Human papillomavirus (HPV) type 58 has been found to be prevalent among Chinese patients with cervical cancer. This study examined the oncogenic risk of HPV58 variants in Hong Kong, a southern part of China. Altogether, 1924 women were studied: 42.8% with a normal cervix, 16.2% with cervical intraepithelial neoplasia (CIN) I, 12.7% with CIN II, 20.8% with CIN III, and 7.6% with invasive cervical cancer (ICC). The overall prevalence of HPV58 was 11.4% (220) and increased statistically significantly with the severity of neoplasia (P(trend)<.001, chi(2) test for trend). Among HPV58-positive women, the occurrence of E7 632C-->T (T20I) and E7 760G-->A (G63S) variants (T20I/G63S) showed a positive trend of association with the severity of neoplasia (P(trend)<.001, chi(2) test for trend). HPV58 variants carrying these two substitutions showed an odds ratio (OR) for ICC of 26.79 (95% confidence interval = 10.14 to 74.72), and this OR was 6.9-fold higher than the ORs of variants without these substitutions. Patients with CIN III or ICC who were also infected with T20I/G63S variants had a statistically significant younger age at diagnosis than those infected with other variants (median age = 37 years versus 48 years; P =.038, two-sided Mann-Whitney U test). Thus, HPV58 variants carrying E7 T20I/G63S substitutions may be associated with an increased risk for cervical cancer.

Human papillomavirus (HPV) 58 accounts for a notable proportion of cervical cancers in East Asia and parts of Latin America, but it is uncommon elsewhere. The reason for such ethnogeographical predilection is unknown. In our study, nucleotide sequences of E6 and E7 genes of 401 HPV58 isolates collected from 15 countries/cities across four continents were examined. Phylogenetic relationship, geographical distribution and risk association of nucleotide sequence variations were analyzed. We found that the E6 genes of HPV58 variants were more conserved than E7. Thus, E6 is a more appropriate target for type-specific detection, whereas E7 is more appropriate for strain differentiation. The frequency of sequence variation varied geographically. Africa had significantly more isolates with E6-367A (D86E) but significantly less isolates with E6-203G, -245G, -367C (prototype-like) than other regions (p ≤ 0.003). E7-632T, -760A (T20I, G63S) was more frequently found in Asia, and E7-793G (T74A) was more frequent in Africa (p < 0.001). Variants with T20I and G63S substitutions at E7 conferred a significantly higher risk for cervical intraepithelial neoplasia grade III and invasive cervical cancer compared to other HPV58 variants (odds ratio = 4.44, p = 0.007). In conclusion, T20I and/or G63S substitution(s) at E7 of HPV58 is/are associated with a higher risk for cervical neoplasia. These substitutions are more commonly found in Asia and the Americas, which may account for the higher disease attribution of HPV58 in these areas.

Consensus primers targeting human papillomaviruses (HPVs) have biases in sensitivity toward certain HPV types. We applied 3 primer sets (GP51/61, MY09/11, PGMY09/11) in parallel on 120 Chinese cervical cancer specimens. GP51/61 exhibited a poor sensitivity for HPV52, for which the prevalence among squamous cell cervical cancer was underestimated from 14.6% to 0%. The fact that HPV52 should rank second in prevalence among squamous cell cervical carcinoma in Hong Kong could be missed if GP51/61, a worldwide commonly used primer set, was selected for HPV detection. Biases in HPV type-specific sensitivity may result in misprioritization of vaccine candidates. ' 2005 Wiley-Liss, Inc.Key words: human papillomavirus; detection; genotype; vaccine; Chinese; Hong Kong; PCR Cervical cancer is the second most common cancer in women worldwide. Strong and consistent evidence accumulated over the past 2 decades confirms the aetiologic role of human papillomaviruses (HPVs) and provides a strong impetus for developing HPV vaccines to prevent cervical cancer. More than 100 HPV types have been identified, and at least 30 have been found in cervical cancers. 1 Given the diversity of HPV types and the largely typespecific immunity after natural infections, 2-4 it is important to delineate the prevalence of different HPV types found in cervical cancers so as to guide the selection of vaccine candidates. Most studies on HPV have employed consensus primers with an intention to cover a broad spectrum of HPV types. With the more than 10% sequence variation between HPV types, biases in sensitivity of a given primer set toward certain types could happen. In our study, we examined the influence of detection methods on assessing the prevalence of HPVs and thus their priority as cervical cancer vaccine candidates. Material and methodsA total of 120 cervical cancer specimens (105 fresh frozen and 15 paraffin embedded; 89 squamous cell carcinoma, 26 adenocarcinoma, 4 adenosquamous carcinoma and 1 lymphoepitheliod carcinoma) collected from Hong Kong Chinese aged 26-84 years (mean 55 years; SD 13.9) were examined. Total DNA was extracted by the QIAamp DNA mini kit (QIAGEN, Hilden, Germany) and with the quality of extracted preparations confirmed by beta-globin PCR. 5 The clinical materials were collected with a written informed consent. Our study was approved by the local institutional ethics committee, and the human experimentation guidelines of the local institute were followed in the conduct of our study.HPV detection and typing was accomplished by 3 different methods in parallel. In the first method, HPV DNA was amplified by the GP51/61 primers that target an approx. 150 bp fragment of the L1 region. 5,6 The HPV type was identified by direct sequencing of PCR amplicons. In the second method, the MY09/ 11 primers that target an approx. 450 bp fragment of the L1 region was used for PCR. 7,8 HPV type was identified by restriction fragment length polymorphisms (RFLPs) using endonucleases RsaI and DdeI as previously described. 8 Ambiguous RFLPs w...

Key words: human papillomavirus infection; cervical cancer, epidemiology; ChinaThere is strong epidemiologic evidence indicating that human papillomavirus (HPV) plays a central role in the etiology of cervical cancer. [1][2][3][4] The women positive for HPV DNA have a risk of developing cervical cancer 15-50 times higher than those without HPV DNA. 1,2,4,5 Although HPV infection is common among young women, only a small minority go on to develop cervical cancer. This situation was reviewed by a group of researchers, who concluded that viral persistence of oncogenic HPV appears to be crucial for the development of cervical cancer. 6 Indeed, HPV-16, -18, -31 and -33 have been officially declared to be oncogenic by the World Health Organization (WHO). 7 The International Biological Study on Cervical Cancer (IBSCC) study group revealed that on average 92.9% of the tumors contained HPV DNA, with a range of 75-100%. 8 Although this international survey included 10 of the 18 regions of the world and provided the most extensive global view of HPV in cervical cancer, there were no data from China, 1 of the largest populations in the world. Furthermore, there are few published data from a well-designed study using a quality-controlled method on the prevalence of either HPV infection or HPV genotypes in cervical cancers in China.We conducted a multicenter study of HPV infection in cervical cancer by selecting 5 geographic regions of China: Shanghai (Eastern China), Guangzhou (Southern China), Sichuan (Western China), Beijing (Northern China) and Hong Kong (Specific Administration Region). MATERIAL AND METHODS PatientsCervical cancer specimens were collected from each of the 5 regions in China, including Shanghai, Guangzhou, Sichuan, Beijing and Hong Kong. Each of the 5 settings (Tumor Hospital, Shanghai Medical University in Shanghai, Tumor Hospital, Sun Yat-sen University of Medical Sciences in Guangzhou, Second Hospital, West China Medical University in Sichuan, Tumor Hospital, Chinese Academy of Medical Sciences in Beijing, and Prince of Wales Hospital, The Chinese University of Hong Kong in Hong Kong) was responsible for collecting 150 or more tumor specimens consecutively from the year 1997 to 1999. Patients from Hong Kong were prospectively recruited with informed consent, and all specimens were freshly frozen. Those specimens collected in other parts of China were paraffin-embedded and retrieved retrospectively from the pathology files in those reference centers. Ethical approvals were obtained from each of the ethical review boards of the respective institutes. Histology reviewAll histologic slides submitted were reviewed by 1 of the investigators (M.K.M.C.) to reestablish the histologic type and