High prevalence of cervical high-risk human papillomavirus infection mostly covered by Gardasil-9 prophylactic vaccine in adult women living in N’Djamena, Chad

Abstract

Background We conducted in 2018 a descriptive, quantitative, population-based, cross-sectional survey estimating the prevalence of cervical high-risk human papillomavirus (HR-HPV) infection and associated risk factors among adult women living in N’Djamena, Chad. Methods Five of the 10 districts of N’Djamena were randomly selected for inclusion. Peer educators contacted adult women in community-churches or women association networks to participate in the survey and come to the clinic for women’s sexual health “ La Renaissance Plus ”, N’Djamena. Medical, socio-demographical and behavioral informations were collected. HPV DNA was detected and genotyped in endocervical swab using Anyplex II HPV28 genotyping test (Seegene, Seoul, South Korea). Results 253 women (mean age, 35.0 years; range, 25–65) including 3.5% of HIV-positive women were prospectively enrolled. The prevalence of HPV infection was 22.9%, including 68.9% of HR-HPV infection and 27.6% being infected with multiple genotypes, providing a total HR-HPV prevalence of 15.8% (95% CI%: 11.3–20.3). The most prevalent HR-HPV genotypes were HPV-58, HPV-35, HPV-56, HPV-31, HPV-16, HPV-45, HPV-52 and HPV-18. HPV types targeted by the prophylactic Gardasil-9 vaccine were detected in nearly 70% (67.5%) and HPV-58 was the most frequently detected. HIV infection was a risk factor strongly associated with cervical infection with any HPV [adjusted Odds ratio (aOR): 17.4], multiple types of HPV (aOR: 8.9), HR-HPV (aOR: 13.2) and cervical infection with multiple HR-HPV (aOR: 8.4). Conclusion These observations highlight the unsuspected high burden of cervical HR-HPV infection in Chadian women, and point the potential risk of further development of HPV-associated cervical precancerous and neoplastic lesions in a large proportion of women in Chad. The high rate of preventable Gardasil-9 vaccine genotypes constitutes the rationale for introducing primary vaccine prevention against cervical cancer in young female adolescents living in Chad.

Human Immunodeficiency Virus is a Driven Factor of Human Papilloma Virus among Women: Evidence from a Cross-sectional Analysis in Yaoundé, Cameroon

“…Out of a sample of 278 women enrolled, the mean age (37 years) mainly represents the most sexually active population and therefore having chronic exposure to sexually transmitted infections, including HPV. These results are similar to those obtained in Cameroon with Kabayene et al(mean age of 38.5 years) and in Chad (mean age of 35 years) (12,17,18).…”

“…As reported by Kevin A. Ault in 2006, High-risk, oncogenic HPV types (including HPV 16 and HPV 18) are associated with 99.7% of all cervical cancers (11). A recent study conducted in Chad during the year 2018 showed that 11 genotypes of HR-HPV were detected in nearly 70% of the study population, and HR-HPV 58 genotype was the most prevalent (22.9%) (12). In Cameroon, out of 14,000 new cases of cancer reported in 2016, cervical cancer occupied the second leading position of cancers among women (23.2%) (12,13).…”

“…A recent study conducted in Chad during the year 2018 showed that 11 genotypes of HR-HPV were detected in nearly 70% of the study population, and HR-HPV 58 genotype was the most prevalent (22.9%) (12). In Cameroon, out of 14,000 new cases of cancer reported in 2016, cervical cancer occupied the second leading position of cancers among women (23.2%) (12,13). These observations are very concerning and suggest a high burden of HPV in these settings where HIV is also highly prevalent (14,15).…”

Human Immunodeficiency Virus is a Driven Factor of Human Papilloma Virus among Women: Evidence from a Cross-sectional Analysis in Yaoundé, Cameroon

“…Direct consequences are clinical manifestations of HPV-associated dysplasia, which has been recognized in early HIV epidemics (10). As reported by Kevin A. Ault in 2006, High-risk, oncogenic HPV types (including HPV 16 and HPV 18) are associated with 99.7% of all cervical cancers (11). A recent study conducted in Chad during the year 2018 showed that 11 genotypes of HR-HPV were detected in nearly 70% of the study population, and HR-HPV 58 genotype was the most prevalent (22.9%) (12).…”

Human Immunodeficiency Virus is a Driven Factor of Human Papilloma Virus among Women: Evidence from a Cross-sectional Analysis in Yaoundé, Cameroon

“…Factors that contribute to HPV infections include: early sexual activity, multiple sexual partners, immunocompromised (HIV essentially), smoking, and prolonged oral contraception [8]. Thus, the primary prevention of cervical cancer by vaccinating girls aged 9 to 14 years with one of the 3 available vaccines (Cervarix, Gardasil-4 or Gardasil-9) before they begin sexual intercourse would theoretically protect them against most HR-HPV infections [9,10]. This primary prevention, combined with other prevention strategies (secondary and tertiary prevention) already in place in SSA, would be the ideal equation to overcome the high burden of cervical cancer on this continent [11,12].…”