Prevalence of oncogenic human papillomavirus genotypes in patients diagnosed with anogenital malignancies in Botswana

Abstract

Background: Human papillomavirus (HPV) associated malignancies are the leading cause of cancer death in Botswana. We sought to determine causative HPV types in patients with anogenital malignancies in Botswana to inform vaccine strategy. Methods: We used formalin-fixed and paraffin-embedded (FFPE) tissue blocks from patients diagnosed with anal, penile and vulvar squamous cell carcinomas between the years, 2014 and 2016. Presence of HPV 16, 18, or other high-risk (HR) types was detected using Abbott m2000 real-time PCR platform. Tissues with other high-risk types were subsequently analysed using a multiplex qPCR assay that includes 15 validated fluorophore probes. Results: A total of 126 tissue specimens, comprising of 21 anal (9 males, 12 females), 31 penile and 74 vulvar were studied. Ninety-three (73.8%) patients had their HIV status documented in the records while the rest did not. Eighty-three (83) out of 93 were HIV positive, a prevalence of 89.4% (95% CI: 81-94). HPV was detected in 68/126 (54%) tissues, of which 69% (95% CI: 54-79) had HPV 16 only, 28% (95% CI: 19-40) had other hr.-HPV types and 2. 9% (95% CI, 3.5-10.1) were co-infected with HPV 16 and other hr.-types. Other high-risk types detected included HPV 26,31,33,35,39,45,51,52, 66 and 68. HPV 18 was not detected. Multiple-type HPV infection was detected in 44 of 47 (93.6%) HIV positive participants co-infected with HPV. In HIV-negative individuals, only HPV 16 was detected. Conclusion: In our study, anogenital carcinomas were associated with HPV 16 and other hr.-HPV types besides HPV 16 and 18. HIV co-infected patients had multiple hr.-HPV types detected whereas in HIV-negative patients only HPV 16 was detected. Our study suggests that multivalent vaccines may be more suitable in this setting, especially for HIV-infected individuals.

Cancer of the vulva: 2021 update

“…As for cervical premalignant lesions predisposing to cervical cancer, persistent HPV infection, particularly by HPV 16 subtype, has been associated with the long‐term development of high‐grade squamous intraepithelial lesion (HSIL) and SCC of the vulva. 9 , 10 , 11 The introduction of HPV vaccination as a primary prevention strategy in cervical cancer has been shown to also reduce the prevalence of noncervical premalignant lesions among vaccinated women 12 who were not initially infected with high‐risk HPV types or types included in the vaccines, with vaccine efficacies of more than 90%. 13 Long‐term trends analyses by the Norwegian Cancer Register also show promising estimates of reduction in HPV‐associated cases of vulvar cancer in future years, among HPV‐vaccinated communities.…”

“…HIV infection and cigarette smoking are also common predisposing factors. 1,3,9,20 As shown in Table 1, the terminology and definitions for premalignant or precursor lesions of vulvar cancer have been reviewed and changed in the last few decades. Currently, such lesions arising from the vulva and the anus are all included and named as "lower anogenital squamous intraepithelial lesions."…”

Cancer of the vulva

“…HIV infection and cigarette smoking are also common predisposing factors. 1,3,9,19 As shown in Table 1, the terminology and definitions for premalignant or precursor lesions of vulvar cancer have been reviewed and changed in the last decades. Currently, such lesions arising from the vulva and the anus are all included and named as "lower anogenital squamous intraepithelial lesions."…”

“…As for cervical premalignant lesions predisposing to cervical cancer, persistent HPV infection, particularly by HPV 16 subtype, has been associated with the long‐term development of high‐grade squamous intraepithelial lesion (HSIL) and SCC of the vulva . The introduction of HPV vaccination as a primary prevention strategy in cervical cancer has been shown to also reduce the prevalence of noncervical premalignant lesions among vaccinated women .…”

“…intraepithelial lesion (HSIL) and SCC of the vulva. [9][10][11] The introduction of HPV vaccination as a primary prevention strategy in cervical cancer has been shown to also reduce the prevalence of noncervical premalignant lesions among vaccinated women. 12 Long-term trends analyses by the Norwegian Cancer Register also show promising estimates of reduction in HPV-associated cases of vulvar cancer in future years, among HPV-vaccinated communities.…”