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Finan RR, Chemaitelly H, Racoubian E, Aimagambetova G, Almawi WY. Genetic diversity of human papillomavirus (HPV) as specified by the detection method, gender, and year of sampling: a retrospective cross-sectional study. Arch Gynecol Obstet 2023; 307:1469-1479. [PMID: 36624228 DOI: 10.1007/s00404-022-06907-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE This study assesses HPV prevalence and genotype distribution in Lebanon, and identifies differentials in HPV infection, infection with multiple genotypes, and with high-risk genotypes, by sex, age, and year of data collection. METHODS Study participants comprised 1042 female and 160 male participants between 2006 and 2018. HPV genotyping was done by PCR and hybridization (2006-2013) or real-time PCR (2013 onwards). Diversity of HPV genotypes across gender, age groups, and years of data collection was tested by applying Shannon Diversity Index. RESULTS The overall HPV prevalence was 44.8% among study participants, and threefold higher in women than men. Single HPV infection was seen in two-third of HPV-positive participants. Women were less likely to be infected with multiple HPV strains, but more likely to be infected with high-risk or mixed-risk HPV genotypes. HPV-16 (11.0%, 9.8%) and HPV-53 (8.5%, 4.9%) were the most prevalent high-risk HPV genotypes in women and men, respectively, while HPV-18 prevalence was 4.9% in men and 3.1% in women, while HPV-59 prevalence was 6.6% in men and 2.1% in women. Samples collected post-2011 from women showed twice higher odds of HPV infection than those collected earlier and were threefold more likely to be infected with multiple HPV strains, and twice more likely to be infected with high-risk genotypes compared to those tested earlier. Women scored higher on Shannon index indicating high diversity in HPV types and frequency, with trend of increased diversity over time. While the odds of HPV infection remained associated with sex and temporal trend in multivariable analysis, odds of having high-risk genotypes was mainly associated with infection with multiple HPV strains. CONCLUSION Our study showed high diversity in HPV genotypes and an increasing trend of infection with multiple and high-risk genotypes in recent years. Findings underscore the need for effective screening/surveillance and HPV vaccination programs.
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Affiliation(s)
- Ramzi R Finan
- Department of Obstetrics and Gynecology, St Joseph University, Beirut, Lebanon
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, USA
| | - Eddie Racoubian
- St. Marc Medical and Diagnostic Center, Ashrafieh, Beirut, Lebanon
| | | | - Wassim Y Almawi
- Nazarbayev University School of Medicine, Astana, Kazakhstan. .,Faculte' des Sciences de Tunis, Universite' de Tunis El Manar, Campus Universitaire El-Manar, 2092, Tunis, Tunisia.
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Gargano JW, McClung N, Lewis RM, Park IU, Whitney E, Castilho JL, Pemmaraju M, Niccolai LM, Brackney M, Debess E, Ehlers S, Bennett NM, Scahill M, Cleveland AA, Querec TD, Unger ER, Markowitz LE. HPV type-specific trends in cervical precancers in the United States, 2008-2016. Int J Cancer 2022; 152:137-150. [PMID: 35904861 DOI: 10.1002/ijc.34231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022]
Abstract
Declines in cervical intraepithelial neoplasia grades 2-3 and adenocarcinoma in situ (CIN2+) observed among young women suggest impact from human papillomavirus (HPV) vaccination. To further evaluate vaccine impact including cross-protection and type replacement, we described high-risk (HR)-HPV type-specific cervical precancer incidence rates among women aged 20-39 years, 2008-2016. We analyzed cross-sectional population-based data on 18,344 cases of CIN2+ from a 5-site surveillance system. Diagnostic specimens were tested for individual HPV types, including 14 HR-HPV types (HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68). We estimated age-specific annual HR-HPV type-specific CIN2+ incidence per 100,000 screened women for individual types, vaccine HR-HPV types (HPV16/18) and non-vaccine HR-HPV types (non-HPV16/18). We evaluated trends using average annual percent changes (AAPC) and 95% confidence intervals (CI), and estimated total declines by comparing 2015-2016 to 2008-2009 using incidence rate ratios. Among 20-24-year-olds, HPV16/18-CIN2+ declined from 2008 through 2016 (AAPC: -21.3%, 95% CI: -28.1%, -13.8%), whereas no trend was observed for non-HPV16/18-CIN2+ (AAPC: -1.8%, 95% CI: -8.1%, 4.9%). After 2010, CIN2+ among 20-24-year-olds was more often caused by non-vaccine versus vaccine HR-HPV types. No significant declining trends were observed in older age groups. In 2015-2016 compared to 2008-2009, HPV16-CIN2+ declined 78%, HPV18-CIN2+ 72%, and HPV31-CIN2+ 51% among 20-24-year-olds; no increases were observed in type-specific CIN2+ incidence. Among 25-29-year-olds, HPV16-CIN2+ declined 18%; CIN2+ attributed to seven nonvaccine types increased significantly. No significant declines were observed in older groups. Significant declines in HPV16/18-CIN2+ in 20-24-year-olds and HPV16-CIN2+ in 25-29-year-olds corroborate impact of HPV vaccination. A declining trend in HPV31-CIN2+ is consistent with cross-protection from vaccination.
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Affiliation(s)
- Julia W Gargano
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Nancy McClung
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Rayleen M Lewis
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States.,Synergy America, Inc., Duluth, Georgia, United States
| | - Ina U Park
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, United States
| | - Erin Whitney
- California Emerging Infections Program, Oakland, California
| | - Jessica L Castilho
- Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | | | - Linda M Niccolai
- Connecticut Emerging Infections Program at Yale, New Haven, Connecticut, United States
| | - Monica Brackney
- Connecticut Emerging Infections Program at Yale, New Haven, Connecticut, United States
| | - Emilio Debess
- Oregon Department of Human Services, Portland, Oregon, United States
| | - Sara Ehlers
- Oregon Department of Human Services, Portland, Oregon, United States
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
| | - Mary Scahill
- University of Rochester School of Medicine and Dentistry, Rochester, New York, United States
| | - Angela A Cleveland
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Troy D Querec
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Elizabeth R Unger
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Lauri E Markowitz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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