Human papillomavirus epidemiology in populations with normal or abnormal cervical cytology or cervical cancer in the Middle East and North Africa: A systematic review and meta-analysis

Abstract

BackgroundHuman papillomavirus (HPV), one of the most common sexually transmitted viral infections worldwide, is the leading cause of cervical cancer. In Middle East and North Africa (MENA) Region HPV data is at scarce, and most of the countries haven’t implemented any vaccination programs. This present meta-analysis and systematic review aimed to describe human papillomavirus (HPV) epidemiology by clinical subgroups in the (MENA) region. MethodsStudies assessing HPV prevalence rates were systematically reviewed, and the selected articles were reported following the PRISMA guideline. Random-effects meta-analyses and meta-regression were used to estimate HPV pooled mean prevalence rates and their association with other factors. ResultsFor the cervical cancer population in the MENA region, the pooled HPV prevalence rate was 81% (95% CI, 70%–90%). HPV detected in cervical cancer samples was most prevalent in the Maghreb countries (88%; 95% CI, 78%–96%) and least prevalent in Iran (73%; 95% CI, 62%–83%).For the subgroup with abnormal-cervical cytology in the MENA region, the pooled HPV prevalence rate was 54% (95% CI, 41%–67%), with the highest prevalence reported in Northeast Africa (94%; 95% CI, 91%–96%), and the lowest prevalence in the Levant region (31%; 95 CI, 16%–49%). In the general population subgroup in the MENA region, the pooled HPV prevalence rate was 16% (95% CI, 14%–17%), HPV was most prevalent in the Northeast Africa region (21%; 95 CI, 7%–40%) and least prevalent in the Levant region (7%; 95 CI, 2%–14%). ConclusionThe present meta-analysis comprehensively described the current HPV prevalence rates in the MENA region and found that the rates have continued to increase with time, especially in African regions. Designing personalized awareness and vaccination programs that respect the various cultural and religious values remains the main challenge in prevention of cervical cancer in the MENA region.