HPV Types in Cervical Precancer by HIV Status and Birth Region: A Population-Based Register Study

Abstract

Background: Data are lacking regarding which human papillomavirus (HPV) types cause high-grade cervical neoplasia (CIN2þ) in people with HIV in Europe. We assessed which HPV types are associated with CIN2þ in women living in Sweden by HIV status.Methods: The Swedish National HIV Registry, the Swedish Population Registry, and the Swedish National Cervical Screening Registry were linked. CIN2þ tissue blocks of 130 women living with HIV (WLWH) and 234 HIV-negative women, matched for country of birth (1:2), were retrieved from bio-banks and HPV genotyped. Adjusted ORs (adjOR), stratified by country of birth, were calculated using conditional logistic regression. Matching was broken for cross-group comparisons.Results: WLWH with CIN2 were less likely to have HPV16 [14% vs. 40%; adjOR 0.1; 95% confidence interval (CI), 0.04-0.56] than HIV-negative women, but among women with CIN3, there was no difference in HPV16 prevalence by HIV status (adjOR 0.9; 95% CI, 0.51-1.70). WLWH were six times more likely to have HPV35 in CIN3 than HIV-negative women (adjOR 6.2; 95% CI, 1.3-30.4). WLWH from sub-Saharan Africa (SSA) had less 9-valent vaccine types, compared with both HIV-negative women born in Sweden (adjOR 0.1; 95% CI, 0.02-0.44) and WLWH born in Sweden (adjOR 0.1; 95% CI, 0.01-0.73), mostly because of decreased HPV16 and increased HPV35.Conclusions: WLWH from SSA were less likely to be covered by the 9-valent vaccine, mostly due to less HPV16 and more HPV35.Impact: This could have implications for HPV vaccines, currently not including HPV35, and for HPV-screening algorithms in women with origin from SSA.

High human papillomavirus (HPV)-35 prevalence among South African women with cervical intraepithelial neoplasia warrants attention

“…Sub-Saharan African HIV-positive women were reported to have decreased HPV types targeted by Gardasil®9 HPV vaccine (HPV-6/11/16/18/31/33/45/52/58) when compared with Sweden-born HIV-negative and HIV-positive women. These observations were influenced by decreased HPV-16 and increased HPV-35 prevalence in sub-Saharan African women [ 26 ]. Unfortunately, the currently commercially available HPV vaccines are not targeting HPV-35 [ 6 ].…”

Hookworm infection associates with a vaginal Type 1/Type 2 immune signature and increased HPV load

“…In addition, we detected a distribution of HPV types that has similarities and differences to that reported in some cohorts in Sub-Saharan Africa (SSA). Importantly, HPV 35 that is implicated in cervical cancer progression in SSA (33,34), and not included in any current HPV vaccine, is one of the predominant HPV types we detected in our cohort. This highlights a need to develop better HPV vaccines specific for each population according to HPV type distribution.…”

Metatranscriptome analysis in human papillomavirus negative cervical cancers

“…Literature agrees on reporting that “healthy” women show a vaginal microbiome with low diversity, dominated by Lactobacillus , and that one of the most prominent features of “disease” is an increase of pH (due to a decrease of lactate concentration), reduction of lactobacilli and a great diversity of bacterial vaginosis-related bacteria, which are primarily anaerobic bacteria 23 . Studies on HPV positive CIN and cervical cancers show higher diversity in vaginal microbiota, with depletion of Lactobacillus crispatus and increase abundance of anaerobic bacteria 24 , 25 . While our results from cervical cancer cases agree with the literature (higher diversity of bacteria and low abundance of Lactobacillus, only present in 10/446), microbiome differences between HPV negative and HPV positive cervical cancers have not been studied yet.…”

“…( 1234567890 www.nature.com/scientificreports/ bacteria 23 . Studies on HPV positive CIN and cervical cancers show higher diversity in vaginal microbiota, with depletion of Lactobacillus crispatus and increase abundance of anaerobic bacteria 24,25 . While our results from cervical cancer cases agree with the literature (higher diversity of bacteria and low abundance of Lactobacillus, only present in 10/446), microbiome differences between HPV negative and HPV positive cervical cancers have not been studied yet.…”