High prevalence and co-infection of high-risk Human Papillomavirus genotypes among unvaccinated young women from Paraguay

Abstract

Paraguay launched a human papillomavirus (HPV) vaccination program in 2013, so virological surveillance is important for measuring the impact of HPV vaccines. This study aimed to estimate the type-specific HPV frequency in unvaccinated sexually active women aged 18–25 years in the metropolitan area of Asuncion as a baseline for monitoring the HPV vaccination program. This study included 208 women, attending the Central Laboratory of Public Health between May 2020 and December 2021, were invited for testing through social networks and flyers at local health centers and higher education institutes. All participants who agreed to contribute to the study signed a free, prior, and informed consent form and answered a questionnaire that included basic demographic data and determining factors of HPV infection. Human papillomavirus detection and genotyping were conducted using the CLART HPV2 test (Genomica, Madrid, Spain) that allows the individual identification of 35 genotypes. 54.8% women were positive for any HPV type, with 42.3% positive for high-risk HPV (HR-HPV) types. Several factors were associated with HPV detection including the number of sexual partners, new sexual partners, non-use of condoms, and history of other sexual infections. Moreover, multiple infections were identified in 43.0% of the young women. We detected 29 different viral types present in both single and multiple infections. HPV-58 was the most commonly detected HPV type (14.9%), followed by HPV-16, HPV-51, and HPV-66 (12.3%). We estimated the prevalence of bivalent (16/18), quadrivalent (6/11/16/18), and nonavalent (6/11/16/18/31/33/45/52/58) vaccine types to be 8.2%, 13%, and 38%, respectively. These results reinforce the importance of surveillance studies and provide the first data regarding circulating HPV genotypes in the unvaccinated population in Paraguay, thus generating a baseline to compare future changes in the overall and type-specific HPV prevalence after HPV vaccination.

Human Papillomavirus (HPV) Infection and Risk Behavior in Vaccinated and Non-Vaccinated Paraguayan Young Women

“…In a previous study conducted by our research group, representing the primary comprehensive report on HPV prevalence and genotypic distribution in Paraguay, we substantiated the existence of HPV types targeted by contemporary vaccines circulating among unvaccinated, sexually active young women. This established baseline serves as a pivotal tool for evaluating the impact of the national HPV immunization program, facilitating the estimation of both vaccine and non-vaccine HPV type prevalence [ 66 ]. Understanding the risk behaviors associated with HPV infection is important for prevention and public health.…”

High-risk HPV prevalence and vaccination coverage among Indigenous women in the Colombian Amazon: Implications for cervical cancer prevention. Cross-sectional study

“…An overall prevalence of HPV infection of 31.1% was found, which is within a wide range of prevalence reported by other studies in Colombia: Torrado et al [ 17 ] reported 10% in the lower income strata of the mestizo population in a Colombian city; Angarita & Forero [ 9 ] found 47.4% in one group of Indigenous population; Camargo [ 11 ] found 49.6% in five Colombian cities, and Puerto et al [ 10 ] found 60.3% in women aged 18 to 25 years in Bogota. In other Latin American countries, Carrión et al [ 18 ] reported a prevalence of 34% in an Ecuadorian Indigenous population, Martorell et al reported 35.4% in a Peruvian Indigenous population [ 19 ] and Bobadilla et al [ 20 ] in Paraguay reported a prevalence of 54.8%. This variation is found throughout the Latin American region as described by Moya and Rojas [ 21 ], who reviewed 39 publications in which HPV infection prevalence ranged from 6.7% to 82.2%.…”

HPV and Cervical Cancer: Molecular and Immunological Aspects, Epidemiology and Effect of Vaccination in Latin American Women

“…Studies carried out in young (under 25 years), unvaccinated, and sexually active Latin American women reported a high prevalence of HPV (greater than 50%); for example, in Paraguay, the prevalence was 54.8% [ 84 ], in Brazil 54.6% [ 85 ], in Colombia it was 60.3% [ 86 ], and in Argentina it was 56.3% [ 87 ]. By contrast, studies carried out on women who attend routine checkups and are over 25 years old found that this percentage is lower, as is the case of the ESTAMPA subcohort study realized in Argentina, Colombia, Costa Rica, Honduras, Paraguay, and Uruguay when only 13% of samples were HPV-positive [ 88 ].…”

“…The implementation of HPV vaccines in this region has markedly improved vaccine availability and accessibility since the late-2000s. The majority of the Latin American countries use the tetravalent vaccine; however, some countries such as Paraguay and Argentina could prevent around 38% of HPV with the nonavalent vaccine ( Table 1 ), which is significantly higher than expected with the quadrivalent vaccine (13% and 22.5%, respectively) [ 84 , 87 ]; therefore, the nonavalent vaccine is expected to be available in the upcoming years. Unfortunately, despite these endeavors, the region is falling behind the goal of achieving 90% coverage with two doses of the HPV vaccine for girls by age 15 by 2030 [ 12 , 130 ].…”

“…In addition, the most used vaccine is the quadrivalent, followed by the bivalent [ 12 ]. However, in studies carried out in a young, sexually active population prior to vaccination, it was reported that the coverage of the nonavalent vaccine would be better for preventing genotypes distributed in the population [ 84 , 85 , 86 , 87 ]. So, in future strategies, it might be worth including it in vaccination schedules.…”