Human papillomavirus prevalence and type distribution in invasive cervical cancer in sub-Saharan Africa

Abstract

In sub-Saharan Africa, invasive cervical cancer (ICC) incidence and mortality are among the highest in the world. This cross-sectional epidemiological study assessed human papillomavirus (HPV) prevalence and type distribution in women with ICC in Ghana, Nigeria, and South Africa. Cervical biopsy specimens were obtained from women aged ³21 years with lesions clinically suggestive of ICC. A questionnaire was used to evaluate the HIV status and the medical, sexual, and reproductive history of women. Histopathological diagnosis of ICC was determined by light microscopy examination of hematoxylin and eosin stained sections of paraffin-embedded cervical specimens; samples with a confirmed histopathological diagnosis underwent HPV DNA testing by polymerase chain reaction. HPVpositive specimens were typed by reverse hybridization line probe assay. Between October 2007 and March 2010, cervical specimens from 659 women were collected (167 in Ghana, 192 in Nigeria, and 300 in South Africa); 570 cases were histologically confirmed as ICC. The tumor type was identified in 551/570 women with ICC; squamous cell carcinoma was observed in 476/570 (83.5%) cases. The HPV-positivity rate in ICC cases was 90.4% (515/570). In ICC cases with single HPV infection (447/515 [86.8%]), the most commonly detected HPV types were HPV16 (51.2%), HPV18 (17.2%), HPV35 (8.7%), HPV45 (7.4%), HPV33 (4.0%), and HPV52 (2.2%). HPV type distribution appeared to differ according to tumor type and HIV status. In conclusion, HPV16 and HPV18 were the most frequently detected types in women with ICC in sub-Saharan Africa and implementation of HPV vaccination may reduce the ICC disease burden in this region.