Human Papillomavirus Genotypes and HPV16 E6/E7 Variants among Patients with Genital Cancers in Vietnam

Systematic literature review on the clinical and economic burden of human papillomavirus-related diseases in select areas in the Asia-Pacific region

Compared with Europe and America, adoption of human papillomavirus (HPV) vaccination into national immunization programs across the Asia-Pacific (AP) region has remained low. Moreover, HPV burden in this region has not been reviewed comprehensively. Therefore, this systematic literature review (SLR) aimed to summarize the clinical and economic burden of HPV and HPV-related diseases in select AP areas. An SLR was conducted January 2000-February 2022 using MEDLINE/Embase. Observational studies reporting incidence, prevalence, costs, or healthcare resource utilization (HCRU) of HPV and HPV-related disease among adults (≥18 years) from select AP areas were included. A total of 254 publications were included. Reported incidence per 100,000 person-years was 15.4-252.0 for cervical cancer (n = 5 publications), 0.2-55.5 for head and neck cancer (n = 7 publications), and 0.2-13.7 for anal cancer (n = 4 publications). Prevalence rates were 9.1%-100% for cervical cancer (n = 40 publications), 0.0%-95.6% for head and neck cancer (n = 48 publications), 0.0%-100% for anal cancer (n = 4 publications), 36.0%-79.6% for penile cancer (n = 4 publications), and 44.0%-82.0% for vaginal/vulvar cancer (n = 3 publications). Few studies reported on costs or HCRU, and high data variability was observed. Despite data variability, the high burden of HPV and HPV-related diseases makes clear the need for effective HPV screening, greater education, and reductions in vaccine hesitancy, particularly among lower- and middle-income areas. Improved data collection measures should be considered in data-scarce areas to better inform policy decision-making and improve monitoring of the impact of HPV vaccination.

Identification of HPV16 Lineages in South African and Mozambican Women with Normal and Abnormal Cervical Cytology

BACKGROUND

Human papillomavirus 16 (HPV16) is an oncogenic virus responsible for the majority of invasive cervical cancer cases worldwide. Due to genetic modifications, some variants are more oncogenic than others. We analysed the HPV16 phylogeny in HPV16-positive cervical Desoxyribonucleic Acid (DNA) samples collected from South African and Mozambican women to detect the circulating lineages.

METHODS

Polymerase chain reaction (PCR) amplification of the long control region (LCR) and 300 nucleotides of the E6 region was performed using HPV16-specific primers on HPV16-positive cervical samples collected in women from South Africa and Mozambique. HPV16 sequences were obtained through Next Generation Sequencing (NGS) methods. Geneious prime and MEGA 11 software were used to align the sequences to 16 HPV16 reference sequences, gathering the A, B, C, and D lineages and generating the phylogenetic tree. Single nucleotide polymorphisms (SNPs) in the LCR and E6 regions were analysed and the phylogenetic tree was generated using Geneious Prime software.

RESULTS

Fifty-eight sequences were analysed. Of these sequences, 79% (46/58) were from women who had abnormal cervical cytology. Fifteen SNPs in the LCR and eight in the E6 region were found to be the most common in all sequences. The phylogenetic analysis determined that 45% of the isolates belonged to the A1 sublineage (European variant), 34% belonged to the C1 sublineage (African 1 variant), 16% belonged to the B1 and B2 sublineage (African 2 variant), two isolates belonged to the D1-3 sublineages (Asian-American variant), and one to the North American variant.

CONCLUSIONS

The African and European HPV16 variants were the most common circulating lineages in South African and Mozambican women. A high-grade squamous intraepithelial lesion (HSIL) was the most common cervical abnormality observed and linked to European and African lineages. These findings may contribute to understanding molecular HPV16 epidemiology in South Africa and Mozambique.

Distribution of human papillomavirus among Vietnamese women with cervical cancer and unusual genetic variability of HPV16

HPV16, with typical mutations that differ in geographical distribution and carcinogenic potency, has implications for cervical cancer screening, clinical diagnosis, and treatment. DNASTAR and MEGA were used to identify HPV16 variants and construct a phylogenetic tree. The most prevalent HPV genotypes were HPV16 (63.9%), HPV18 (26.7%), and other HPV (6.9%). HPV16 alterations were found in all E6, E7, and L1 genes, including 15 missense and 18 synonymous mutations. Missense mutations include R10G, Q14H, D25E, H78Y, L83V (E6); M29V, R35K, L78R, L95P (E7); H73Y, T176 N, N178T, T317P, T386S, L472F/I (L1). HPV16 sublineages include A1 (17.2%), A2 (0.9%), A3 (56.0%), A4 (19.0%), D1 (4.3%), and D3 (2.6%). Although several mutations in the oncoproteins E6, E7, and L1 have been detected, mutations known to be associated with cervical cancer risk, such as D25E and L83V, occur at a relatively low frequency. This suggests that HPV16 mutations are associated with cervical cancer through a complicated mechanism.

The E6 gene polymorphism of Human papillomavirus 16 in relation to the risk of cervical cancer in Tunisian women

Human papillomavirus type 16 (HPV-16) is the most prevalent HPV type worldwide and in Tunisia and the major carcinogenic HPV type found in cervical precancers and cancers. Previous studies have reported that genetic diversity of HPV16-E6 oncoprotein might be associated with cervical intraepithelial neoplasia progression. In this study we aimed to investigate the prevalence of HPV-16 E6 variants in precancerous lesions in Tunisian population to assess potential correlation with disease severity. Positive HPV cervical samples were obtained from the Laboratory of Anatomy Pathology of Pasteur Institute of Tunis. Cytological study was performed to identify cervical precancerous lesions. HPVs were typed using Reverse Line Hybridization. Only samples with HPV-16 single infection were selected for HP16-E6 genetic diversity investigation. HPV-16 E6 gene amplification was performed by PCR using specific primers and sequenced by Sanger Sequencing. The multiple alignment of generated sequences was performed using MEGAX software. Phylogenetic tree was constructed using Maximum Likehood method. The ternary complex of E6, E6AP and p53 core domain was used to perform in silico point mutations and thermodynamic calculations to assess stability and binding affinity. Genetic analysis of Tunisian E6-HPV16 sequences showed the presence of three lineages: European (A), African (C) and Asian American (D). Interestingly, the EUR variants were identified as the dominant lineage of HPV-16 and HPV-16 E6 350 G (L83V) was the most detected mutation in precancerous lesions. Modelling data showed that African variants induced the largest destabilizing effect on E6 structure and decreasing thereby in the affinity toward E6AP. Therefore, women infected with European variants are associated with low and high intraepithelial lesions. The findings give useful information for personalized decision algorithms of intra-epithelial cervical neoplasia in Tunisian women.

Does Human Papillomavirus Infection Influence the Frequency and Severity of Nutritional Disorders in Head and Neck Cancer?

BACKGROUND

About 87% of head and neck cancer (HNC) patients (mostly oropharyngeal cancer-OPC) are infected with human papillomavirus (HPV). Recent studies have demonstrated a significant correlation between HPV infection and nutritional disorders in HNC patients. Therefore, we formed a hypothesis that nutritional disorders or their severity in HNC patients may be associated with the occurrence of HPV infection due to known molecular differences in involved tissue. This literature review aimed to evaluate the influence of HPV infection on the occurrence and severity of nutritional disorders in HNC patients.

MATERIALS AND METHODS

The PubMed database was used to search papers with the keywords "HPV", "HNC", and "nutritional disorders" in different variants and combinations.

CONCLUSIONS

The data available in the discussed papers indicate, among other things, that HPV-positive patients may be at higher risk of malnutrition, critical weight loss, and necessity for gastrostomy after radiotherapy or chemoradiotherapy (C-RT). It should be highlighted that despite some studies demonstrating positive results, currently available data regarding the influence of HPV infection on the occurrence and severity of nutritional disorders in HNC remain limited and inconclusive, and thus further research on this issue is warranted.

Human papillomavirus prevalence and genotype distribution in Vietnamese male patients between 2016 and 2020

Human papillomavirus (HPV) infection in men is a serious issue because it is associated with genital warts, anogenital cancers, and HPV transmission to their sex partners. This study aimed to investigate the prevalence and genotypes of HPVs in Vietnamese male patients hospitalized with sexually transmitted infection (STI) symptoms between 2016 and 2020 by using polymerase chain reaction and reverse dot blot hybridization analysis. HPV DNA was detected in 191/941 (20.3%) penile cell samples. The HPV patient's mean age was 30.3 in the range of 16- and 69-year-old. The highest HPV prevalence (84.7%) was found in patients between 20- and 39-year-old. A total of 313 HPV genotypes were identified. The multiple-infection rate was 42.9%. The most common high-risk (HR)-HPV genotypes were HPV-16 (8.0%), HPV-51 (7.7%), HPV-52 (4.8%), HPV-56 (4.2%), and HPV-18 (3.8%). Furthermore, HPV-11 and HPV-6 genotypes were the two most common low-risk (LR)-HPV genotypes with the rate of 36.7% and 21.4%, respectively. Notably, HPV-52 was found circulating in Vietnam for the first time. In conclusion, this study results showed that HPV prevalence in Vietnamese male patients was common and diverse. In addition, regarding public health and cancer prevention, the inclusion of the HPV vaccination into the national vaccination program for both men and women is recommended.

Current Updates on Cancer-Causing Types of Human Papillomaviruses (HPVs) in East, Southeast, and South Asia

Simple Summary

Among the over 200 human papillomavirus (HPV) genotypes identified, approximately 15 of them can cause human cancers. In this review, we provided an updated overview of the distribution of cancer-causing HPV genotypes by countries in East, Southeast and South Asia. Besides the standard screening and treatment methods employed in these regions, we unravel HPV detection methods and therapeutics utilised in certain countries that differ from other part of the world. The discrepancies may be partly due to health infrastructure, socio-economy and cultural diversities. Additionally, we highlighted the area lack of study, particularly on the oncogenicity of HPV genotype variants of high prevalence in these regions.

Abstract

Human papillomavirus (HPV) infection remains one of the most prominent cancer-causing DNA viruses, contributing to approximately 5% of human cancers. While association between HPV and cervical cancers has been well-established, evidence on the attribution of head and neck cancers (HNC) to HPV have been increasing in recent years. Among the cancer-causing HPV genotypes, HPV16 and 18 remain the major contributors to cancers across the globe. Nonetheless, the distribution of HPV genotypes in ethnically, geographically, and socio-economically diverse East, Southeast, and South Asia may differ from other parts of the world. In this review, we garner and provide updated insight into various aspects of HPV reported in recent years (2015–2021) in these regions. We included: (i) the HPV genotypes detected in normal cancers of the uterine cervix and head and neck, as well as the distribution of the HPV genotypes by geography and age groups; (ii) the laboratory diagnostic methods and treatment regimens used within these regions; and (iii) the oncogenic properties of HPV prototypes and their variants contributing to carcinogenesis. More importantly, we also unveil the similarities and discrepancies between these aspects, the areas lacking study, and the challenges faced in HPV studies.

Genetic variants of HPV-16 and their geographical and anatomical distribution in men: A systematic review with meta-analysis

BACKGROUND

The prevalence of Human Papillomavirus type 16 (HPV-16) variants in men and the association with tumor development has not been fully investigated. We estimated the prevalence of genital, anal, and oral HPV-16 infections in men through a systematic review and meta-analysis.

METHODS

Seven databases were searched and included studies that identified HPV-16 positive males, HPV-16 variants (lineages/sublineages), and indicated the sample's anatomical origin. This protocol is registered in PROSPERO (CRD42020178013).

RESULTS

The database searches yielded 14 studies including 445 HPV-16 positive samples classified as lineage A (n = 390), lineage D (n = 43), lineage B (n = 10), and lineage C (n = 2) variants. Lineage A variants predominated among the anatomical sites and the diverse geographical regions.

CONCLUSIONS

HPV-16 lineages vary according to anatomical and geographical region. According to this preliminary evaluation of the current literature, we hypothesize that, similar to women, specific HPV-16 variants may also be associated to increased cancer risk in men.

Analysis of HPV Genotypes and Liquid-Based Cervical Cytology: Results from a Tertiary Academic Center in Northwestern Turkey

High-risk human papilloma virus (hrHPV) plays an important role in cervical cancer. The aim of this study was to investigate the distribution of HPV genotypes in the region and to correlate it with liquid-based-cytology (LBC) and colposcopic biopsy results. Furthermore, the potential relationship between HPV infections and bacterial vaginosis (BV) was investigated. HPV genotypes were determined using real-time PCR. LBC, biopsies, and BV examinations were performed by the Pathology and Cytology. Consecutive cervical specimens of 409 women who underwent both cytology and HPV-DNA tests were included in the study. A total of 172 (42.1%) patients were positive for HPV-DNA; of these, 107 (26.2%) had hrHPV. The most common HPV genotypes were HPV 59, 16, 33, 52, and 51, at 16.6%, 15.9%, 13.4%, 13.4%, and 8.9%, respectively. Epithelial cell abnormality was detected in 11.5% of LBC test results. The genotypes of HPV 33, 56, 66, and 68 were found at a higher rate in patients with epithelial cell abnormalities than in those with no detected abnormalities. Bacterial vaginosis was found in 24 patients (5.9%). HPV-DNA positivity was observed to be statistically higher in patients with BV than in those without BV.

Phylogeny and polymorphism in the E6 and E7 of human papillomavirus: alpha-9 (HPV16, 31, 33, 52, 58), alpha-5 (HPV51), alpha-6 (HPV53, 66), alpha-7 (HPV18, 39, 59, 68) and alpha-10 (HPV6, 44) in women from Shanghai

Background

Persistent infection with human papillomaviruses (HPVs) has been associated with cervical intraepithelial neoplasia (CIN) and cervical cancer. However, why only a fraction of HPV cases progress to cancer is still unclear.

Methods

We focused on the heterogeneity, classification, evolution and dispersal of variants for 14 common HPV types in 262 HPV-positive patients with cervical lesions. The E6 and E7 genes of HPV were sequenced and compared with the HPV reference for sequence analysis. Phylogenetic trees were constructed using the neighbour-joining tree method with MEGA 7.0.

Results

In this study, 233 E6 and 212 E7 sequences were successfully amplified by PCR, and these sequences were divided into 5 species groups: alpha-9 (HPV16, 31, 33, 52, 58), alpha-5 (HPV51), alpha-6 (HPV53, 66), alpha-7 (HPV18, 39, 59, 68) and alpha-10 (HPV6, 44). The incidence of high-grade squamous intraepithelial lesion (HSIL) in patients infected with alpha-9 HPV was significantly increased compared with other groups (P < 0.0001), especially HPV16 (P < 0.0001). Strikingly, E7 had significantly fewer nonsynonymous variants in the HSIL compared to <HSIL groups (P = 3.17× 10^- 4). The A388C (K93 N) variation in HPV58 E6 can significantly reduce the risk of HSIL (P = 0.015). However, T7220G (D32E) variation in HPV16 E6 and A7689G (N29S) in HPV16 E7 increased the incidence of HSIL compared to the <HSIL group (P = 0.036 and 0.022).

Conclusions

Strict conservation of E7 is important for HPV carcinogenicity, especially N29 of HPV16. The findings in this work provide preventative/therapeutic interventions for HPV infections and CIN.

Low concordance of oral and genital HPV infection among male patients with sexually transmitted infections in Vietnam

Background

Human papillomavirus (HPV) causes cancers in men, including penile, anal, and oropharyngeal cancers. This cross-sectional study aimed to investigate the prevalence, the genotypes, and the risk factors of HPV infections in the oral cavity, compared to those in the genitals, among males diagnosed with sexually transmitted infections (STIs) in Vietnam.

Methods

Oral, urinary, penile, and urethral samples were collected from 198 male Vietnamese patients with STIs (median age 31.0 years, range 17–68). HPV DNA was isolated and amplified with PCR, with modified and/or original GP5⁺/GP6⁺ primers. Samples were genotyped with a gene array assay and/or population sequencing.

Results

HPV DNA was detected in 69 (34.8%) of 198 patients. Of these, 16 patients (8.1%) had infections in the oral cavity and 58 (29.3%) had infections in the genitals (4.5% in the urine, 25.8% in the penis, and 8.1% in the urethra). The concordance of HPV infections between the oral cavity and the genitals was poor (kappa = 0.01). Of the 16 patients with oral HPV DNA, 11 (68.8%) had no HPV DNA in the genitals. In the remaining five patients, HPV DNA was found at both sites, but only one showed similar strains at both sites. In the other four patients, the HPV genotypes were completely discordant between these sites. HPV18 was the most common high-risk HPV genotype in both oral (9/16, 56.3%) and genital (10/58, 17.2%) sites. Multivariable analyses showed that older age (OR 1.05), higher education (OR 2.17), and no knowledge of STIs (OR 4.21) were independent risk factors for genital HPV infections; in contrast, only older age (OR 1.05) was an independent risk factor for oral HPV infections.

Conclusions

The low concordance of HPV genotypes between oral and genital infection sites suggested that the acquisition, persistence, and/or clearance of HPV infections were different between these sites. Although HPV DNA was detected significantly less frequently in oral samples than in genital samples, oral samples should also be used for HPV screening in men.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-4175-0) contains supplementary material, which is available to authorized users.