Prevalence of hr‑HPV genotypes among vaccinated and unvaccinated women in central Italy: a retrospective study: hr‑HPV genotypes in women of central Italy

Prevalence of hr‑HPV genotypes among vaccinated and unvaccinated women in central Italy: a retrospective study

hr‑HPV genotypes in women of central Italy

Authors

  • Angela Serafini Biolab - Laboratori Analisi Cliniche Convenzionati, Istituto di Ricerca, Pesaro, Italy
  • Mauro De Santi Unit Hygiene, Department of Biomolecular Sciences, University of Urbino "Carlo Bo”
  • Giuditta Fiorella Schiavano Department of Humanities, University of Urbino "Carlo Bo”, Urbino, Italy https://orcid.org/0000-0002-1427-3486
  • Michele De Nictolis Biolab - Laboratori Analisi Cliniche Convenzionati, Istituto di Ricerca, Pesaro, Italy
  • Giorgio Brandi Università degli Studi di Urbino "Carlo Bo"

Keywords:

HPV genotypes, cervical cancer, Real-Time PCR, pap test, anti-Hpv vaccination

Abstract

Background and aim: Human papillomavirus is the most common sexually transmitted infection worldwide. Data on the prevalence of genital HPV infection are heterogeneous since the risk of infection and the gravity of diseases is depending by geography, socioeconomic conditions, assessed population. In the present study, it was evaluated the prevalence of high-risk HPV genotypes in women who have attended at a diagnostic laboratory in the Marche region (Italy) for cervical cancer test. Methods: Pap tests and biomolecular analyses were conducted in 875 women for the identification of hr-HPV genotypes and common concomitant infections of the genital tract. Multiplex Real-time PCR was used for the simultaneous identification of hr-HPV 16, 18, and non-specified pooled detection of HPV 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68. Results: Of 875 women tested, 228 (26%) resulted hr-HPV positive, with a higher prevalence (28%) in the range of 35-44 years. In the unvaccinated group,the prevalence of infection was about 5 times higher vs. vaccinated women. The hr-HPV16 was the most diagnosed genotype, followed by hr-HPV18. The high-grade cytological abnormalities were identified only in unvaccinated women. Finally, 71 % of hr-HPV infections were concomitant with other infections of the genital tract. Conclusions: A meaningful diffusion of hr-HPV, prevalently genotypes HPV-16, was observed in women > 25 years, frequently associated with other sexually transmitted infections, and a substantial difference in the risk of cervical cancer in unvaccinated compared to vaccinated women. The enhancement of primary and secondary prevention interventions must be further incentivized.  

References

Kombe AJK, Li B, Zahid A, et al. Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation. Front Public Health. 2021; 8:552028. doi: 10.3389/fpubh.2020.552028.

World Health Organization. Human papillomavirus vaccines: WHO position paper. May 2017-Recommendations. Vaccine.2017; 35:5753–55. doi. org/ 10. 1016/j.

Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999; 189:12– 9. doi.org/10.1002/(SICI) 1096-9896(199909)189:1%3C12::AID-PATH431%3E3.0.CO;2-F.

Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global Burden of Cancers Attributable to Infections in 2012: A Synthetic Analysis. Lancet Global Health. 2016:4:e609–16. doi: 10.1016/s2214-109x(16)30143-7.

Serrano B, Brotons M, Bosch FX, Bruni L. Epidemiology and Burden of HPV-Related Disease. Best Pract Res Clin Obstet Gynaecol. 2018: 47:14–26.doi: 10.1016/j.bpobgyn. 2017. 08.006.

de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide Burden of Cancer Attributable to HPV by Site, Country and HPV Type. Int J Cancer. 2017: 141:664–70. doi: 10.1002/ ijc.30716.

Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71: 209–249.doi: 10.3322/caac.21660

Arbyn M, Weiderpass E, Bruni L, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020; 8:e191–e203. doi. org/ 10. 1016/ S2214- 109X(19) 30482-6.

Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus and cervical cancer.Lancet.2013; 382: 889–99. doi. org/ 10. 1016/ S0140- 6736(13) 60022-7.

Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. 2003; 16:1–17.doi:10.1128/CMR.16.1.1-17.2003.

Burd EM. Human papillomavirus laboratory testing: The changing paradigm. Clin. Microbiol. Rev. 2016; 29: 291–319.doi. org/10.1128/ CMR.00013-15.

Bharti AC, Singh T, Bhat A, Pande D, Jadli M. Therapeutic startegies for human papillomavirus infection and associated cancers. Front Biosci. (Elite Ed). 2018; 10:15–73. doi. org/ 10. 2741/ e808.

Doorbar J, Egawa N, Griffin H, Kranjec C, Murakami I. Human papillomavirus molecular biology and disease association. Rev Med Virol. 2015; 25:2–23. doi.org/ 10. 1002/ rmv.1822.

Palefsky JM. Epidemiology of human papillomavirus infections. In: UpToDate, Post TW (Ed), 2016; UpToDate, Waltham, MA.

Schiffman M, Clifford G, Buonaguro FM. Classification of weakly carcinogenic human papillomavirus types: Addressing the limits of epidemiology at the borderline. Infect Agent Cancer. 2009; 4:8. doi:10.1186/1750-9378-4-8.

Petca A, Borislavschi A, Zvanca ME, Petca RC, Sandru F, Dumitrascu MC. Non-sexual HPV transmission and role of vaccination for a better future (Review). Exp Ther Med. 2020; 20:186. doi: 10.3892/etm.2020.9316.

World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. 2020. www.who.int/publications/i/item/9789240014107.

Arbyn M, Anttila A, Jordan J, et al. European guidelines for quality assurance in cervical cancer screening second edition—summary document. Ann Oncol. 2010;21:448–58. doi.org/ 10.1093/ anno nc/ mdp471.

Ministero della Salute. Piano Nazionale della Prevenzione 2020-2025. 2020.www.salute. gov.it.

Ministero della Salute. Screening per il tumore del collo dell’utero. 2019. www.salute.gov.it.

Ciavattini A, Giannella L, De Vincenzo R, et al. HPV vaccination: the position paper of the Italian society of colposcopy and cervico-vaginal pathology (SICPCV). Vaccines (Basel). 2020;8(3):E354. doi:10.3390/ vaccines8030354.

Food and Drug Administration. FDA approves gardasil 9 for prevention of certain cancers caused by five additional types of HPV. Available from: https://www.esmo.org/oncology-news/archive/fda- approves-gardasil-9-for-prevention-of-certain-cancers-caused-by- five-additional-types-of-hpv. Accessed September 20, 2023.

Perkins RB, Guido RS, Castle PE, et al. ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24(2):102–31. doi:10.1097/LGT.0000000000000525.

Giorgi Rossi P, Chini F, Borgia P, et al. Epidemiologia del Papillomavirus umano (HPV), incidenza del cancro della cervice uterina e diffusione dello screening: differenze fra macro aree in Italia. Epidemiol Prev. 2012; 36(2):108-19. PMID: 22706361.

Lei J, Ploner A, Elfström KM, et al. HPV Vaccination and the Risk of Invasive Cervical Cancer. N Engl J Med. 2020; 383:1340-8. doi: 10.1056/NEJMoa1917338.

Adams AR, Nortey PA, Dortey BA, Asmah RH, Wiredu EK. Cervical human papillomavirus prevalence, genotypes, and associated risk factors among female sex workers in greater Accra, Ghana. J Oncol. 2019;2019:8062176. doi: 10.1155/2019/8062176.

Piana A, Sotgiu G, Castiglia P, et al. Prevalence and type distribution of human papillomavirus infection in women from North Sardinia, Italy. BMC Public Health. 2011; 11:785.doi: 10.1186/1471-2458-11-785.

Piana A, Sotgiu G, Cocuzza C, et al.High HPV-51 prevalence in invasive cervical cancers: Results of a pre-immunization survey in North Sardinia, Italy. PLoS ONE. 2013; 8: e63395. doi: 10.1371/journal.pone.0063395.

Chan CK, Aimagambetova G, Ukybassova T, Kongrtay K, Azizan A. Human Papillomavirus Infection and Cervical Cancer: Epidemiology, Screening, and Vaccination—Review of Current Perspectives. J Oncol. 2019;10:2019:3257939. doi: 10.1155/2019/ 3257939.

Kavanagh K, Pollock KG, Potts A, et al. Introduction and sustained high coverage of the HPV bivalent vaccine leads to a reduction in prevalence of HPV 16/18 and closely related HPV types. Br J Cancer. 2014; 110:2804–11.doi: 10.1038/bjc.2014.198.

Delibera della Giunta Regionale, seduta del 3/02/2020 delibera 74. Modifica della DGR 458/2017 concernente "Adeguamento dell’offerta vaccinale nella Regione Marche in relazione al recepimento del nuovo piano Nazionale Prevenzione Vaccinale 2017-2019-Direttive alle Aziende del S.S.R".

SicheroL, Picconi MA, Villa LL. The contribution of Latin American research to HPV epidemiology and natural history knowledge. Braz J Med Biol Res 2020;53(2):e9560. doi: 10.1590/1414-431X20199560.

Schiffman M, Doorbar J, Wentzensen N, et al. Carcinogenic human papillomavirus infection. Nat Rev Dis Prim 2016;1(2):16086.doi: 10.1038/nrdp.2016.86.

Casas CPR, Albuquerque RCR, Loureiro RB, et al. Cervical cancer screening in low- and middle-income countries: A systematic review of economic evaluation studies. Clinics (Sao Paulo). 2022;77:100080. doi: 10.1016/j.clinsp.2022.100080.

Salibay C, Chen Z, Ma B, et al. High-risk HPV testing improves accuracy in detection of CIN2+ lesions in ASC-H postmenopausal women? An academic hospital experiences. J Am Soc Cytopathol. 2023;12(1):58-65. doi: 10.1016/j.jasc.2022.08.004.

Zhu H, Shen Z, Luo H, Zhang W, Zhu X. Chlamydia Trachomatis Infection-Associated Risk of Cervical Cancer: A Meta-Analysis. Medicine 2016; 95: e3077. doi: 10.1097/MD. 0000000000003077.

Wang L, Zhu L, Li H, et al. Association between asymptomatic sexually transmitted infections and high-risk human papillomavirus in cervical lesions. J Int Med. Res. 2019; 47: 5548–89. doi: 10.1177/0300060519865633.

Martinelli M, Musumeci R, Sechi I, et al. Prevalence of Human Papillomavirus (HPV) and Other Sexually Transmitted Infections (STIs) among Italian Women Referred for a Colposcopy. Int J Environ Res Public Health. 2019 Dec 9;16(24):5000. doi: 10.3390/ijerph16245000.

Roeters AM, Boon ME, van Haaften M, Vernooij F, Bontekoe TR, Heintz AP. Inflammatory events as detected in cervical smears and squamous intraepithelial lesions. Diagn Cytopathol. 2010; 38:85–93. doi: 10.1002/dc.21169.

Mancini F, Vescio F, Mochi S, Accardi L, di Bonito P, Ciervo A. HPV and Chlamydia trachomatis coinfection in women with Pap smear abnormality: Baseline data of the HPV Pathogen ISS study. Infez. Med. 2018; 26;139–44.PIMD299332086.

Castle PE, Giuliano AR. Chapter 4: Genital tract infections, cervical inflammation, and antioxidant nutrients–assessing their roles as human papillomavirus cofactors. J Natl Cancer Inst Monogr. 2003; 31: 29–3. doi: 10.1093/oxfordjournals.jncimonographs.a003478.

Ye H, Song T, Zeng X, Li L, Hou M, Xi M. Association between genital mycoplasmas infection and human papillomavirus infection, abnormal cervical cytopathology, and cervical cancer: A systematic review and meta-analysis. Arch Gynecol Obstet. 2018; 297: 1377–87.doi: 10.1007/s00404-018-4733-5.

Downloads

Published

21-06-2024

Issue

Section

ORIGINAL CLINICAL RESEARCH

How to Cite

1.
Serafini A, De Santi M, Schiavano GF, De Nictolis M, Brandi G. Prevalence of hr‑HPV genotypes among vaccinated and unvaccinated women in central Italy: a retrospective study: hr‑HPV genotypes in women of central Italy . Acta Biomed [Internet]. 2024 Jun. 21 [cited 2024 Jul. 25];95(3):e2024037. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/15352