Prevalence of human papillomavirus in Indonesia: a population-based study in three regions

Abstract

Cervical cancer is the most common cancer among women in the Indonesian population, yet little is known about the prevalence of human papillomavirus (HPV). We investigated age-specific prevalence of HPV types and possible risk factors of HPV positivity in a population-based sample of 2686 women, aged 15 -70 years, in Jakarta, Tasikmalaya, and Bali, Indonesia. The overall HPV prevalence was 11.4%, age-standardized to the world standard population 11.6%. The most prevalent types found were HPV 52, HPV 16, HPV 18, and HPV 39, respectively, 23.2, 18.0, 16.1, and 11.8% of the high-risk HPV types. In 20.7% of infections, multiple types were involved. Different age-specific prevalence patterns were seen: overall high in Jakarta, and in Tasikmalaya, and declining with age in Bali. The number of marriages was most associated with HPV positivity (OR 1.81 95% CI 1.31 -2.51)). Remarkably, in Indonesia HPV 16 and HPV 18 are equally common in the general population, as they are in cervical cancer. HPV 52 was the most prevalent type in the general population, suggesting that this type should be included when prophylactic HPV vaccination is introduced in Indonesia. Cervical cancer is the most common cancer in women in Indonesia, as in most developing countries (Tjindarbumi and Mangunkusumo, 2002;Parkin et al, 2005). From hospital-based data, it accounts for 28.6% of female cancers in Indonesia (Tjindarbumi and Mangunkusumo, 2002).Human papillomavirus (HPV) prevalence, age-specific prevalence, and type of distribution differ substantially between populations (Clifford et al, 2005;Franceschi et al, 2006) and HPV 18 has a greater role in cervical cancer in Indonesia than in the rest of the world. HPV 18 was found as frequently as HPV 16 in cervical cancer (Schellekens et al, 2004), or even more frequently than HPV 16 (Bosch et al, 1995). A small hospital-based case -control study conducted in Jakarta also found a high prevalence of HPV 18 in controls (de Boer et al, 2006). In view of the lack of population-based relevant data, we report here the age-specific prevalence data for HPV among women in Jakarta and Tasikmalaya on the island of Java and among women on the island of Bali, and assess possible risk factors in the aetiology of cervical cancer. MATERIAL AND METHODSThis population-based study was conducted as part of a screening project for cervical cancer in Jakarta and Tasikmalaya on the island of Java and different regions on the island of Bali in Indonesia between October 2004 and February 2006. Women were excluded if they were virgin, pregnant, had undergone a hysterectomy, or had previous cervical cancer. During our study it appeared that only married, divorced or widowed women participated in screening. Women who had never been married would strictly still be virgins because sexual intercourse before marriage is not allowed following Indonesia's cultural and religious rules.To reach women, in each region a collaboration was set up with the Pembinaan Kesejahteraan Keluarga (PKK), the national Indonesian Family Welfare Or...

Human Papillomavirus Genotypes Profile in Cervical Cancer Patients at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

“…HPV-58, HP-33, HPV 45, HPV-31 and HPV-35 (Bruni et al, 2010). Research about prevalence of HPV in other place in Indonesia showed that HPV-16 has the highest percentage, followed by HPV-18 and HPV-52, and this study recommended HPV-52 to be included for the next generation of HPV vaccine (Vet et al, 2008). Interestingly, the percentage of HPV-45 in our study is more than the HPV-52, though we had much smaller number of genotyping tests available.…”

Human papillomavirus infection in Beijing, People's Republic of China: a population-based study

“…Meanwhile, a large proportion of women with only one sexual partner (96.9%) in this general population was probably an important cause of low HPV prevalence in Beijing. In previous Asian studies, HPV prevalence was lower, such as in Vietnam (Hanoi, 2.0%; Pham et al, 2003), Thailand (Lampang, 9.1%; Sukvirach et al, 2003) and Indonesia (11.4%; Vet et al, 2008), compared with countries such as Nigeria (Ibadan, 26.3%; Thomas et al, 2004) and Chile (29.2%;Ferreccio et al, 2008).…”

HPV Genotyping Linear Assay Test Comparison in Cervical Cancer Patients: Implications for HPV Prevalence and Molecular Epidemiology in a Limited-resource Area in Bandung, Indonesia

“…The HPV-16 was dominantly infected the cervical cancer, followed by HPV 18, 45 and 52, concordant the global result. Furthermore, study in three regions in Indonesia has reported that though HPV-16 and HPV-18 were equally common in the general population, HPV-52 was the most prevalent type and this HPV-52 is recommended to be included for prophylactic HPV vaccination (de Vet et al, 2008). In our study, HPV 52 did not come as a single infection, but as a co-infection with other hrHPV-16 or 18 suggesting that HPV 52 is a transient infection, in opposite to HPV 16 and HPV 18 that contributed greatly in the cervical cancer development.…”

“…HPV-52 that was detected by Linear Assay 1 cannot be distinguished by other HPV 33, 38 and 58 as stated in the manufacturer guidelines (data not shown), in opposite to Linear Assay 2 that can detect HPV 52 individually. In Indonesian population HPV 52 is prevalent (de Vet et al, 2008), alternative is given replace with available using genoflow technique since linear assay 1 cannot distinguish between 52/31. GenoFlow (GF) HPV Array-Test (Diagcor Bioscience Inc., Hong Kong) was recently developed which can detect 33 HPV genotypes by a "flow-through" hybridization technology (Wong et al, 2012).…”

“…In Indonesia, HPV genotyping tests have hampered with limited resources and costs that makes the test not affordable for population screening, however, study on HPV genotype prevalence using an INNO-line probe assay prototype research genotyping assay (Innogenetics, Ghent, Belgium) had been conducted in Indonesia by Vet et al, and showed that the prevalence of HPV genotypes in general population in three area in Indonesia were dominated by 16,18, and 39 respectively (Vet et al, 2008). The same group has identified that the HPV-18 in Jakarta, capital city of Indonesia was especially found in adenosquamous carcinoma (Schellekens et al, 2004).…”