Abstract
BackgroundLittle is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries. Herein, we conducted a molecular epidemiological study to investigate prevalence of HPV type and HPV-16 variants among cervical-screened unvaccinated Tunisian women.MethodsCross-sectional study was performed on 494 Tunisian women visiting Women’s Healthcare Centers. HPV-DNA detection was carried out on cervical samples using real-time polymerase chain reaction. HPV genotyping and HPV-16 variants were characterized by direct sequencing of L1 viral capsid gene.ResultsThe overall HPV prevalence was 34% (95% CI: 30–38%) with significantly higher prevalence among women with squamous intraepithelial lesions (SIL) than those with no intraepithelial lesions (NIL) 84% (95% CI: 76–92%) and 24.5% (95% CI: 20–29%) respectively. The distribution of HPV prevalence according to women’s age shows a U-shaped curve and the highest HPV prevalence rates were observed among the youngest (≤25 years; 51.2%, 95% CI: 37–67%) and the oldest women (>55 years; 41.7%, 95% The HPV-16 prevalence was 32.8% (95% CI: 22–45%) among women with SIL and 9.2% (95% CI: 6–12%) among women with NIL. Whereas, the HPV-18 prevalence was 1.3% (95% CI: 0–5%) among women with SIL and 0.3% (95% CI: 0–1%) among women with NIL. Among HPV-16 positive women, European lineage (E) was identified as the predominant HPV-16 variant (85.7%, 95% CI: 76–95%). The frequency of E variant was lower among SIL than among NIL women (81%, 95% CI: 64–99%, and 88%, 95% CI: 77–100%, respectively). Conversely, the African-2 variant frequency was higher among SIL than among NIL women (18%, 95% CI: 1–36% and 6%, 95% CI: 2–14%, respectively). In multivariate analysis, young age was the only risk factor that is independently associated with HPV infection. Moreover, HPV infection and menopause were both found to be independently associated with SIL and HSIL.ConclusionHPV DNA testing should be proposed to young and menopausal Tunisian women. Considering HPV prevalence, only 13% of the Tunisian women could be protected by the bivalent HPV vaccine. These results may be helpful for designing an adapted HPV testing and vaccination program in Tunisia.
Highlights
Little is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries
Risk Factors for squamous intraepithelial lesion (SIL) occurrence When we compared epidemiological, demographic, and lifestyle habits of women with no intraepithelial lesion (NIL) and SIL, we found that women with SIL had a higher Human Papillomavirus (HPV) prevalence, a younger age at first intercourse and a longer period of sexual activity (p < 10-6, p = 0.008 and p = 0.010, respectively)
Considering women with normal cervical cytology, when we compared the overall HPV prevalence among Tunisian women with that from neighboring Northern African countries, we reported that it was higher than that of Algeria (5.3%) [22], but lower than that of Morocco (34.3%) [30]
Summary
Little is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries. We conducted a molecular epidemiological study to investigate prevalence of HPV type and HPV-16 variants among cervical-screened unvaccinated Tunisian women. According to the International Agency for Research on Cancer (IARC) 528,000 new cases of cervical cancer were estimated worldwide in 2012 [1]. In Tunisia, where Human Papillomavirus (HPV) screening and vaccination against HPV infection are not common, cervical cancer represents a major public health problem, with an estimated 265 new diagnosed cancer cases and 103 deaths in 2012 [1]. The most frequent HR types, HPV-16 and -18, are associated with approximately 70% of cervical cancer cases worldwide [10]. Several reports have described that HPV-16 variants differ in their pathogenicity and can affect the persistence of HPV infection and its progression from cervical precancerous lesion to cervical cancer. HPV-16 non-European variants were more pathogenic in highgrade cervical lesions than European variants [12, 13]
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