Epidemiologic Classification of Human Papillomavirus Types Associated with Cervical Cancer

VU University Amsterdam, Amsterdamo, North Holland, Netherlands
New England Journal of Medicine (Impact Factor: 55.87). 03/2003; 348(6):518-27. DOI: 10.1056/NEJMoa021641
Source: PubMed


Infection with human papilloma virus (HPV) is the main cause of cervical cancer, but the risk associated with the various HPV types has not been adequately assessed.
We pooled data from 11 case-control studies from nine countries involving 1918 women with histologically confirmed squamous-cell cervical cancer and 1928 control women. A common protocol and questionnaire were used. Information on risk factors was obtained by personal interviews, and cervical cells were collected for detection of HPV DNA and typing in a central laboratory by polymerase-chain-reaction-based assays (with MY09/MY11 and GP5+/6+ primers).
HPV DNA was detected in 1739 of the 1918 patients with cervical cancer (90.7 percent) and in 259 of the 1928 control women (13.4 percent). With the GP5+/6+ primer, HPV DNA was detected in 96.6 percent of the patients and 15.6 percent of the controls. The most common HPV types in patients, in descending order of frequency, were types 16, 18, 45, 31, 33, 52, 58, and 35. Among control women, types 16, 18, 45, 31, 6, 58, 35, and 33 were the most common. For studies using the GP5+/6+ primer, the pooled odds ratio for cervical cancer associated with the presence of any HPV was 158.2 (95 percent confidence interval, 113.4 to 220.6). The odds ratios were over 45 for the most common and least common HPV types. Fifteen HPV types were classified as high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82); 3 were classified as probable high-risk types (26, 53, and 66); and 12 were classified as low-risk types (6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108). There was good agreement between our epidemiologic classification and the classification based on phylogenetic grouping.
In addition to HPV types 16 and 18, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82 should be considered carcinogenic, or high-risk, types, and types 26, 53, and 66 should be considered probably carcinogenic.

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    • "Therefore, these may suggest a phylogenetic related HPV prevalence in Ghana, although the bases for such specificities are still not clear. Although, the frequency of multiple-infections varies with the type of HPV detection method used[25], the 52.2 % multiple-infections observed in this study as compared to that of the earlier Ghanaian study, 19.6 %[18], are discussed in light of the fact that most (about 96 %) of the cases in this study (Fig. 1) were invasive cancers (IAC and ISSC) which are known to be associated with high multiple-infections[25]. Also, data from neighbouring countries have shown similar high frequencies of multiple-infections. "
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    ABSTRACT: Background Human Papillomavirus (HPV) infections have been shown to be a necessary risk factor for the development of cervical cancer. However, HPV genotype distribution varies geographically, both in type and relative prevalence. In order to ensure a successful introduction of available vaccines, there is the need to identify pre-vaccination HPV genotype prevalence in Ghana and the extent of single and multiple-infections. Methods Paraffin-embedded cervical tissues of 256 confirmed cervical cancer cases diagnosed at the Korle-Bu Teaching Hospital during the period January 2004 to December 2006 were selected after hematoxylin and eosin staining and confirmation. Following a heat-proteinase K-based tissue lysis, HPV was detected and typed by a nested-multiplex PCR assay using an E6/E7 consensus primer and type-specific primers. Results Of the 256 cases, 230 (89.8 %, 95 % CI 85.7–93.4 %) were positive for HPV DNA. HPV18 (47.4 %), HPV59 (42.2 %), HPV45 (37.4 %) and HPV16 (9.0 %) were the four common HPV genotypes detected. A total of 110 (47.8 %) of the 230 HPV DNA positive tissues, were infected by a single HPV genotype while the other 120 (52.2 %) were infected by multiple HPV genotypes. A significant association was determined between each of the following HPV genotypes and multiple-infection; HPV18 (OR = 6.97; 95 % CI, 3.89–12.50), HPV59 (OR = 9.56; 95 % CI, 5.57–20.02) and HPV45 (OR = 1.94; 95 % CI, 1.12–3.35). Conclusion The prevalence of the following high risk HPV genotypes (HPV18, HPV59, HPV45) were relatively high among the cases of cervical cancers reported at this hospital in Ghana during the study period. Additionally, there was a high frequency of HPV multiple-infections among these cases.
    Full-text · Article · Dec 2016 · Infectious Agents and Cancer
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    • "Eighteen types; in particular, HPV 16 and HPV 18, described as high-risk/oncogenic types, are associated with the development of cervical cancer. The lowrisk/non-oncogenic HPV types (mainly types 6 and 11), result in genital warts[2]. The majority of cervical HPV infections are cleared or suppressed by cell-mediated immunity within 1–2 years of exposure[3]. "
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    ABSTRACT: Objectives: HPV infection causes cervical cancer, yet information on prevalence and risk factors for HPV in Africa remain sparse. This study describes the prevalence of HPV genotypes and risk factors associated with HPV among young women ≤ 30 years of age in KwaZulu-Natal (KZN), South Africa. Methods: Cervicovaginal lavage samples were tested for HPV genotypes in 224 women enrolled in a prospective cohort study. Clinical, behavioural and demographic data were collected. We measured prevalence of HPV genotypes and using logistic regression, examined for factors associated with HPV. Results: Median age of participants was 21 years [interquartile range (IQR):18-23]. The overall prevalence of HPV was 76.3% (171/224) with multiple and single genotypes prevalent in 56.3% and 20.1% of women respectively. Proportion of women with high-risk genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56 and 58) was 54.5%. Women not living with their partner [adjusted odds ratio (aOR)] = 3.42 95% CI1.22-9.60; p = 0.019), was significantly associated with HPV infection and high-risk HPV genotype infection. Conclusion: The high burden of HPV and associated risk behaviours highlight the need to intensify behavioural interventions to prevent HPV acquisition in young women. The large scale delivery of HPV vaccine should be prioritised to prevent HPV acquisition and reduce HPV-related morbidity.
    Full-text · Article · Jan 2016 · PLoS ONE
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    • "During the investigation Munoz (France) and others also established that HPV16 was most often detected among the infected women (54.6%). Meantime HPV18 was detected in 11% of women in the group of patients only and in 7.3% of women in the control group (Munoz et al., 2003), (Fig. 4). "
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    ABSTRACT: HPV is one of the major risk factors of cervical cancer and precancerous changes. Infection with its oncogenic types determines a faster progress of pre-cancer changes. Women infected with oncogenic HPV types or multiple HPV infection must be under careful observation of a gynaecologist. The aim of this article is to identify infection of women who have various cytological changes in the cervix with the HPV and its genotypes by means of molecular methods. A total of 99 women took part in the investigation (the experimental group is 33 women, the control group is 66). Flat epithelium cells from the cervix were taken to determine HPV, and DNA was isolated from all samples. The isolated DNA was studied to determine general HPV, and positive samples were genotyped (HV6/11, HPV16, HPV18, HPV31, HPV33, HPV45 and HPV59) by multiplex PCR. Having carried out HPV tests, twice as high incidence rate of infection with HPV in the experimental group than that in the control group was established (40 and 21%, respectively). High cancer risk HPV genotypes were determined in 62% of women in the experimental group, whereas in the control group oncogenic HPVs of HPV16 and HPV31 genotypes were identified in 36% of women. Double HPV infection was diagnosed in 4 women in the experimental group, which can determine a faster progress of pre-cancer intra-epithelial lesions.
    Preview · Article · Dec 2015 · Biologija
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