Prevalence and Genotyping of High Risk Human Papillomavirus in Cervical Cancer Samples from Punjab, Pakistan

Abstract

Cervical cancer is the third most common cause of cancer-related death in women worldwide. Infection with high-risk human papillomavirus (HPV) is established as the cause of cervical carcinoma, therefore, high risk HPV detection may have prognostic significance for the women who are at increased risk of disease progression. The paucity of data on the incidence of cervical cancer in Pakistan makes it difficult to determine disease burden. Even less information is available regarding the prevalent HPV strains in cervical specimens collected from this region. Cervical cancer is a neglected disease in Pakistan in terms of screening, prevention, and vaccination. Identification and accurate genotyping of the virus burden in cancer specimens is important to inform intervention policies for future management of HPV associated disease and to potentially stratify patients dependent on HPV status. In this study, detection and genotyping of HPV types 16 and 18 from 77 cervical specimens were carried out. Consensus primers GP5+/GP6+, which detect 44 genital HPV types, and type specific primers (TS16 and TS18) were used in conjunction with newly designed type specific primers. Using a combination of these methods of detection, a total of 94.81% (95% CI ±4.95) of cervical lesions were positive for HPV. Single infections of HPV16 were detected in 24.68% (95% CI ±9.63) of total samples and HPV18 was found in 25.97% (95% CI ±9.79) samples. Interestingly, a high proportion of samples (40.26%, 95% CI ±10.95) was positive for both HPV16 and 18, indicating a higher incidence of co-infection than previously reported for similar ethnic regions. The HPV genotype of 3.90% of HPV positive samples remained undetected, although these samples were positive with the GP5+/GP6+ primer set indicating infection with an HPV type other than 16 or 18. These data indicate that the overall incidence of high risk HPV infection in cervical cancer and intraepithelial neoplasia specimens in Punjab, Pakistan is in line with the worldwide prevalence, but that the incidence of HPV16 and 18 co-infections in our cohort is higher than that previously reported.

A comparative study of p53 expression in premalignant and malignant cervical lesions at a tertiary care institute of Rohilkhand region, India

“…SCC was observed as the most common cervical malignancy comprising 93.33% of cases, in the present study, distribution almost being similar to that reported by Lo et al [19] (90.4%), Raza et al [20] (86.8%), and Siddiqa et al [21] (91.5%). However, in a study done by Gul et al, [22] the proportion of SCCs was comparatively less, i.e., 58.9%.…”

Prevalence of High risk Human Papillomavirus in cervical dysplasia and cancer samples from twin cities in Pakistan

“…Although, studies showing association of HPV in cervical cancer have started to emerge, there seems to be regional disparity regarding HPV genotype prevalence and its etiological role in cervical cancer in different parts of Pakistan, highlighting the essential need for further investigation. [22][23][24] High-risk HPV infection accounts for more than 99% of cervical cancer cases and approximately 5 percent of all cancers worldwide. 25 As a necessary factor for the development of cervical malignancies, high risk HPV is often found in the pre-malignant genital lesions.…”

Human Papillomavirus Genotype Distribution in Invasive Cervical Cancer in Pakistan

“…While some studies from Pakistan show similar low rates of co-infection a recent study conducted in Punjab registered higher rates of HPV16/18 co-infection (34.0%) [11,12]. The use of different primers for HPV-DNA detection can explain the differences in the sensitivity to detect HPV infections.…”

“…In Pakistan, there is only limited opportunistic screening, which is mostly based on visual inspection using acetic acid (VIA) [11,15,16]. Countries with resource constraints, like Pakistan, often lack personnel with technical expertise and public health infrastructure to provide Papanicolaou smear and cervical cytology [17].…”