High human papillomavirus (HPV)-35 prevalence among South African women with cervical intraepithelial neoplasia warrants attention.

Zizipho Z A Mbulawa,Keletso Phohlo,Mirta Garcia-Jardon,Anna-Lise Williamson,Charles B Businge,Maria Lina Tornesello

doi:10.1371/journal.pone.0264498

Abstract

Human papillomavirus (HPV) prevalence and genotype distribution data is important for HPV vaccine monitoring. This study investigated the prevalence and distribution of HPV genotypes in cervical lesions of unvaccinated women referred to Nelson Mandela Academic Hospital Gynaecology Department due to different abnormal cervical conditions. A total of 459 women referred to the Nelson Mandela Academic Hospital Gynaecology department were recruited. When the cervical biopsy was collected for histopathology, an adjacent biopsy was provided for HPV detection. Roche Linear Array HPV genotyping assay that detects 37 HPV genotypes was used to detect HPV infection in cervical biopsies. HPV infection was detected in 84.2% (383/455) of participants. The six most dominant HPV types were HPV-16 (34.7%), followed by HPV-35 (17.4%), HPV-58 (12.1%), HPV-45 (11.6%), HPV-18 (11.4%) and HPV-52 (9.7%). HPV-35 was the third most dominant type among women with cervical intraepithelial lesion (CIN)-2 (12.6%; single infection: 5.7% and multiple infection: 6.9%), the second most dominant type among women with CIN3 (22.2%; single infection: 8.0% and multiple infection: 14.2%); and the fourth most dominant type among women with cervical cancer (12.5%; single infection: 7.1% and multiple infection: 5.4%). A proportion of 41.1% (187/455) was positive for HPV types targeted by the Cervarix®, 42.4% (193/455) by Gardasil®4, and 66.6% (303/455) by Gardasil®9. There was a statistically significant increase when the prevalence of women infected with HPV-35 only or with other HPV types other than Gardasil®9 types was included to those infected with Gardasil®9 HPV types (66.6%, 303/455 increase to 76.0%, 346/455, p = 0.002). High HPV-35 prevalence in this population, especially among women with CIN3 warrants attention since it is not included in current commercially available HPV vaccines.

Highlights

Cervical cancer is the second most common cancer in South African women [1]
Between February 2018 and March 2020, women aged 18 years with atypical squamous cells cannot exclude high-grade lesions (ASC-H), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), and cervical cancer referred to Nelson Mandela Academic Hospital Gynaecology department were recruited
When the cervical biopsy was collected for histopathology analysis, an adjacent piece was provided for Human papillomavirus (HPV) detection; it is possible that the biopsy for HPV detection was not part of the lesion

Summary

Introduction

Cervical cancer is the second most common cancer in South African women [1]. The National Cancer Registry (NCR) of South Africa reported an age-standardized rate (ASR) of 22.56 per 100,000 for all South African women in 2014 and an ASR of 27.01 per 100,000 for black African women [2]. Of the African countries, South Africa has the largest population affected by human immunodeficiency virus (HIV) infection, with 7.8 million people living with HIV and 230 000 new infections reported in 2020 [4]. Both cervical cancer and HIV burden are high in African countries [5–7]. Persistent infection with HR-HPV genotypes is associated with the development of cervical lesions and cervical cancer [14]. Studies in Sub-Saharan African populations have reported an HPV-35 prevalence of up to 40% among women with cervical intraepithelial neoplasia (CIN) or cervical cancer [21,31,35–38]

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