20, P < .001); and CC: HPV-16 (OR = 25.01, 95% CI 18.83-33.21, P < .001). In multiple infections, the HPV genotypes (HPV-16 and HPV-18) were also associated with a high risk of lesions [LSIL: HPV-18 (OR = 3.45; 95% CI 1.36-8.91; P = .009); HSIL: HPV-18 (OR = 5.12; 95% CI 1.21-21.68; P = .026); and CC: HPV-16 (OR = 3.03; 95% CI 1.72-5.32; P < .001)] compared to single infection. In the analysis adjusted for age, giving birth, and cigarette smoking, a significant increase in the risk of LSIL, HSIL, and CC was maintained.

CONCLUSIONS

This study provides current data on the prevalence and distribution of HPV genotypes in women from southern Mexico, which could serve as a valuable reference to guide nationwide CC screening programs and provide scientific evidence that could be useful for vaccine development efforts. Likewise, it was identified that infection with carcinogenic HPV genotypes is an independent risk factor for LSIL, HSIL, and CC.

Sobrevida específica do câncer do colo do útero na Grande Cuiabá, Mato Grosso, Brasil

RESUMO: Objetivo: Estimar a sobrevida específica em cinco anos de mulheres diagnosticadas com câncer do colo do útero que residem nos municípios de Cuiabá e Várzea Grande, Mato Grosso. Métodos: Estudo de coorte retrospectiva com informações provenientes do Registro de Câncer de Base Populacional de Cuiabá e do Sistema de Informação sobre Mortalidade. Para estimar a probabilidade de sobrevivência específica em cinco anos, foram utilizados o estimador de Kaplan-Meier e o teste de log-rank. Para verificar a proporcionalidade das taxas de falhas, usou-se o teste de resíduos de Schoenfeld, conforme o nível de significância estatística de 0,05. Resultados: A sobrevida específica em cinco anos e o tempo mediano de sobrevida foram de 90% e 50,3 meses, respectivamente, para o câncer do colo do útero. Quando se analisa por idade, a maior sobrevida específica foi entre as mulheres de 20 a 49 anos (91,7%) e o tempo mediano de sobrevida foi de 53,3 meses. Para o tipo histológico, a maior sobrevida específica foi entre as mulheres com adenocarcinoma (92,3%) e o tempo mediano de sobrevida foi de 53,5 meses. Conclusão: Este estudo mostrou que a sobrevida específica após cinco anos do diagnóstico se manteve em torno de 90% em pacientes com câncer de colo do útero. As pacientes entre 20 e 49 anos tiveram maiores sobrevidas específicas e houve diferença estatisticamente significativa somente entre as faixas etárias.

Possible high-grade squamous intraepithelial lesion (pHSIL) in the new cervical screening paradigm: The outcomes and the role of clinicopathological review

BACKGROUND

A renewed National Cervical Screening Program (NCSP) was introduced in Australia in December 2017. Under the renewed NCSP, there are limited data to guide the management of discordant colposcopy and biopsy results after a liquid-based cytology (LBC) finding of 'possible high-grade squamous intraepithelial lesion' (pHSIL).

AIMS

This study aims to determine the proportion of women referred with pHSIL who are found to have HSIL, identify influencing factors of women most at risk, and examine the role that cytopathology review plays in management decisions.

MATERIALS AND METHODS

Two-hundred and thirty-two women presenting to a tertiary women's hospital in Australia with pHSIL since December 2017 were identified. Women with HSIL following colposcopy directed biopsy were referred for treatment. When HSIL was not identified, these patients were referred for multidisciplinary clinicopathological review. Pathological outcomes and treatment recommendations are included.

MAIN OUTCOME MEASURES

The primary outcome of the study was histological confirmation of HSIL.

RESULTS

Primary outcome data were available for 182 women (78.5%); 62 (34.1%) had HSIL on histology, three (1.7%) had adenocarcinoma in situ (AIS) and one (1%) had cervical squamous cell carcinoma (SCC). There was no association between age and the presence of HSIL. The presence of human papillomavirus 16 and/or 18 increased the likelihood of HSIL on histology (relative risk 1.9; 95% CI 1.27-2.80, P = 0.002). Fifty-nine (25.4%) women were referred for observation who had low-grade squamous intraepithelial lesion/no dysplasia.

CONCLUSIONS

Clinicopathological review optimises management and triage of patients with pHSIL on referral cytology. Understanding outcomes in these patients informs counselling and management.

Strong reduction in prevalence of HPV16/18 and closely related HPV types in sexually active adolescent women following the introduction of HPV vaccination in Argentina

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HPV16/18 decreased by >93% in vaccinated sexually active Argentine girls.

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Detected reduction of HPV31 and 45 would add to the success of immunization.

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No genotype replacement was observed.

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First HPV vaccination monitoring data reported from a Latin American country.

Prevalence and correlation of human papillomavirus genotypes with clinical factors in cervical samples from Mexican women

IMPACT STATEMENT

We are submitting data regarding the prevalence and type distribution of the HPV infection and the risk factors associated with it, which may provide a valuable reference to reinforce screening strategies, and to maintain HPV genotype surveillance in Mexico. We discuss the overall prevalence of HPV infection as detected in normal cytological samples stratified by age, different types of infection, and oncogenic capacity. One of the most important findings was that common HPV genotypes detected in healthy women were the genotype numbers: 6, 31, 16, and 56, likewise, smoking and having a history of more than three sexual partners over their lifetime, represented the main risk factors in this study. Furthermore, we found a low frequency of cytological abnormalities and CIN 1-3 in women with HR-HPV.

Role of Epstein-Barr Virus and Human Papillomavirus Coinfection in Cervical Cancer: Epidemiology, Mechanisms and Perspectives

High-risk human papillomavirus (HR-HPV) is etiologically associated with the development and progression of cervical cancer, although other factors are involved. Epstein-Barr virus (EBV) detection in premalignant and malignant tissues from uterine cervix has been widely reported; however, its contribution to cervical cancer development is still unclear. Here, a comprehensive analysis regarding EBV presence and its potential role in cervical cancer, the frequency of EBV/HR-HPV coinfection in uterine cervix and EBV infection in tissue-infiltrating lymphocytes were revised. Overall, reports suggest a potential link of EBV to the development of cervical carcinomas in two possible pathways: (1) Infecting epithelial cells, thus synergizing with HR-HPV (direct pathway), and/or (2) infecting tissue-infiltrating lymphocytes that could generate local immunosuppression (indirect pathway). In situ hybridization (ISH) and/or immunohistochemical methods are mandatory for discriminating the cell type infected by EBV. However, further studies are needed for a better understanding of the EBV/HR-HPV coinfection role in cervical carcinogenesis.

Multiple HPV Infections and Viral Load Association in Persistent Cervical Lesions in Mexican Women

Persistent high-risk human papillomavirus (HR-HPV) infections play a major role in the development of invasive cervical cancer (CC), and screening for such infections is in many countries the primary method of detecting and preventing CC. HPV typing can be used for triage and risk stratification of women with atypical squamous cells of undetermined significance (ASC-US)/low-grade cervical lesions (LSIL), though the current clinical practice in Mexico is to diagnose CC or its preceding conditions mainly via histology and HR-HPV detection. Additional information regarding these HPV infections, such as viral load and co-infecting agents, might also be useful for diagnosing, predicting, and evaluating the possible consequences of the infection and of its prevention by vaccination. The goal of this follow-up hospital case study was to determine if HPV types, multiple HPV infections, and viral loads were associated with infection persistence and the cervical lesion grade. A total of 294 cervical cytology samples drawn from patients with gynecological alterations were used in this study. HPV types were identified by real-time PCR DNA analysis. A subset of HPV-positive patients was reevaluated to identify persistent infections. We identified HPV types 16, 18, and 39 as the most prevalent. One hundred five of the patients (59%) were infected with more than one type of HPV. The types of HPV associated with multiple HPV infections were 16, 18, and 39. In the follow-up samples, 38% of patients had not cleared the initially detected HPV infection, and these were considered persistent. We found here an association between multiple HPV infections and high viral loads with and infection persistence. Our findings suggest there are benefits in ascertaining viral load and multiple HPV infections status of HR-HPV infections for predicting the risk of persistence, a requirement for developing CC. These findings contribute to our understanding of HPV epidemiology and may allow screening programs to better assess the cancer-developing risks associated with individual HR-HPV infections.

The contribution of Latin American research to HPV epidemiology and natural history knowledge

Our aim was to review the major contributions of studies conducted in different Latin American (LA) countries to the field of human papillomavirus (HPV) epidemiology, natural history, risk of disease, and prevention strategies, mainly in the uterine cervix. Although cytological screening is established in several countries in LA, incidence and mortality rates from cervical cancer (CC) are still extremely high. Finally, data from large cohort studies conducted in LA countries provided seminal data to propose primary and secondary prevention modalities: the HPV vaccine has been introduced in the national immunization programs of several LA countries and multiple screening experiences using HPV testing are under evaluation in the region.

High risk HPV infection prevalence and associated cofactors: a population-based study in female ISSSTE beneficiaries attending the HPV screening and early detection of cervical cancer program

BACKGROUND

Cervical cancer is the second cause leading of malignancy-related death among Mexican women. The present study determined the population-based prevalence of high risk Human Papillomavirus (HR-HPV) infection and associated cofactors in female beneficiaries of the Institute of Security and Social Services for State Workers (ISSSTE) attending the Program for HPV Screening and Early Detection of Cervical Cancer and registered in the Women's Cancer Detection System (SIDECAM).

METHODS

In a cross-sectional study, cervical samples from 115,651 female users of the program for HPV screening and early detection of cervical cancer recruited in 23 ISSSTE care centers were analyzed for HR-HPV. Logistic regression analyses, adjusting for potential confounders, were performed to determine the association of HR-HPV infection with sexual health and behavior variables and with positivity to cervical premalignant lesions by cytology.

RESULTS

The overall prevalence of HR-HPV infection among female ISSSTE beneficiaries in the 2013-2015 period was 13%. A bivariate analysis of relevant variables for HR-HPV infection showed a statistically significant association for age, number of sexual partners, use of hormonal contraceptives and smoking. A statistical association was found between infection by HR-HPV with the use of hormonal contraceptives, number of sexual partners and smoking and association of HPV 16 and other non-16/18 HR-HPV infection with number of lifetime sexual partners and tobacco use adjusted for age, history of hormonal contraception, number of sexual partners and tobacco use with the exception of exposition variable itself. Similarly, an association was found between HR-HPV infection, regardless of the virus genotype, with positivity to cervical premalignant lesions adjusted for age, number of lifetime sexual partners, history of hormonal contraception and tobacco use.

CONCLUSIONS

HR-HPV prevalence in female ISSSTE Women's Cancer Program users is similar to the population-based prevalence previously reported in Mexican women without cervical alterations. The ISSSTE robust screening and early detection program, based on cytology studies and HPV co-testing, allows us to know the prevalence of HR-HPV infection among female users of the service.

The burden of 14 hr-HPV genotypes in women attending routine cervical cancer screening in 20 states of Mexico: a cross-sectional study

In Mexico, HPV vaccines available immunize against genotypes 16/18 and 16/18/6/11; however, there is limited surveillance about carcinogenic subtypes in different states of the country that allow evaluating the effectiveness of vaccination and cervical cancer screening programs. Here, we report the regional and age-specific prevalence of 14 hr-HPV genotypes as well as their prevalence in abnormal cytology (from ASCUS to cervical cancer) among Mexican women which were undergoing from cervical cancer screening in the Salud Digna clinics in 20 states of the country. This study includes women with social security from the majority of public health institutions (IMSS, ISSSTE, SEMAR, and PEMEX), and women without social security. For cervical cancer screening, we used the SurePath liquid-based cytology and the BD Onclarity HPV Assay. From December 1, 2016, to August 2, 2018, the hr-HPV prevalence among 60,135 women was 24.78%, the most prevalent types were HPV 16 (4.13%), HPV 31 (4.12%) and HPV 51 (3.39%), while HPV 18 (1.70%) was less prevalent among infected women. Interestingly, the genotypes not covered by current vaccines in Mexico were commonly found in precancerous lesions, evidencing their carcinogenic potential, so it is necessary to increase their surveillance and inclusion in cervical cancer screening triage.

Human papillomavirus in Ethiopia

Over 99% of cervical cancer cases are associated with genital infection by certain types of human papillomaviruses (HPVs). To outline optimal vaccination strategies and HPV based cervical cancer screening, synthesized data on the genotype distribution of HPV is fundamental that is otherwise missed in Ethiopia. The aim of this study is to compile the findings on HPV genotyping in Ethiopia. Published articles were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. Further, Google Scholar and the Google databases were also searched manually for grey literature. The included studies in the review employed 859 women (age range 15-85 years) with different kinds of cervical abnormalities. A total of 534 HPV sequences were reported; the proportion of high risk HPVs was varied 80.4-100%. The top five identified genotypes were HPV 16 (45.3%; 95% CI 41.1-49.6%), HPV 52 (9.4%; 95% CI 7.2-12.1%), HPV 18 (8.2%; 95% CI 6.2-10.9%), HPV 58 (6.9%; 95% CI 5.1-9.4%) and HPV 45 (5.2%; 95% CI 3.7-7.5%). The combined prevalence of HPV 16/18 was at 53.6% (95% CI 49.3-57.8%). In this review, HPV 16 in particular, but also HPV 52 and 18, warrant exceptional consideration in vaccination and HPV based screening programs in Ethiopia. To the best of our knowledge, this study represents the first of its kind to establish the genotype distribution of HPV from different kinds of cervical lesions in Ethiopia although it was synthesized out of few studies. Hence, additional nationwide data are needed to strengthen our finding.

Acquisition of a phospho-acceptor site enhances HPV E6 PDZ-binding motif functional promiscuity

All cancer-causing human papillomavirus (HPV) E6 oncoproteins have a C-terminal PDZ-binding motif (PBM), which correlates with oncogenic potential. Nonetheless, several HPVs with little or no oncogenic potential also have an E6 PBM, with minor sequence differences affecting PDZ protein selectivity. Furthermore, certain HPV types have a phospho-acceptor site embedded within the PBM. We therefore compared HPV-18, HPV-66 and HPV-40 E6 proteins to examine the possible link between the ability to target multiple PDZ proteins and the acquisition of a phospho-acceptor site. The mutation of essential residues in HPV-18E6 reduces its phosphorylation, and fewer PDZ substrates are bound. In contrast, the generation of consensus phospho-acceptor sites in HPV-66 and HPV-40 E6 PBMs increases the PDZ proteins recognized. Thus, although phosphorylation of the E6 PBM and PDZ protein recognition are mutually exclusive, they are closely linked, with the acquisition of a phospho-acceptor site also contributing to an expansion in the number of PDZ proteins bound.

Prevalence of human papillomavirus type-18 in head and neck cancer among the Chinese population: A PRISMA-compliant meta-analysis

BACKGROUND

China has a high burden of head and neck cancer globally and oncogenic human papillomavirus (HPV) has been hypothesized as a risk factor for head and neck cancer, but research was absent for establishing HPV prevalence in China. We aimed to conduct a meta-analysis to estimate the high-risk HPV-18 prevalence of head and neck cancer in the Chinese population.

METHODS

This meta-analysis was reported following the guideline of PRISMA. The reports on HPV and head and neck cancer in a Chinese population published between Jan 1, 2006 and May 31, 2018 were retrieved via CNKI/WANFANG/MEDLINE/EMBASE/COCHRANE databases. A random-effect model was used to calculate pooled prevalence and corresponding 95% confidence intervals.

RESULTS

A total of 1881 head and neck cancer cases from 19 studies were included in this meta-analysis. Overall, the pooled HPV-18 prevalence among head and neck cancer cases was 6.0% (4.1%-7.9%) in China, 31.2% (13.0%-49.4%) in laryngeal cancer, 7.2% (3.9%-10.5%) in oral cancer and 0.6% (0.0%-1.3%) in oropharyngeal cancer, 18.7% (6.2%-31.2%) in fresh or frozen biopsies and 4.3% (2.5%-6.1%) in paraffin-embedded fixed biopsies, 29.5% (15.6%-43.3%) by E6/E7 region and 3.9% (0.5%-7.4%) by L1 region of HPV gene. The highest HPV-18 prevalence was found in Central China.

CONCLUSIONS

High prevalence of HPV-18 was found in the samples of Chinese head and neck cancers. Prophylactic HPV-vaccination may reduce the burden of HPV-related head and neck cancer in China.

Prevalence of Human Papillomavirus Type-16 in Head and Neck Cancer Among the Chinese Population: A Meta-Analysis

Background: The burden of head and neck cancer in China is heavier, and studies have shown that it may be associated with HPV infection, especially high-risk HPV. Objectives: We aimed to conduct a meta-analysis to estimate the high-risk HPV-16 prevalence of head and neck cancer in the Chinese population. Methods: The reports on HPV and head and neck cancer in a Chinese population published between Jan 1, 2006 and Oct 23, 2018 were retrieved via WANFANG/CNKI/MEDLINE/EMBASE databases. The pooled prevalence and corresponding 95% confidence intervals was calculated by a random-effect model. Results: The meta-analysis included a total of 2,896 head and neck cancer cases from 28 studies. Overall, the pooled HPV-16 prevalence among head and neck cancer cases was 24.7% (20.2-29.3%) in China, 31.6% (21.7-41.5%) in oropharyngeal cancer, 28.5% (18.2-38.7%) in laryngeal cancer and 14.9% (10.1-19.7%) in oral cancer, 25.3% (14.8-35.8%) in fresh or frozen biopsies and 25.0% (19.5-30.5%) in paraffin-embedded fixed biopsies, 36.5% (17.9-55.1%) by E6/E7 region and 14.3% (6.4-22.1%) by L1 region of HPV gene. The highest HPV-16 prevalence was found in Central China. Conclusions: High prevalence of HPV-16 was found in the samples of Chinese head and neck cancers. Preventive HPV-vaccination may reduce the burden of HPV-related head and neck cancer in China.

Epidemiology and survival of cervical cancer in the French West-Indies: data from the Martinique Cancer Registry (2002-2011)

Background: The Caribbean ranks seventh among world regions most affected by cervical cancer. Social health inequalities, such as differences in access to screening services, engender disparities in incidence and mortality between low- and middle-income countries and industrialized countries. The French National Cancer Plan 2014–2019 focuses on reducing inequalities in cervical cancer.

Objective: The aim of this study was to describe the geographical distribution and overall survival of cervical cancer, based on data from a population-based cancer registry in Martinique (French West-Indies).

Methods: We included all cases of cervical cancer diagnosed between 2002 and 2011. The geographical distribution was described by zone of residence and by aggregated units for statistical information (IRIS). Based on the results of the model, standardized incidence rates (SIRs) were calculated using a Gamma Poisson model. Survival rates were calculated using the Kaplan–Meier method. Cox proportional hazards models were used to investigate the risk factors for cervical cancer mortality.

Results: A total of 1253 cases were analyzed (947 in situ tumors and 306 invasive cancers). 1230 cases with geolocalization were used to map the distribution of the incidence of in situ and invasive cervical cancers. Five IRIS were significantly over-incident. The 5-year overall survival rate was 55%, with a median survival of 6.5 years [95% CI: 4.9–10.1]. Multivariate analysis confirmed age at diagnosis (HR = 2.15 [1.50–3.09]; p < 0.0001), FIGO stage (HR = 3.53 [2.50–4.99]; p < 0.0001) and zone of residence (HR = 1.51 [1.06–2.13]; p = 0.02) as risk factors.

Conclusions: Prognostic factors suggest that cervical cancer needs to be diagnosed at an early stage. Our results could allow cervical cancer screening programs to clearly identify geographical areas that would benefit from targeted interventions with a view to reducing incidence and mortality of cervical cancer in the Caribbean.

Human papillomavirus infection as a prognostic marker for lung adenocarcinoma: a systematic review and meta-analysis

Although a number of studies have investigated the association between human papillomavirus (HPV) and lung cancer prognosis, the results remain inconsistent. We therefore conducted a meta-analysis of epidemiologic studies to address this issue. Searches of the MEDLINE and EMBASE electronic databases from their inception until June 30, 2016 yielded nine studies involving a total of 1,205 lung cancer cases that were used to conduct the meta-analysis. Study-specific risk estimates were pooled using a random-effects model. The pooled hazard ratio (HR) comparing HPV-positive to HPV-negative cancers 1.00 (95% confidence interval (CI): 0.78-1.28) was not significantly correlated with overall survival. However, lung adenocarcinoma patients with HPV infections exhibited a survival benefit compared to those without HPV infection (HR=0.69, 95% CI: 0.50-0.96). This meta-analysis suggests HPV infection is a prognostic marker in lung adenocarcinoma. To further elucidate the epidemiology and pathogenesis of HPV infections in lung cancer, future large prospective studies are encouraged to stratify survival analysis based on the pathological type and clinical stage of the cancer.

Predicting Factors for High-Grade Cervical Dysplasia in Women With Low-Grade Cervical Cytology and Nonvisible Squamocolumnar Junction

OBJECTIVE

To assess the risk of developing high-grade cervical dysplasia among women with low-grade cervical cytology and nonvisible squamocolumnar junction (SCJ) at colposcopic examination.

METHODS

Data of consecutive women with low-grade intraepithelial lesion(≤LSIL) undergoing colposcopic examination, which was unsatisfactory (due to the lack of the visualization of the entire SCJ), were retrospectively reviewed. The risk of developing high-grade cervical intraepithelial neoplasia (CIN2+) was assessed using Kaplan-Meier and Cox models.

RESULTS

Data of 86 women were retrieved. Mean (standard deviation [SD]) age was 36.3 (13.4) years. A total of 71 (82.5%) patients had high-risk human papillomavirus (HR-HPV) at the time of diagnosis. Among the 63 patients undergoing repetition of HPV testing, 15 (24%) and 48 (76%) women had positive and negative tests for HR-HPV at 12 months, respectively. We observed that 5 (33%) of 15 patients with HPV persistence developed CIN2+, while only 1 (2%) patient of 48 patients without HPV persistence developed CIN2+ (odds ratio [OR]: 23.5; 95% confidence interval [CI]: 2.46-223.7; P < .001). The length of HR-HPV persistence correlated with an increased risk of developing CIN2+ ( P < .001; P for trend). High-risk HPV persistence is the only factor predicting for CIN2+ (hazard ratio: 3.19; 95% CI: 1.55-6.57; P = .002).

CONCLUSIONS

High-risk HPV persistence predicts the risk of developing CIN2+ in patients with unsatisfactory colposcopic examination. Further studies are warranted in order to implement the use of HPV testing in patients with unsatisfactory colposcopy.

Prevalence of human papillomavirus genotypes and relative risk of cervical cancer in China: a systematic review and meta-analysis

High-risk HPV (hrHPV) is related to cervical carcinogenesis, although clinical data comparing the natural history and carcinogenic potential of type-specific HPV remain limited. Furthermore, the nationwide prevalence rates of overall and type-specific HPV among women with cervical precancerous lesions and cancer have not been reported. Here, a meta-analysis was performed for type-specific HPV distribution among 30,165 HPV-positive women, including 12,094 invasive cervical cancers (ICCs), 10,026 cervical intraepithelial neoplasia grade 2/3 (CIN2/3), 3246 CIN1, and 4799 normal cervices from 45 PCR-based studies. We found that HPV16 was the most common hrHPV type involved in cervical disease. The HPV16 positivity rate varied little across normal (22.7%) and CIN1 individuals (23.6%) but increased through the CIN2 (37.6%) and CIN3 patients (51.9%) to 65.6% in ICC cases. HPV16, 18, 35, 39, 45, and 59 were more frequent in ICC than CIN3, with ICC:CIN3 ratios ranging from 2.3 for HPV18 to 1.1 for HPV35/45. HPV31, 33, 52, and 58 were more frequent in CIN3 compared with normal cervices but less common in ICC compared with CIN3 (ICC:CIN3 ratios ranging from 0.6 for HPV58 and 0.4 for HPV52). The ICC:normal ratios were particularly high for HPV18, 52 and 58 in West China (4.1, 3.9 and 2.9, respectively) and for HPV45 and 59 in North China (1.6 and 1.1, respectively). In summary, this study is the most comprehensive analysis of type-specific HPV distribution in cervical carcinogenesis and could be valuable for HPV-based cervical cancer screening strategies and vaccination policies in China.

The prognostic value of HPV combined p16 status in patients with anal squamous cell carcinoma: a meta-analysis

Human papillomavirus (HPV) DNA and p16 expression have been identified to be related to the progression of anal squamous cell carcinoma (ASCC). However, the prognostic relevance of combined detection, particularly HPV-/p16+ and HPV+/p16- signatures, is unknown. A meta-analysis of epidemiologic studies was therefore conducted to address this issue. Data were collected from studies comparing overall survival (OS) and disease-free survival (DFS) / disease-specific survival (DSS) / relapse-free survival (RFS) / progression-free survival (PFS) in ASCC patients with HPV and p16 status. The electronic databases of MEDLINE and EMBASE were searched from their inception till 31 May 2017. Study-specific risk estimates were pooled using a fixed-effects model for OS and DFS/DSS/RFS/PFS. Four studies involving a total of 398 ASCC cases were included in this meta-analysis. The pooled results showed that HPV+/p16+ cancers were significantly associated with improved OS (HR = 0.30, 95% CI: 0.17-0.51) and DFS/DSS/RFS/PFS (HR = 0.23, 95% CI: 0.14-0.36). However, patients with HPV-/p16+ or HPV+/p16- do not have a comparably good prognosis compared with HPV+/p16+ patients. The meta-analysis indicated that concomitant detection of HPV-DNA and p16 expression may be of prognostic or therapeutic utility in the evaluation of factors contributing to ASCC. Testing tumor specimens for HPV-DNA and p16 expression might indirectly affect treatment decisions.

Conducting and Disseminating Epidemiological Systematic Reviews in Latin America and the Caribbean: Pitfalls and Lessons Learned

OBJECTIVES

To describe the experience, pitfalls, and lessons learned in conducting and disseminating epidemiological systematic reviews (SRs) in Latin America and the Caribbean between 2007 and 2016.

METHODS

We used a mixed-methods approach, including a descriptive cross-sectional study and a qualitative study of pitfalls and lessons learned. The following end points were analyzed: number of primary research studies included, country of origin, study design, risk of bias, citations in social media, number of researchers and experts involved, and time devoted by them to conduct SRs. Data for the qualitative study were collected through sessions with multiprofessional focus groups of the reviewers' core team held from February to March 2016. We performed a thematic analysis of the following domains: sources of information, evidence quantity and quality, statistical analysis, and dissemination of findings in both academic and social media.

RESULTS

A total of 19 SRs were produced, including 1016 primary research studies. Brazil (35%) and Argentina (19%) contributed the largest number of studies. The most frequent design was cross-sectional (35%). Only 27% of the studies included in the SRs were judged as having a low risk of bias. We identified key challenges at different stages of the process. We found substantial difficulties in all domains derived from the thematic analysis and proposed potential solutions for each of them.

CONCLUSIONS

There are large gaps in epidemiological evidence from primary research, particularly from population-based studies. Special approaches are needed to identify, assess, synthesize, interpret, and disseminate epidemiological evidence from Latin America and the Caribbean.

Molecular epidemiology and phylogenetic analysis of human papillomavirus infection in women with cervical lesions and cancer from the coastal region of Ecuador

The aim of the present study was to gather information regarding the molecular epidemiology of Human papillomavirus (HPV) and related risk factors in a group of women with low- and high-grade cervical lesions and cancer from the coastal region of Ecuador. In addition, we studied the evolution of HPV variants from the most prevalent types and provided a temporal framework for their emergence, which may help to trace the source of dissemination within the region. We analyzed 166 samples, including 57 CIN1, 95 CIN2/3 and 14 cancer cases. HPV detection and typing was done by PCR-sequencing (MY09/MY11). HPV variants and estimation of the time to most recent common ancestor (tMRCA) was assessed through phylogeny and coalescence analysis. HPV DNA was found in 54.4% of CIN1, 74.7% of CIN2/3 and 78.6% of cancer samples. HPV16 (38.9%) and HPV58 (19.5%) were the most prevalent types. Risk factors for the development of cervical lesions/cancer were the following: three or more pregnancies (OR=4.3), HPV infection (OR=3.7 for high-risk types; OR=3.5 for HPV16), among others. With regard to HPV evolution, HPV16 isolates belonged to lineages A (69%) and D (31%) whereas HPV58 isolates belonged only to lineage A. The period of emergence of HPV16 was in association with human populations (tMRCA=91052 years for HPV16A and 27000 years for HPV16D), whereas HPV58A preceded Homo sapiens evolution (322257 years). This study provides novel data on HPV epidemiology and evolution in Ecuador, which will be fundamental in the vaccine era.

Type-specific human papillomavirus prevalence in cervical intraepithelial neoplasia and cancer in Iran

In Iran, human papillomavirus (HPV) vaccination is not currently included in the national vaccination program and there are no comprehensive approaches to cervical screening program. Regional data on distribution of HPV types in women is important to predict the impact of current HPV vaccines. Although several studies on distribution of HPV types in cervical precancer and cancer have been conducted in Iran, in most of them HPV positive samples were subjected to specific-primer genotyping (mainly 16 and 18), and leaving the other HPV genotypes almost undetermined. Therefore, the present study aimed to investigate the distribution of HPV types in cervical neoplasia from West and Northwest of Iran. A total of 112 women with atypia, cervical intraepithelial neoplasia, and invasive cervical cancer were included. A PCR assay was performed in all samples to detect the presence of the HPV genome using the GP5+/6+ L1 consensus primer set. All HPV positive samples were subjected for sequencing. In overall, HPV prevalence was 20% in atypica, 44.5% in cervical intraepithelial neoplasia I, 92.3% in cervical intraepithelial neoplasia II-III, and 98.2% in invasive cervical cancer. The most frequent HPV type was HPV 16 (79.2%), which was followed by HPV types 18, 6, and 33 at the frequencies of 6.5%, 5.1%, and 2.7%, respectively. The least HPV types were found to be 31, 45, 53, 58, and 66. In conclusion, this study shows that the current HPV vaccines could have great impact to reduce the burden of cervical cancer in Iran.

The distribution of human papillomavirus genotypes in cervical cancer and intraepithelial neoplasia lesions among Chinese women in Yunnan Province

This study was designed to explore baseline data about the prevalence and distribution of human papillomavirus (HPV) genotypes among Chinese women who had cervical intraepithelial lesions and cervical cancer. A total of 511 patients were recruited, and biopsy samples were collected from these patients. Polymerase chain reaction was used to detect HPV-positive samples, and the HPV GenoArray kit was used for genotyping. A total of 23 genotypes were detected, including 13 that were high risk-HPV (HR-HPV), 3 that were potential high risk-HPV (PHR-HPV) and 7 that were low risk-HPV (LR-HPV). The prevalence rates of HPV infection in Han women diagnosed with cervical intraepithelial lesions (CIN) 1, 2, and 3 and squamous cell carcinoma (SCC) were 98.30%, 97.56, 100% and 90%, respectively. The HPV-positive cases in women of other ethnicities diagnosed with CIN1, CIN2, and CIN3 and SCC were 95%, 90.91%, 88.23% and 83.33%, respectively. The most frequent genotypes in both ethnic groups were HPV-16, 52, and 58. LR-HPV was detected in SCC lesions in the non-Han ethnic group. In the Han ethnic group, the LR-HPV genotype was mostly restricted to CIN1 lesions. Furthermore, we found a high prevalence of PHR-HPV-81 in SCC lesions among Han women. Ethnic background, smoking, sex at an early age, unprotected sex, use of contraceptives, and the withdrawal method were found to be significantly associated with HPV infection. In conclusion, this study explores epidemiological data regarding the prevalence of HPV and the genotype distribution in patients with SCC and CIN lesions in Yunnan Province, China.

Prevalence of Human Papillomavirus subtypes 16 and 18 among Yemeni Patients with Cervical Cancer

Background: The Human Papillomavirus (HPV) is a DNA tumor virus that causes epithelial proliferation. There are more than 100 HPV subtypes, of which 13 subtypes are regarded as high risk subtypes that can cause cancers of epithelial mucosal surfaces. High risk human papilloma viruses (HR-HPV) subtypes 16 and 18 plays a major role in the etiology of cervical cancer worldwide. Therefore, the aim of this study was to screen for the existence of HPV16 and HPV18 among Yemeni women with cervical lesions. Methodology: Formalin fixed paraffin wax processed tissue blocks were retrieved for 200 patients (150 were previously diagnosed with cervical cancer and the remaining 50 were diagnosed with different benign conditions). Results: Of the 200 cervical cancer tissue specimens, HR-HPV 16 was identified in 74/200 (37%) samples and couldn’t be recognized in 126/200(63%) tissue samples. HR-HPV 18 was identified in 32/200 (16%) specimens and couldn’t be recognized in 168/200(84%) tissue specimens. Conclusion: HR-HPV subtypes were prevalent among Yemeni women with cervical cancer, with significant increase of HR-HPV subtype 16 over the HR-HPV subtype 18.

Prevalence of High-Risk Genotypes of Human Papillomavirus: Women Diagnosed with Premalignant and Malignant Pap Smear Tests in Southern Ecuador

Human papillomavirus (HPV) is the primary infectious agent for the development of cervical cancer, although the presence of the virus alone is insufficient for viral development and proliferation; this can be attributed to the increase in potential oncogenic risk, along with other risk factors. In the present investigation, the prevalence of high-risk HPV was determined from samples of premalignant or malignant cervical cytology in women from the southern region of Ecuador. The kit we used was able to detect genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. In addition, 64.5% of the analyzed samples were positive for HPV, with genotypes 16 and 18 being the most prevalent (16 was detected in 148 samples and 18 in 108). Genotypes 58 and 51 were the third most frequent simple and multiple infections, respectively. The data are very similar to those obtained worldwide, suggesting that the strategy of sex education, and the use of vaccines as primary prevention agents, could significantly decrease the incidence and mortality rate of cervical cancer in the southern region of Ecuador.

Prevalence of high-risk human papillomavirus among women in two English-speaking Caribbean countries

OBJECTIVE

To characterize high-risk human papillomavirus (HPV) infections in a sample of women in two small English-speaking Caribbean countries: Saint Kitts and Nevis and Saint Vincent and the Grenadines.

METHODS

Sexually active women ≥ 30 years old attending primary care health facilities participated in the study. Each participant had a gynecological examination, and two cervical specimens were collected: (1) a specimen for a Papanicolaou (Pap) test and (2) a sample of exfoliated cervical cells for HPV DNA testing, using the HPV High Risk Screen Real-TM (Sacace). High-risk HPV genotypes were assessed in 404 women in Saint Kitts and Nevis and 368 women in Saint Vincent and the Grenadines.

RESULTS

High-risk HPV was detected in 102 of 404 (25.2%) in Saint Kitts and Nevis and in 109 of 368 (29.6%) in Saint Vincent and the Grenadines. High-risk HPV genotypes 52, 35, 51, 45, and 31 were the most common high-risk types in Saint Kitts and Nevis. In Saint Vincent and the Grenadines, the most common high-risk HPV genotypes were 45, 35, 31, 18, and 51. Current age was found to be significantly associated with high-risk HPV infection in both countries. In addition, in Saint Vincent and the Grenadines, high parity (> 3 pregnancies) and having had an abnormal Pap smear were found to be independent risk factors for high-risk HPV.

CONCLUSIONS

These results contribute to the evidence on HPV prevalence for small island states of the Caribbean and support the accelerated introduction of the 9-valent HPV vaccine in the two countries and elsewhere in the English-speaking Caribbean. Use of the study's results to guide the development of policy regarding implementation of HPV testing as the primary screening modality for older women is recommended.

Prevalence of Human Papillomavirus infection among Chilean women from 2012 to 2016

Here, we evaluated the prevalence of Human Papillomavirus (HPV) in two groups of Chilean women. The first group consisted of 3235 women aged 18-64 years attended in six primary care centers of Santiago. The second group consisted of 456 women 18-85 aged who consulted the Gynaecology Department of the Reference Hospital of Santiago. Samples were collected from October 2012 to February 2016. Cervical swabs were analyzed both HPV genotyping by PCR and Reverse Line Blot, and cervical cytology by Pap testing. Results showed a prevalence of 12.0% HPV positive, 10.3% high-risk (HR) HPV types positive, 3.9% low-risk (LR) HPV types positive, and 1.0% Pap positive in group 1. The most frequent types were 16, 66, and 59, with a prevalence of 3.0%, 1.6%, and 1.5%, respectively. The prevalence were 71.9% HPV positive, 67.3% HR-HPV types positive, 13.6% LR-HPV types positive, and 62.5% Pap positive in group 2. The most frequent types were 16, 31, and 58, with prevalence of 33.6%, 10.5%, and 7.0%, respectively. Among infected women with HPV: 7.6% were infected with HPV16 or HPV18, 3.0% with HPV31, HPV33 or HPV45, and 6.7% with any other HR-HPV. These findings show great difference in HPV prevalence and types between primary care and reference center, and provide useful epidemiological information to assess the impact of HPV vaccination in the future.

Human papillomavirus-related esophageal cancer survival: A systematic review and meta-analysis

BACKGROUND

Human papillomavirus (HPV) has been identified to be related to progression of esophageal cancer. However, the results remain controversial. A meta-analysis of epidemiologic studies was therefore conducted to address this issue.

METHODS

The electronic databases of MEDLINE and Excerpta Medica database were searched till April 30, 2016. Study-specific risk estimates were pooled using a random-effects model.

RESULTS

Ten studies involving a total of 1184 esophageal cancer cases were included in this meta-analysis. The pooled hazard ratio comparing HPV-positive to HPV-negative esophageal cancers was 1.03 (95% confidence interval 0.78-1.37), which was not significantly correlated with improved survival. However, HPV-16-positive patients might have a significantly favorable survival (hazard ratio 0.73, 95% confidence interval 0.44-1.21).

CONCLUSION

The meta-analysis indicated that HPV infection may not be of prognostic utility in the evaluation of factors contributing to esophageal cancer. Further large prospective studies are encouraged to stratify survival analysis by HPV type.

Distinctive distribution of HPV genotypes in cervical cancers in multi-ethnic Suriname: implications for prevention and vaccination

Suriname is ranked as high-risk country for cervical cancer, but recent national data of HPV prevalence and distribution in cervical cancer is scarce. In a retrospective cross-sectional study, cervical cancer incidence, HPV prevalence and HPV-type-specific distribution were investigated in all cervical cancer cases (n = 111), diagnosed in two consecutive years. HPV presence and type-specific prevalence were determined in paraffin-embedded biopsies utilizing master-nested multiplex PCR assays, targeting 14 HPV types. The age-standardized incidence rate of cervical cancer was 22·4/100 000 women, justifying revision of the current international ranking of Suriname. Eleven HPV types were detected, with the most common types in descending order of frequency: 16, 18, 45, 66, 58/52/35. HPV16 was predominant, although with markedly low presence (25%). HPV16 or 18 infections were detected in 43% of the cases, while 28% were untyped, implicating a divergent HPV-type distribution in Suriname with significant variation in the prevalence of less common high-risk virus types and/or presence of HPV16 variants. HPV-type distribution differed between ethnic groups. A vaccination efficacy of just 28–30% was anticipated, next to an uneven vaccination impact in different ethnic groups, cautioning Suriname and other multi-ethnic countries to tailor the information presented to different ethnic communities.

Current Technologies and Recent Developments for Screening of HPV-Associated Cervical and Oropharyngeal Cancers

Mucosal infection by the human papillomavirus (HPV) is responsible for a growing number of malignancies, predominantly represented by cervical cancer and oropharyngeal squamous cell carcinoma. Because of the prevalence of the virus, persistence of infection, and long latency period, novel and low-cost methods are needed for effective population level screening and monitoring. We review established methods for screening of cervical and oral cancer as well as commercially-available techniques for detection of HPV DNA. We then describe the ongoing development of microfluidic nucleic acid-based biosensors to evaluate circulating host microRNAs that are produced in response to an oncogenic HPV infection. The goal is to develop an ideal screening platform that is low-cost, portable, and easy to use, with appropriate signal stability, sensitivity and specificity. Advances in technologies for sample lysis, pre-treatment and concentration, and multiplexed nucleic acid detection are provided. Continued development of these devices provides opportunities for cancer screening in low resource settings, for point-of-care diagnostics and self-screening, and for monitoring response to vaccination or surgical treatment.