Human Papillomavirus (HPV) Infection: Molecular Epidemiology, Genotyping, Seroprevalence and Associated Risk Factors among Arab Women in Qatar.

Asha A Elmi,Soha R Dargham,Asma A J Al-Thani,Nady Mohamed-Nady,Paul Amuna,Devendra Bansal,Ali A Sultan,Anushree Acharya,Sini Skariah,Laith J Abu-Raddad,Diane Medved Harper

doi:10.1371/journal.pone.0169197

Abstract

Human Papillomavirus (HPV) infections are known to cause cervical cancer worldwide, however, limited information is currently available on prevalence, types distribution and risk factors for HPV infection in the Arab countries. We conducted a cross-sectional observational study exclusively of women of Arabic origin residing in Qatar (n = 406) who were selected from the Women’s Hospital at Hamad Medical Corporation (HMC) and Health Centers of the Primary Health Care Corporation in Doha, Qatar over the period March 2013 to August 2014. Socio-demographic, behavioral and clinical data were collected. Four hundred and six cervical smears and 292 blood samples were included in the study. HPV typing was done using HPV type-specific primers-based real-time PCR, and Sanger sequencing. HPV-IgG and IgM were quantified using ELISA assays. The prevalence of HPV infection amongst Qatari and non-Qatari Arab women were 9.8% and 6.1%, respectively and 7.6% and 16.7% in women with normal and abnormal cytology, respectively. HPV 81 was the most commonly found genotype in women with normal cytology (34.5%), whereas HPV 81, 16 and 59 in women with abnormal cytology (25.0% each). All the HPV DNA positive women were seronegative and HPV-IgG prevalence was higher in Qatari women than in non-Qatari Arab women. None of the studied factors had any significant association with HPV-DNA positivity or HPV-IgG seropositivity. The overall identified HPV DNA prevalence and HPV seroprevalence among Arab women in Qatar were on the low side compared to global levels.

Highlights

Human Papillomavirus (HPV) is one of the most prevalent sexually transmitted infections worldwide, and molecular studies have implicated infection with specific HPV high-risk (HR) genotypes as etiological agents of cervical cancer [1,2,3]
55.4% of women (n = 225, 95% confidence intervals (CI): 50.7–60.6%) who participated in this study were Qatari nationals, followed by 26.8% (n = 109, 95% CI: 22.7–31.3%) from Fertile Crescent, 10.6% (n = 43, 95% CI: 7.9–13.8%) from Arabian Peninsula, and only 7.1% (n = 29, 95% CI: 4.7–9.9%) from North and East Africa (Table 1)
Our study suggests that these genotypes should included in future vaccines targeting this specific population

Summary

Introduction

Human Papillomavirus (HPV) is one of the most prevalent sexually transmitted infections worldwide, and molecular studies have implicated infection with specific HPV high-risk (HR) genotypes as etiological agents of cervical cancer [1,2,3]. There are over 200 unique HPV genotypes that have been confirmed, of which 30 to 40 are categorized on the basis of their oncogenic potential as HR and low-risk (LR) leading to cervical neoplasia and mild dysplasia, respectively [4]. According to the World Health Organization (WHO), cervical cancer, can be preventable, is responsible for over 270,000 death annually and is the second commonest type of cancer among women worldwide [5]. It is the fifth most diagnosed cancer amongst women in the State of Qatar [6]. HPV vaccines are licensed in Qatar, but currently there is no vaccination program in the country. HPV testing is not routinely practiced, but it is often performed when a Pap smear result is abnormal or the patient request the test

Methods

Results

Discussion

Conclusion