Human papillomavirus genotypes in cervical and other HPV‐related anogenital cancer in Rwanda, according to HIV status

Abstract

The study aim was to describe human papillomavirus (HPV)‐attributable cancer burden in Rwanda, according to anogenital cancer site, HPV type, age and HIV status. Tissue specimens of cervical, vulvar, vaginal, penile and anal cancer diagnosed in 2012–2018 were retrieved from three cancer referral hospitals and tested for high‐risk (HR) HPV DNA. Cervical cancer represented the majority of cases (598 of 738), of which 96.0% were HR‐HPV positive. HPV‐attributable fractions in other cancer sites varied from 53.1% in 81 penile, through 76.7% in 30 vulvar, 83.3% in 24 vaginal, up to 100% in 5 anal cases. HPV16 was the predominant HR‐HPV type in cervical cancer (55.0%), followed by HPV18 (16.6%) and HPV45 (13.4%). HPV16 also predominated in other cancer sites (60–80% of HR‐HPV‐attributable fraction). For cervical cancer, type‐specific prevalence varied significantly by histology (higher alpha‐9 type prevalence in 509 squamous cell carcinoma vs. higher alpha‐7 type prevalence in 80 adenocarcinoma), but not between 501 HIV‐negative and 97 HIV‐positive cases. With respect to types targeted, and/or cross‐protected, by HPV vaccines, HPV16/18 accounted for 73%, HPV31/33/45/52/58 for an additional 22% and other HR‐HPV types for 5%, of HPV‐attributable cancer burden, with no significant difference by HIV status nor age. These data highlight the preventive potential of the ongoing national HPV vaccination program in Rwanda, and in sub‐Saharan Africa as a whole. Importantly for this region, the impact of HIV on the distribution of causal HPV types was relatively minor, confirming type‐specific relevance of HPV vaccines, irrespective of HIV status.

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

“…Unlike most previous studies on CIN3 performed in the United States or in Europe, but similar to recent studies based in SSA, we did not find a significant difference in the prevalence of HPV16 by HIV status in CIN3 (22)(23)(24)(25). Earlier studies on HPV in WLWH with CIN3 are almost all based on PCR from cervical lavage specimens, which may explain why we found a higher proportion of HPV16 in our biopsy-based study (9).…”

Prevalence of high-risk HPV genotypes in sub-Saharan Africa according to HIV status: a 20-year systematic review

“…The studies carried out by Diop-Ndiaye et al [ 29 ], Dols et al [ 30 ] and Denny et al [ 31 ] were excluded from the calculations of the prevalence of multiple HPV infections due to lack of data ( Table 4 ). The mean age of HIV+ and HIV- women did not include data from Mpunga et al [ 32 ], Mudini et al [ 20 ], Marembo et al [ 33 ], Maranga et al [ 34 ], and Banura et al [ 35 ] because they did not specify the mean age and age range of the 2 groups. The data presented in Table 5 were only extracted from the studies carried out by Mpunga et al [ 32 ], Mudini et al [ 20 ], and Maranga et al [ 34 ] due to the fact that their papers reported the prevalence of HPV types for both HIV+ and HIV- women diagnosed with cancer.…”

Epstein‐Barr virus prevalence among subtypes of malignant lymphoma in Rwanda, 2012 to 2018

“…Our representative case series is derived from BCCOE, Burera District, Northern Rwanda, 7,8 which opened in July 2012 to serve as a national cancer referral center. BCCOE was the only hospital in Rwanda to offer immunohistochemistry workup during the study period, thus all biopsies from suspected lymphoma in other hospitals were transferred to BCCOE for final diagnosis.…”