Dynamics of genotype-specific HPV clearance and reinfection in rural Ghana may compromise HPV screening approaches

Krings, Amrei; Boateng, Gifty; Dunyo, Priscilla; Amuah, Joseph E.; Adams, Abdul Rashid; Adunyame, Lois; Nkansah, Dinah Obenewaa; Wormenor, Comfort Mawusi; Hansen, Benjamin Tetteh; Gedzah, Isaac; Asmah, Richard Harry; Wiredu, Edwin K.; Kaufmann, Andreas M.

doi:10.1016/j.pvr.2018.12.004

Cited by 11 publications

(11 citation statements)

References 29 publications

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“…It is interesting to note that none of the surveyed women tested positive for the HPV 31, a vaccine-targeted HPV. Low infection rates from this genotype have also been reported in earlier studies [ 29 , 31 ]. This supports the suggestion that HPV31 infections rapidly clear after primary contact, reducing its carcinogenic potential [ 11 ].…”

Section: Discussionsupporting

confidence: 81%

“…The HPV infection profile at any point represents a cocktail of persistent and new infections. Krings et al reported 6.7% and 21.2% rates of new and old HPV infections respectively, among in a cohort of healthy women after a 4-years of residence in Ghana [ 29 ]. HPV 16 and 18, despite their low infection rate among the healthy individuals, were well represented among the cases, confirming their ability to resist clearance.…”

Section: Discussionmentioning

confidence: 99%

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Human papillomavirus genotype distribution among women with and without cervical cancer: Implication for vaccination and screening in Ghana

et al. 2023

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Introduction Determining the high-risk human papillomavirus (HR-HPV) genotypes burden in women with and without cervical cancer afford a direct comparison of their relative distributions. This quest is fundamental to implementing a future population-based cervical cancer prevention strategy in Ghana. We estimated the cervical cancer risk by HPV genotypes, and the HPV vaccine-preventable proportion of cervical cancer diagnosed in Ghana. Materials and methods An unmatched case-control study was conducted at the two largest cervical cancer treatment centres in Ghana from 1st October 2014 to 31st May 2015. Cases were women diagnosed with cervical cancer and controls were women without cervical cancer who were seeking care at the two hospitals. Nested multiplex polymerase chain reaction (NM-PCR) was used to detect HPV infection in cervical samples. Logistic regression was used to determine the association between the risk of cervical cancer and identified HPV infection. P ≤0.05 was considered statistically significant. Results HPV deoxyribonucleic acid (DNA) data were analysed for 177 women with cervical cancer (cases) and 201 without cancer (controls). Cervical cancer was diagnosed at older ages compared to the age at which controls were recruited (median ages, 57 years vs 34 years; p < 0.001). Most women with cervical cancer were more likely to be single with no formal education, unemployed and less likely to live in metropolitan areas compared to women without cervical cancer (all p-value <0.001). HPV DNA was detected in more women with cervical cancer compared to those without cervical cancer (84.8% vs 45.8%). HR-HPV genotypes 16, 18, 45, 35 and 52 were the most common among women with cervical cancer, while 66, 52, 35, 43 and 31 were frequently detected in those without cancer. HPV 66 and 35 were the most dominant non-vaccine genotypes; HPV 66 was more prevalent among women with cervical cancer and HPV 35 in those without cervical cancer. Cervical cancer risk was associated with a positive HPV test (Adjusted OR (AOR): 5.78; 95% CI: 2.92–11.42), infection with any of the HR-HPV genotypes (AOR: 5.56; 95% CI: 3.27–13.16) or multiple HPV infections (AOR: 9.57 95% CI 4.06–22.56). Conclusion Women with cervical cancer in Ghana have HPV infection with multiple genotypes, including some non-vaccine genotypes, with an estimated cervical cancer risk of about six- to ten-fold in the presence of a positive HPV test. HPV DNA tests and multivalent vaccine targeted at HPV 16, 18, 45 and 35 genotypes will be essential in Ghana’s cervical cancer control programme. Large population-based studies are required in countries where cervical cancer is most prevalent to determine non-vaccine HPV genotypes which should be considered for the next-generation HPV vaccines.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Human papillomavirus genotype distribution among women with and without cervical cancer: Implication for vaccination and screening in Ghana

et al. 2023

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“…Awua et al [44], reported HP-16 (5.9%), HPV-35 (4.7%), HPV-40 (4.7%), HPV-45 (4.3%), HPV-58 (4.0%), HPV-18 (3.6%) to be the most prevalent HPV genotypes detected in self-collected specimens. Krings et al [54] at North Tongu District of Ghana reported top five HPV genotypes: 16 (7.4%), 52 (7.2%), 35 (4.8%, 59 (4.7%) and 56 (3.9%). Concordance between studies on the distributions of observed genotypes strengthen our results and the conclusions that emanate from this work.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of vaccine and non-vaccine human papillomavirus types among women in Accra and Kumasi, Ghana: a cross-sectional study

et al. 2021

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Background Human Papillomavirus (HPV) infection is the main etiological factor for pre-invasive and invasive cervical cancer. HPV type-specific vaccination is being widely recommended to control the burden of disease, but the genotype-specific distribution of HPV may vary in different countries. The aim of the study was to determine the prevalence and distribution of HPV genotypes among women attending reproductive health services in Ghana, their associated risk factors, and to assess the potential coverage of identified HPV genotypes by three licensed vaccines among these women. Method Women presenting for reproductive health services in two regional hospitals in Accra and Kumasi from October 2014 to March 2015 were conveniently recruited into the study (n = 317). HPV-DNA detection and genotype identification were carried out by a nested multiplex PCR assay that combines degenerate E6/E7 consensus primers and type-specific primers for the detection and typing of eighteen HPV genotypes. Cytology was performed to screen women for cervical cancer lesions. Risk factors for HPV infection were analyzed by logistic regression. Statistical significance was accepted for p < 0.05. Results The age of study participants ranged from 21 to 76 years. Among women positive for HPV, 35.0% were infected with high-risk HPV, 14.5% with probable high-risk HPV, and 17.0% with low-risk HPV. The prevalence of HPV 16/18 was 8.2%, HPV 6/11/16/18 was 9.1% and HPV 6/11/16/18/31/33/45/52/58 was 28.4%. The most prevalent among HR-HPV were types 52 (18.3%) and 58 (8.8%). HPV positivity may be associated with educational background (p < 0.001), age at first pregnancy (p = 0.028), and age at coitarche (p = 0.016). Conclusions Our study revealed a high prevalence of HR-HPV infection among women. The high prevalence of HR HPV indicates that multivalent vaccines will be useful for controlling HPV burden in general population contexts. The distribution of HPVs in this population suggests that of the three currently available vaccines the nonavalent vaccine, which protects against seven HPV types in addition to HPV 16 and 18, has the highest coverage of HPV infections among Ghanaian women. Healthcare officials planning to reduce the transmission of HPV and cervical cancer must consider the coverage of the nonavalent vaccine as an advantage.

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“…Variability in the distribution of HPV genotypes in HIV positive women compared to the general population introduces the potential for HPV genotypes to spill-over from this population into the general population and has implications for cancer prevention efforts in the general population (Krings et al, 2019). In this study, HIV positive women had multiple HR-HPV genotypes other than HPV 16 and 18.…”

Section: Anthonymentioning

confidence: 84%

Human papillomavirus (HPV) genotypes and associated cervical disease in an anti-retroviral setting in Accra, Ghana

Amelor

Donkoh

Asmah

et al. 2022

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Background The vast majority of women diagnosed with HIV/AIDS are found in the Sub-Saharan African region. These women have a high chance of being infected with human papillomaviruses (HPV), which causes cervical cancer and precursor lesions. Early initiation of HAART coupled with a high HAART compliance may reduce disease burden, but in Ghana, little is known about the distribution of HPV infections and epithelial changes in this vulnerable group. Methods This work was carried out to establish the distribution of genital HPV genotypes among women living with HIV attending a special HIV outpatient clinic at the Korle-Bu Teaching hospital Accra, Ghana. Pap smears were performed for 538 selected women. A highly sensitive nested multiplex PCR (NMPCR) assay was conducted for the detection and typing of human papillomavirus (HPV) genotypes. These included, 6/11, 16,18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56, 58, 59, 66, and 68. Cervical smears were examined for cytologic abnormalities by two cytologists and verified by a pathologist. Results Coverage of HAART in this population was 84%. HPV DNA was detected in 280 out of the 538 individuals studied, 52.0% (95%CI 47.7–56.3). Out of these 129 (46.1%, 95%CI 40.1–52.1) had multiple HPV infections and 151 (53.9%, 95%CI 47.9–59.9) had single infections. The prevalence of LR HPV was 10.2% (95% CI: 11.3–17.6). while that of HR HPV was 29.7% (95% CI: 27.4–35.7). The commonest HR types were, 35 ,18 ,58 ,52 and 45 in descending order. The frequency of HPV 16 was 2.4%. Cytologically, 2.8% had ASCUS, 3.9% LGSIL and 2.8% HGSIL, none of the women was found to have atypical glandular cells or adenocarcinoma. The commonest HPV genotypes detected among women with ASCUS were HPV-18 (25% of all ASCUS cases), 52 (25% of all ASCUS cases) and 68 (25% of all ASCUS cases). Among women with LSIL most prevalent were HPV-52 (66.5% of all LSIL cases), HPV-18 (22.2% of all LSIL cases) and HPV 45 (22.2% of all LSIL cases). HPV-16, 52 and 42 were each found in 50% of all High-grade lesions., being the top three in that order for high grade intraepithelial/severe dysplasia lesions Conclusions There is a high burden of HPV infection in women living with HIV attending clinic at the KBTH. Given the high prevalence of HIV-HPV coinfection despite the high coverage of HAART, associated cervical lesions represent a major public health burden. These results show that currently available prophylactic vaccines have the potential to be useful in the primary prevention of HPV infections among immunocompromised women. This study also found a cross-sectional association between early age at first sex and the presence of precancerous cervical lesions. Efforts to make vaccines available to young girls before sexual debut should be prioritized along with education on safe sexual habits.

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Dynamics of genotype-specific HPV clearance and reinfection in rural Ghana may compromise HPV screening approaches

Cited by 11 publications

References 29 publications

Human papillomavirus genotype distribution among women with and without cervical cancer: Implication for vaccination and screening in Ghana

Human papillomavirus genotype distribution among women with and without cervical cancer: Implication for vaccination and screening in Ghana

Prevalence of vaccine and non-vaccine human papillomavirus types among women in Accra and Kumasi, Ghana: a cross-sectional study

Human papillomavirus (HPV) genotypes and associated cervical disease in an anti-retroviral setting in Accra, Ghana

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