Distribution of human papillomavirus in precancerous and cancerous cervical neoplasia in Tunisian women

Abstract

Background High-risk human papillomavirus (HR-HPV) are responsible for cervical cancer (CC) which represents the second most prevalent gynecological cancer among Tunisian women. Preventive strategies against CC are based on prophylactic vaccines that have not yet been implemented into the national vaccination program of Tunisia. Therefore, the present study aimed to investigate the HPV genotypes distribution in cervical neoplasia in Tunisian women in order to predict the impact of using current HPV vaccines on cancer prevention in Tunisia. Methods A total of 200 formalin-fixed paraffin embedded biopsies were collected in our study. DNA was extracted using Qiagen Mini prep kit. DNA quality was controlled by Beta Globin PCR. Only positive samples for Beta Globin test were used. HPV detection was performed by a nested PCR using PYGMY and GP5+/6+ primers. Genotyping was performed by Reverse Line hybridization using 31 probes. Results The mean age of participants was 38.97 years and 75% were over 30 years. Cervical neoplasia distribution according to age showed that CINII/CINIII was observed among women over 30 years old. All samples were positive for Beta Globin PCR. Overall HPV prevalence in cervical lesions was 83% (166/200). HPV was present in 65% of CINI, 82% of CINII/CINIII and 85% of CC. HR-HPV was statistically significantly associated with cervical intraepithelial neoplasia (p < 10–3). HR-HPV distribution according to lesion grade and cervical cancer showed that HPV16 and HPV18 were present in all lesions. For CINII/CINIII, HPV 35 (37.5%) was the most detected type, followed by HPV18 (33.3%) HPV 45 (28.5%) and HPV 16 (18.9%). HPV 45(57.5%), HPV 18 (53.3%) were the most detected in CC. HPV58, 59, 68 were only detected in CC and associated with HPV45, 18 and HPV16. HPV39, 31, 33, 52, 56 and HPV70 was associated only with CINI. Conclusions Our findings can give useful information for vaccine implementation by helping the health policymakers to choose the most appropriate vaccine type in Tunisia.

The Prevalence, Genotype Distribution and Risk Factors of Human Papillomavirus in Tunisia: A National-Based Study

“…Regarding the poor efficiency of pap screening preventive strategy and about 400 new cases each year, CC represents a major health issue in Tunisia [ 17 ]. Up to now, the data on women HPV cervix infection prevalence and HPV genotype distribution in Tunisia was limited to some governorates and related to specific categories of women [ 4 , 9 , 10 , 11 , 12 , 13 ]. Therefore, there was a need for a national investigation on HPV epidemiology to obtain a detailed picture of the prevalence and distribution of HPV genotypes in Tunisian women population.…”

“…Persistent infection with high-risk HPV (HR-HPV) can lead to precancerous lesions that are likely to progress into cervical cancer [ 3 ]. Most common oncogenic HPV genotypes are HR-HPV16 and 18 that have been identified as the most prevalent in CC samples in previous Tunisian reports [ 4 , 5 ].…”

“…The previous published studies that have estimated the prevalence of HPV in Tunisia were limited to specific study populations or to specific regional areas and have used different tests and methods [ 4 , 5 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

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

“…These “in house” techniques coupled PCR amplification to hybridization to specific probes for 37 anogenital HPV genotypes (LR and HR) immobilized on a nylon membrane. These assays have been analytically validated by their developers [ 23 , 24 , 34 , 35 ] and verified by us upon implementation in our laboratory; they are usually used in many laboratories for HPV genotyping due to their highly valuable sensitive for HPV epidemiological studies and surveillance [ 33 , 36 – 40 ]. The Regional HPV Reference Laboratory from Argentina annually participates in the external control of HPV genotyping (HPV DNA typing proficiency panel), provided by the International Papillomavirus Reference Centre, which adds reliability to the results obtained [ 41 ].…”

Human Papillomaviruses-Related Cancers: An Update on the Presence and Prevention Strategies in the Middle East and North African Regions

“…In Tunisia, a recent study investigated the distribution of HPV in precancerous and cancerous cervical neoplasia and reported an HPV prevalence of 83% in cervical lesions [112]. More specifically, HPV was detected in 65% of CIN I, 82% of CIN II/CIN III, and 85% of cervical cancer cases [112].…”