Prevalence of Human Papillomavirus Genotypes among African Women with Normal Cervical Cytology and Neoplasia: A Systematic Review and Meta-Analysis

Abstract

BackgroundSeveral meta-analyses confirmed the five most prevalent human papillomavirus (HPV) strains in women with and without cervical neoplastic diseases are HPV16, 18, 31, 52, and 58. HPV16/18 are the predominant oncogenic genotypes, causing approximately 70% of global cervical cancer cases. The vast majority of the women studied in previous analyses were from Europe, North America, Asia, and most recently Latin America and the Caribbean. Despite the high burden of cervical cancer morbidity and mortality in Africa, a robust meta-analysis of HPV genotype prevalence and distribution in African women is lacking.Methods and FindingsWe systematically searched 14 major databases from inception to August 2013 without language restriction, following the Meta-Analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-one studies from 23 African countries were identified after screening 1162 citations and data abstracted and study quality appraised from 195 articles. HPV type-specific prevalence and distribution was estimated from 17,273 cases of women with normal cervical cytology; 1019 women with atypical squamous cells of undetermined significance (ASCUS); 1444 women with low-grade squamous intraepithelial lesion (LSIL); 1571 women with high-grade squamous intraepithelial lesion (HSIL); and 4,067 cases of invasive cervical carcinoma (ICC). Overall prevalence of HPV16/18 were 4.4% and 2.8% of women with normal cytology, 12.0% and 4.4% with ASCUS, 14.5% and 10.0% with LSIL, 31.2% and 13.9% with HSIL, and 49.7% and 18.0% with ICC, respectively. Study limitations include the lack of adequate data from Middle and Northern African regions, and variations in the HPV type-specific sensitivity of different genotyping protocols.ConclusionsTo our knowledge, this study is the most comprehensive assessment of the overall prevalence and distribution of HPV genotypes in African women with and without different cervical neoplasias. We have established that HPV16/18 account for 67.7% of ICC cases among African women. Based on our findings, we highly recommend the administration of existing prophylactic vaccines to younger women not infected with HPV16/18 and an increase in HPV screening efforts for high-risk genotypes to prevent cervical cancer. Review registration: International Prospective Register of Systematic Reviews CRD42013006558.

Human Papillomavirus Genotypes in Invasive Cervical Carcinoma in HIV Seropositive and Seronegative Women in Zimbabwe

“…Among HIV-positive participants ICC was diagnosed in much younger women and occurred on average 16 years earlier than among their HIV-negative counterparts. The overall HPV prevalence of 94% was in keeping with rates found elsewhere in literature [11,16]. HPV 16 and 18 remained the commonest HPV genotypes isolated in patients with ICC regardless of HIV status, being isolated in 83% of cases.…”

“…In a recent meta-analysis of HPV genotypes in ICC in Sub-Saharan Africa [16], HPV16, 18, 45, 35, 33, 52, 31, 58, 51 and 68 were the top ten most frequently detected genotypes amongst women with ICC. These studies, however did not take into consideration the patients' HIV status.…”

Human papillomavirus infection among Bangladeshi women with cervical intraepithelial neoplasia and chronic cervicitis

“…It was probably that younger CIN cases had infection with high risk oncogenic HPV types in their early life which progressed into CIN in middle age. The higher rate of HPV infection among women of this age group was found in other studies [6,13].…”

“…The rate of HPV infection was significantly low in chronic cervicitis (18.2%) but it was comparatively higher than that in women with normal cervical cytology [12]. Studies in different countries of Africa reported similar high rate of HPV infection in different grade of CIN [6]. But a previous study from Bangladesh in 2009 reported only 7-10% HPV positivity rate among CIN 2, CIN 3 and invasive carcinoma of the cervix [14].…”

“…The prevalence rate of HPV infection in different countries ranged from 1.6% to 41.9% [5]. A meta analysis hasreported an overall rate of HPV infection among African women with normal cervical cytology as 29.0% while the range varied from 12% to as high as 76.3% [6,7]. The prevalence of HPV infection in women with normal cervical cytology ranged from 6.7% to 11.4% in China, Nepal, Thailand and Indonesia [8][9][10][11].…”