Prevalence of specific types of human papillomavirus and cervical squamous intraepithelial lesions in consecutive, previously unscreened, West‐African women over 35 years of age

Abstract

Previous studies among women worldwide have demonstrated that infection with specific types of human papillomaviruses (HPV) is central to the pathogenesis of cervical neoplasia. There is little data, however, concerning the prevalence of specific HPV types and the association of each type with cervical neoplasia among women in sub-Saharan Africa, who remain at very high risk of cervical cancer. We studied 2,065 consecutive patients aged 35 years or older, presenting to community health clinics in Dakar and Pikine, West Africa, who had not been screened previously for cytologic abnormalities or HPV. Cytologic diagnosis and HPV detection were accomplished using a ThinPrep Pap and a polymerase chain reaction-based reverse-line strip assay, respectively. Odds ratios (OR) and associated 95% confidence intervals (CI) were estimated using polynomial logistic regression. Cytologic abnormalities were found in 426 women (20%), including 254 (12%) with atypical squamous cells of undetermined significance, 86 (4%) with low-grade squamous intraepithelial lesions, 66 (3%) with high-grade squamous intraepithelial lesions (HSIL) and 20 (1%) with invasive cancer. HPV infection was detected in 18%. Among women with negative cytologic findings, the prevalence of high risk but not low risk HPV types increased with age. HPV16 (2.4%) and HPV58 (1.6%) were the most frequently detected HPV types in this population, as well as being the most strongly associated with risk of HSIL/cancer (HPV16: OR ‫؍‬ 88, 95% CI ‫؍‬ 39 -200; HPV58: OR ‫؍‬ 51, 95% CI ‫؍‬ 16 -161). These data suggest that in addition to HPV16, HPV58 should be considered in the strategic planning of vaccination against cervical cancer in this geographic region. © 2002 Wiley-Liss, Inc. Key words: human papillomavirus; squamous intraepithelial lesion; AfricaGenital human papillomaviruses (HPV) are common sexually transmitted viruses and a subset, termed "high risk" types, are integral to the development of invasive cervical cancer 1,2 and its cytologic precursors, squamous intraepithelial lesions (SIL). [3][4][5] HPV16 is the most common HPV type found in the cervix and in cervical cancers, where it is detected in over 50% of cases. 6 Other HPV types detected commonly in cervical cancers include types 18, 45 and 31. 6 Development of appropriate HPV vaccines requires knowledge of the prevalence of various HPV types in neoplastic and nonneoplastic cervical lesions in populations at high risk of cervical cancer. Thus far, data concerning type-specific HPV prevalence has come primarily from studies among women in Europe and North and South America. [7][8][9][10][11][12] Although there appears to be little geographic variation in the prevalence of HPV16, this does not seem to be the case for many other HPV types. For example, HPV39 and HPV59 are confined largely to cervical cancers in Central and South America; HPV types 56 and 68 are relatively common elsewhere but not in Central and South America. 6 Further, HPV52 and 58 are rare in North America and Europe, but relatively preva...

Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso

“…Human papillomavirus-52, HPV-35, and HPV-58 were the most prevalent types in the present study. A high prevalence of these HPV types has been also observed in other African studies (Gravitt et al, 2000;Castellsague et al, 2001;De Vuyst et al, 2003;Mayaud et al, 2003;Xi et al, 2003;Baay et al, 2004;Thomas et al, 2004;Wall et al, 2005).…”

“…While the epidemiology of genital HPV types has been relatively better studied in Southern and Eastern African countries such as Kenya (Temmerman et al, 1999;De Vuyst et al, 2003), Malawi (Miotti et al, 1996), Mozambique (Castellsague et al, 2001), Tanzania (Mayaud et al, 2003), Uganda (Serwadda et al, 1999), and Zimbabwe (Gravitt et al, 2002;Baay et al, 2004), data from Western Africa have been scarce. The prevalence of HPV infection and associated cervical lesions have been studied in Ivory Coast (La Ruche et al, 1998) and Mali (Bayo et al, 2002), but detailed HPV types were only reported from Senegal (Xi et al, 2003), Nigeria (Thomas et al, 2004), and The Gambia (Wall et al, 2005). Prevalence rates of HPV infection ranging from 13 to 40% have been reported from low-risk or general populations of sub-Saharan African countries (Miotti et al, 1996;Temmerman et al, 1999;Castellsague et al, 2001;De Vuyst et al, 2003;Mayaud et al, 2003;Xi et al, 2003;Baay et al, 2004;Thomas et al, 2004;Wall et al, 2005).…”

“…The prevalence of HPV infection and associated cervical lesions have been studied in Ivory Coast (La Ruche et al, 1998) and Mali (Bayo et al, 2002), but detailed HPV types were only reported from Senegal (Xi et al, 2003), Nigeria (Thomas et al, 2004), and The Gambia (Wall et al, 2005). Prevalence rates of HPV infection ranging from 13 to 40% have been reported from low-risk or general populations of sub-Saharan African countries (Miotti et al, 1996;Temmerman et al, 1999;Castellsague et al, 2001;De Vuyst et al, 2003;Mayaud et al, 2003;Xi et al, 2003;Baay et al, 2004;Thomas et al, 2004;Wall et al, 2005). The 66% prevalence found in the present study, which is still much higher than the 40% prevalence found in similar highrisk populations in Africa (Kreiss et al, 1992;Langley et al, 1996;Piper et al, 1999), might reflect the high sexual exposure of our study population and, as mentioned earlier, may be attributed in part to the exhaustive nature of our HPV detection strategy.…”

Against which human papillomavirus types shall we vaccinate and screen? the international perspective

“…The number of cases studied from Africa and Europe/North America was about half of the number studied from Central/South America and south Asia, and large regions such as China were not included. Thus, the prevalence of HPV-58, e.g., which has been reported to be high in China, 24 Korea 25 and some regions of Africa, 26 may be underestimated in our study.…”

“…In the first stage, the L1 primers MY09 and MY11 and 26 specific probes were used [HPVs 6,11,16,18,26, 6 In the second stage, paraffin-embedded tissue from 66 biopsies found to be HPV DNAnegative in the first stage were retested using type-specific E7 primers for 14 high-risk HPVs (HPVs 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) and consensus GP5ϩ/6ϩ and CP I/II primers. 4 Paraffin-embedded tissue was used for these 66 cases because the remaining tissue of the original frozen biopsies had been fixed in formalin.…”