Epidemiology, characterization of genotypes of human papillomavirus in a population of women in Ouagadougou

Objectives

This work was carried out in order to determine the prevalence of different HPV genotypes in a population of women attending gynecological consultation.

Material and methods

From May to June 2010, cervical samples were obtained from 300 women attending gynecological consultation in two health centers in Ouagadougou. The strains of HPV genotyping was done using the technique of polymerase chain reaction (PCR) followed by reverse hybridization on nitrocellulose strips.

Results

Among the 73 women(24.3%) infected with HPV, only 27.4% (20/73) of them were infected with a HPV low risk (BR), the 72.6% (53/73). Other women were infected with at least one high risk HPV (HR). By combining the HPV genotypes found without taking into account the number of infected women, we found a total of 84 HPV among whom we have high-risk HPV : HPV-50'S(26/84 or 31.0%), HPV-18 (12/84 or 14.3%), HPV-16 (9/84 or 10.7%), HPV-30'S (5/84 or 5.9%), HPV-HR (5/84 or 5.9%) and HPV-45 (3/84 or 3.6%) and low-risk HPV: HPV-6 (15/84 or 17.9%) and HPV-BR (9/84 or 10.7%). We have found no HPV-11.

Discussion and conclusion

The prevalence of HPV found in our series is comparable to that found in the world. To complete this study, it would be necessary to investigate the prevalence of HPV found in cervical lesions in Burkina Faso.     

HPV infection among women in a representative rural and suburban population of the USA

Objective

To study the prevalence of low-risk and high-risk HPV genotypes in a largely suburban, non-Hispanic, white female population of the USA, and to determine the positive predictive value of one-occasion HPV detection and genotyping using high-grade squamous intraepithelial lesion (HSIL) cytology as the endpoint for clinical evaluation.

Methods

HPV DNA present in liquid-based cytology specimens collected by gynecologists in private practice was amplified using nested polymerase chain reaction. HPV DNA was validated by signature DNA sequencing for accurate genotyping.

Results

Of 2633 specimens, 278 were positive for HPV DNA of any genotype. Among 255 single HPV infections, the most prevalent genotype was HPV-16 (n = 50; 19.6%), followed by HPV-52 (n = 24; 9.4%). Only 10 specimens, all positive for a high-risk HPV, were associated with an HSIL cytology result. Among them were 6 of the 50 specimens (12%) tested positive for HPV-16. One novel HPV-39 variant was detected in repeat testing in a patient with persistent HPV infection.

Conclusion

DNA sequencing is a useful method for increasing the specificity of HPV genotyping as an aid to follow persistent high-risk HPV infections to reduce excessive colposcopies in populations with low cancer prevalence.     

Detection and genotyping of cervical HPV with simultaneous cervical cytology in Turkish women: a hospital-based study

Purpose

To investigate the prevalence of cervical human papilloma virus (HPV) with genotyping and simultaneous cervical cytology among Turkish women in a university hospital. A review of literature was done as well to summarize the results of similar Turkish studies based on hospital data.

Methods

Women who were subjected to cervical HPV-DNA testing with simultaneous cervical Pap test were included. Seeplex HPV 18-plex Genotyping Test was used for HPV detection and typing. Liquid-based cytology was used for Pap test and Bethesda system was used for results.

Results

Study group included 890 patients with a mean age of 39.5?years. The prevalence of any HPV was 25.7% while high-risk HPV was positive in 23.0%. There were no significant differences in HPV prevalence between younger and older women. Among HPV-positive women, 89.5% had at least one type of high-risk HPV. Most common HPV was type 16 followed by type 31 and 51. Abnormal cervical cytology rate was 11.6%. Rate of HPV positivity was significantly higher in women with abnormal cervical cytology compared to women with normal cytology (54.4 vs. 22.0%).

Conclusions

Cervical HPV infection is a serious and gradually growing problem for Turkish women according to hospital-based data. This may be associated with low age at marriage and more sensitive HPV detection methods.     

Prevalence of human papillomavirus genotypes among women in Hunan province,China

Objective

Human papillomavirus (HPV) infection has been implicated as a causative factor of cervical cancer. This study aimed to examine HPV genotype distribution and prevalence among women in Hunan province, mid-south China.

Study design

Cervical samples were collected from 3640 women for cervical cancer screening. Participants were screened by cytology, and HPV genotyping was performed by DNA chip.

Results

Of the 3640 cases, 22.6% (822/3640) were HPV DNA positive, of whom 19.0% (156/822) had multiple infections and 20.0% (726/3640) were confirmed to have high-risk HPV infection. The most common HPV genotype was HPV-16, followed by -52, -58, -18, -6 and -39. Cytological examination showed that the HPV positive rate was 59.3% (80/135) in women with atypical squamous cells of undetermined significance, 66.1% (111/168) in women with low-grade squamous intra-epithelial lesions, 72.6% (106/146) in women with high-grade squamous intra-epithelial lesions, and 87.2% (68/78) in women with invasive cervical cancer, all of which were significantly higher than the rate in women with normal squamous cells (14.3%, 451/3115).

Conclusion

This is the first study to report the prevalence and genotype distribution of HPV infection among women in Hunan province, China. The findings provide important guidance for a vaccination programme in this region aimed at immunizing women before they are infected with HPV.     

Prevalence of genital human papillomavirus infection and genotypes among women from Fujian province, PR China

Objective

The prevalence and distribution of oncogenic human papillomavirus (HPV) genotypes in women who underwent screening for cervical cancer in Fujian province, China, were assessed and the correlation of genotypes with the histological results was evaluated.

Study design

Cervical samples were collected from 2338 women for cervical cancer screening. Participants were screened by liquid-based cytology and HPV genotyping using DNA Chip and referred to colposcopy and biopsy samples for further analyses if cytology results indicated undetermined significance (ASCUS) or higher.

Results

The prevalent types with cervical intraepithelial neoplasia 1 (CIN 1) were HPV-52 (22.5%), HPV-16 (11.6%) and HPV-CP8304 (10.1%). The prevalent types with cervical intraepithelial neoplasia 2 or 3 (CIN2/3) were HPV-16 (24.5%), HPV-33 (21.6%), and HPV-52 (19.6%). The prevalent types with carcinoma, including squamous cell carcinoma (SCC) and adenocarcinoma (ADCA), were HPV-16 (42.7%), HPV-18 (20.8%) and HPV-33 (12.5%). Analysis by odds ratio (OR) revealed that HPV-66, -68, and -CP8304 (HPV-CP8304: OR, 7.34; 95% confidence interval (CI) = 3.73-14.46) were associated with CIN 1; HPV-52 was CIN 2/3-associated type (OR, 7.25; 95%CI = 4.19-12.53); HPV-16, -18, -31, -33, -45, -53, -58, and -59 were associated with carcinoma (HPV-45: OR, 54.78; 95%CI = 10.49-286.16).

Conclusion

It was concluded that HPV infection in Chinese women in Fujian province showed higher frequencies of HPV-52 and HPV-33. However, HPV-16 was still the most common type in CIN2/3 and carcinoma. HPV-16, -18, -31, -33, -45, -53, -58 and -59 have more dominant oncogenic risk over other types in this area.     

Cervical Cancer Screening and the Immunosuppressed Patient: the Issues in Screening High-Risk Populations

Purpose of Review

While evidence-based guidelines are available for cervical cancer screening in the general population, women at higher risk of persistent HPV infection and cervical cancer are excluded. There is limited evidence to guide screening practices for “high-risk” women, in particular, those who are immunosuppressed.

Recent Findings

Women with immunosuppression demonstrate an increased risk of cervical dysplasia and invasive cervical cancer (ICC) compared to the baseline population. Women with HIV were found to have increased rates of ICC and recurrent dysplasia, compounded by lower CD4 counts. Women with other forms of immune suppression demonstrated variable risk of dysplasia and cancer with the highest risk in transplant recipients and variable risk of dysplasia reported in autoimmune diseases. Data support updated screening guidelines for women with HIV: annual cytology for 3 years, and if screening is negative, increased screening intervals to every 3 years. However, women with HIV and other forms of immunosuppression have been reported to be less compliant with screening guidelines.

Summary

While there is high-quality data to support screening intervals for women with HIV, we were not able to identify data to guide modality and interval of screening in other types of immune compromise. Compliance with screening is lower both in women with HIV and other immune-mediated disease. Improving screening compliance in this high-risk population with a simplified screening strategy is likely the most important factor for reducing the risk of cervical cancer and further research is needed.

     

Risk factors for human papillomavirus persistence among women undergoing cold-knife conization for treatment of high-grade cervical intraepithelial neoplasia

Objective

To investigate the risk factors potentially associated with high-risk human papillomavirus (HPV) persistence in women undergoing cold-knife conization (CKC) for treatment of high-grade cervical intraepithelial neoplasia (CIN).

Methods

Medical records of women who underwent CKC for treatment of CIN 2/3 between 2007 and 2012 at a tertiary hospital in Ankara, Turkey, were retrospectively analyzed. Cases involving persistent HPV infection after 1 year of follow-up were identified. Using univariate and multivariate analyses, the impact of various factors such as patient age, menopausal status, parity, high-risk HPV type, excised cone dimensions (width, height, and depth), and surgical margin status on high-risk HPV persistence was assessed.

Results

A total of 292 women underwent CKC for treatment of CIN 2/3 within the study period. After women with a subsequent diagnosis of cervical cancer, subsequent total hysterectomy, and inadequate follow-up data were eliminated, 113 women were eligible for final analysis. High-risk HPV persistence was detected in 24 (21.2%) women, and multivariate analysis revealed that patient age and cone depth were significant independent predictors (P < 0.05).

Conclusion

High-risk HPV persistence may be encountered after CKC procedures. It is important to evaluate persistent HPV infections after treatment because affected women are at increased risk for disease persistence, recurrence, and progression.     

A Study of Cervical Intraepithelial Neoplasia in Pregnancy

Objective

To find the incidence of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in pregnant women and compare Pap smear with the HPV DNA test in detecting HPV infection.

Materials and Methods

Hundred antenatal women, irrespective of gestational age, were enrolled as subjects in this prospective pilot study for blood investigations, wet mount examination of cervical discharge, Pap smear, and high-risk HPV DNA detection of cervical scrape by PCR. Women showing abnormality in Pap smear and/or those who were high-risk HPV DNA positive were subjected to colposcopy.

Results

The incidence of HPV-positive pregnant women was 18 %. Koilocytosis on Pap smear was observed in six women. Three high-risk HPV DNA-positive women showed changes consistent with CIN 1 on colposcopy.

Conclusions

The HPV DNA test is the most sensitive and reliable in detecting HPV infection as compared to Pap smear, but considering the cost of PCR, Pap smear screening of all antenatal women was recommended.     

Prevalence and genotype distribution of human papillomavirus in women with cervical cancer or high-grade precancerous lesions in Chengdu, western China

Objective

To study the prevalence and genotype distribution of human papillomavirus (HPV) among women with cervical cancer or high-grade squamous intraepithelial lesions (HSIL) in western China.

Methods

Cervical cast-off cells from 144 women with cervical cancer and 63 women with HSIL were tested for HPV genotypes using an oligonucleotide microarray.

Results

The overall HPV prevalence was 80.6% in cases of carcinoma and 61.9% in cases of HSIL. The most common genotypes were HPV-16 (carcinoma, 68.1%; HSIL, 34.9%) and HPV-58 (carcinoma, 8.3%; HSIL, 17.5%). Other high-risk types included HPV-18, -31, -33, -35, -45, and -52, with HPV-18 more common in adenocarcinomas than in squamous cell carcinomas (21.4% vs 3.1%; P < 0.02). The HPV prevalence was lower among patients older than 49 years (P < 0.02).

Conclusion

The prevalence of HPV-16 and HPV-58 was high. This finding may help to improve HPV vaccination and cervical cancer prevention programs in western China.     

Characteristics of HPV prevalence among women in Liaoning province, China

Objectives

To investigate the prevalence rates of specific human papillomavirus (HPV) types infecting women in Liaoning Province, China.

Methods

Specimens from 4780 patients with cervical disease and 165 age-matched controls were tested for HPV genotypes using a chip hybridization assay.

Results

The infection rates were 35.66% for patients with cervicitis, 54.61% for those with ASCUS, 64.14% for those with CIN, 83.76% for those with cervical cancer in situ, and 83.12% for those with invasive cervical cancer. The most common HPV genotype was HPV-16, followed by HPV-58, HPV-52, HPV-33, HPV-53, and HPV-31. There were 1529 single and 731 multiple infections among the 4780 patients. Single infections with high-risk genotypes were associated with various cervical diseases. HPV-16 was present in 399 of the patients with multiple infections.

Conclusion

Compared with prevalence rates for other populations, the rates of specific HPV types infecting women are different in Liaoning Province of China.     

New variants of E6 and E7 oncogenes of human papillomavirus type 31 identified in Northeastern Brazil

Objective

We sought to characterize E6 and E7 oncogenes genetic variability of HPV-31 isolated from cervical scraping samples of Northeastern Brazilian women.

Methods

E6 and E7 were amplified with specific primers, cloned and sequenced. The sequences obtained were aligned with the GenBank reference sequences with the aim of evaluating the possible genetic variants.

Results

We identified several genetic variants in E6 and E7 sequences from HPV-31 positive women. Three nucleotide changes in E6 were described for the first time in this study. Some nucleotide changes were non-synonymous substitutions.

Conclusion

The knowledge of region/country HPV specific genetic variations is relevant to understand the epidemiology and the development of effective vaccines.     

Baseline characteristics and prevalence of HPV 6, 11, 16, 18 in young German women participating in phase III clinical trials of a quadrivalent HPV (6/11/16/18) vaccine

Introduction

As limited data among German women exist about HPV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae, we report the prevalence of these genital infections and general baseline demographics of the young German women enrolled in the phase III trials of the quadrivalent HPV vaccine.

Materials and methods

German females (n = 437; 9–23 years) were recruited among 3 international phase 3 studies of an HPV-6/11/16/18 vaccine. We present baseline characteristics, prevalence of HPV-6/11/16/18 and, for women aged 16–23, abnormal cervical cytology and sexually transmitted diseases.

Results

Chlamydia trachomatis and Neisseria gonorrhoeae prevalence was 5 and 0.3%, respectively. Approximately 17% of participants had HPV-6, 11, 16, or 18 DNA or antibodies. All subjects <17 years were naïve to the four vaccine types.

Discussion

The results of the vaccine trials have demonstrated that it is worth administering prophylactic HPV vaccines before sexual debut; however, none of these sexually active German women were positive to all four types and most were positive to only one type. Thus, all women had the potential to benefit from vaccination with a quadrivalent HPV vaccine.     

Triaging HPV-positive women with p16/Ki-67 dual-stained cytology: Results from a sub-study nested into the ATHENA trial

Objectives

In addition to genotyping for HPV16/18, dual-immunostaining for p16/Ki-67 has shown promise as a triage of HPV-positive women. We assessed the performance of p16/Ki-67 dual-stained cytology for triaging HPV-positive women undergoing primary HPV screening.

Prevalence of HPV infection and genotypes in women with normal cervical cytology in the state of Paraná, Brazil

Objective

We investigated the prevalence of the human Papillomavirus (HPV) and its genotypes in women with normal cervical cytology in the state of Paraná, Brazil, and also epidemiological characteristics.

Methods

The enrolled patients were seen at six primary health-care units in Pai?andú City, Paraná. Through polymerase chain reaction (PCR) and PCR–RFLP (restriction fragment length polymorphism) techniques, 40 HPV genotypes were found, including 15 high risk, 3 undetermined risk and 22 low risk. Socio-demographic characteristics and sexual behavior were also recorded by interviews based on a structured questionnaire completed at the time of enrollment.

Results

Among 418 patients examined, HPV was detected in 6.7?%, mainly in women aged <25?years. The overall prevalence of high-risk, low-risk and undetermined-risk HPV types was 42.9, 45.7, and 11.7?%, respectively. HPV-16 was the most common type detected (14.3?%), followed by types 66 (11.4?%) and 31 and 70 (8.6?% each). Detection of HPV DNA was positively associated with the number of sexual partners within the previous 12?months (p?Conclusion When considering the lack of studies in Paraná on women with normal cytology, the results of this study will improve estimates of HPV DNA populations, and provide baseline values against which the impact of vaccination can be assessed in the future.     

Cervical cytology and multiple type HPV infection: A study of 8182 women ages 31–65

Objective

The aim of this study is to determine the rates of single and multiple type human papillomavirus (HPV) infection in women in the United States ages 31–65 with known cervical cytology results.

Methods

Type-specific HPV analyses were conducted using the first samples of women who had HPV typing performed by Access Genetics as part of cervical cancer screening between July 2007 and May 2011. Women 31–65 years at testing with associated abnormal cytology results were included. The odds of abnormal cytology (compared to normal results) for multiple vs. single HPV infections were calculated for each cytology sub-type and odds ratios (OR) and 95% confidence intervals (CI) are reported.

Results

The analysis included 8182 women. The majority (67.7%) had ASCUS cervical cytology. A total of 329 (4.0%) were positive for 2 or more HPV types. For all cervical cytology subtypes considered (ASCUS, ASCUS-H, LSIL or HSIL), women with multiple type infections were more likely to have abnormal cytology (compared to normal cytology) with the highest OR associated with HSIL (OR 1.81 (1.26–2.60)). When analyzing HPV type 16 alone, women with multiple type infections were more likely to have abnormal cytology, with the highest OR associated with HSIL cytology (OR 2.98 (1.57–5.64)). Few women had HPV type 18 infections and no results reached statistical significance. Results based on phylogenic family organization focusing on the alpha 9 phylogenic family showed similar results as HPV type 16.

Conclusions

Women ages 31–65 with multiple type HPV infections were more likely to have abnormal cytology than those with single HPV type infections.     

Adoption of HPV testing as an adjunct to conventional cytology in cervical cancer screening in Japan

Objective

To assess the effectiveness of including HPV testing as an adjunct to conventional cytology in cervical cancer screening.

Methods

Atypical epithelial cells (ATC) were classified according to the 2001 Bethesda classification system. The study ran for 6 years from May 2004 to November 2009 in conjunction with public cervical cancer screening for Kanazawa City residents. Patients with ATC (ASC-US, ASC-H, and AGC) underwent parallel testing for high-risk HPV types with the Hybrid Capture II system; HPV positive and cytology-ATC cases were recalled for colposcopic examination and biopsied if necessary. Results were compared with those obtained before HPV screening was initiated.

Results

A total of 62 645 women underwent screening over the 6-year period; of these, 3622 (5.8%) were ATC positive, among whom 527 (14.5%) tested HPV-positive. These 527 women (0.8% of the screened population) were recalled for colposcopic examination. The resulting 426 biopsies were diagnosed as CIN 1 (n = 187), CIN 2 (n = 53), CIN 3 (n = 11), and invasive cervical cancer (n = 2).

Conclusion

HPV testing as an adjunct to conventional cytology in cervical cancer screening seems to increase detection sensitivity with proven cost-effectiveness.     

Cribado de cáncer cervical con citología y test del virus del papiloma humano cada 5 años: una realidad

Objective

To analyze screening for cervical cancer with a combination of cytology and HPV testing in women older than 35 years every 5 years and to determine whether the application of this protocol delays diagnosis of cervical cancer.

Material and methods

Cervical cancer screening strategies have been applied in our hospital since 2005. HPV testing was introduced in 2010 for women older than 35 years. We performed a retrospective study of 500 women attended in our hospital. We studied whether we had correctly applied the strategy and the recommended time interval of the next review. We analyzed cervical cancers diagnosed in our hospital since 2005.

Results

The strategy was correctly applied in 100% of the women. Screening was performed with both cytology and HPV testing in 45.6% and with cytology alone in 23.2%; no screening was performed in 31.2%. The recommended interval until the next review was 5 years in 26% of the patients. The implementation of the strategy did not delay the diagnosis of cancer. Cervical cancer was diagnosed in 27 women since 2005. Only one woman with adenocarcinoma had been correctly screened (before the introduction of HPV testing). In the last 2 years, four microinvasive carcinomas were diagnosed with this strategy.

Conclusions

A combination of cytology and HPV testing can be applied in women older than 35 years and screening intervals can be increased to 5 years in routine clinical practice. This protocol does not delay the diagnosis of cervical cancer and optimizes resources by lengthening the interval between screening tests in healthy women.     

High prevalence of high-risk human papillomavirus infection among women with Trichomonas vaginalis infection on monolayer cytology

Objective

To evaluate the risk of high-risk human papillomavirus (HPV) infection in women with Trichomonas vaginalis infection, and the reason remains unclear.

Methods

A total of 40,000 liquid-based cytology specimens were tested from 2005 to 2008. Among these, high-risk HPV testing using the hybrid capture II assay was performed in positive cases of T. vaginalis according to the age of patients (<30 years old, between 30 and 50 years old, more than 50 years old). As controls, HPV detection was also performed in 450 normal smears.

Results

T. vaginalis was found in 80 cases (0.2%). From these 80 cases, 57 were available for HPV testing (8 patients <30 years old, 42 patients between 30 and 50 years old and 7 patients more than 50 years old). As controls, high-risk HPV was tested in 150 patients with normal cytology for each of these three age categories. High-risk HPV was significantly more frequently detected in women with T. vaginalis than in women with normal smear irrespective of the categories of age (P < 0.01).

Conclusion

For the first time, we demonstrated a significant prevalence of high-risk HPV in women with cytological proved T. vaginalis infection independent of the age ranges. Our data suggest a potential association between these two infectious agents by the way of a sexual intercourse and probably by a biochemical or immunological reasons.     

Cofactors in human papillomavirus infection and cervical carcinogenesis

Objective

This study aimed to identify the effect of various risk factors as the promoters of HPV infection, and to identify which HPV-positive women may have an increased risk of developing cervical cancer.

Methods

Smear preparations were examined and classified according to the Bethesda system. HPV-DNA detection and genotyping was carried out using polymerase chain reaction combined with reverse hybridization line-probe assays. Age, smoking habit, age at first sexual intercourse, number of sexual partners, number of term births, contraceptive method, progesterone therapy, history of sexually transmitted diseases, history or existence of warts and existence of cervical infection were recorded.

Results

642 women (96 women with abnormal cervical cytology and 546 women with normal cytology) provided cervical samples. Smoking habit, number of sexual partners, number of term births, history of sexually transmitted diseases, history or existence of warts and existence of cervical infection were identified as the promoters of HPV infection. History of sexually transmitted diseases, history or existence of warts and existence of cervical infection were identified as cofactors affecting progression from HPV infection to cervical cancer. Neither of contraceptive methods studied was related to HPV infection or coexistence with malign transformation to cervical cancer.

Conclusion

Information gathered from this study could be used to prioritize limited screening and treatment services to woman who have specific characteristics that may put them at an increased risk of HPV infection. Additionally, by identifying which women have a higher risk of cervical cancer; it may be possible to reduce the number of unnecessary colposcopies.