Abstract
High risk human papillomaviruses (HPVs) are the leading cause of cervical cancer (CC) and Pap smear screening has not been successful in preventing CC in Tunisia. HPV vaccination that targets HPV16 and 18 offers a new efficient prevention tool. Identification of HPV types in CC is thus essential to determine the impact of HPV vaccine implementation. The aim of this study is to provide specific data from Tunisia. A total of 89 histological confirmed paraffin embedded samples isolated from patients with CC diagnosed between 2001 and 2011 were collected from five medical centres from Northern and Southern Tunisia. HPV DNA was detected using a nested PCR (MY09/MY11-GP5+/GP6+) and genotyping was assessed using a reverse blot line hybridisation assay that enables the detection of 32 HPV types. HPV DNA was detected in all samples. Twelve high risk types were detected; HPV16 and/or 18 were predominant, accounting together for 92.1% of all the CC cases (HPV16: 83.1%). Single infections accounted for 48.8% of the cases and were mostly linked to HPV 16 (32.6%) and less frequently to HPV 18 (2.4%). The other high risk HPV single infections were linked to HPV 35 (4.6%), 45 (4.6%), 58 (2.3%) and 59 (2.3%). Multiple infections with mixing of 2 to 4 genotypes predominately featrued HPV16 and/or 18 with HPV 35 and 45 (96.6 %) and less frequently with HPV 59, 40, 66, 73 and 58. There was no statistically significant variation in the relative distribution of HPV types with age. These results strongly indicate that prophylactic HPV vaccines can have a major impact in preventing CC in Tunisia.
Highlights
human papillomaviruses (HPVs) infection is the most common sexually transmitted infection all over the world and persistent infection with high risk HPV (HR-HPV) is the cause of cervical cancer (CC) (Walboomers M et al, 1999; Cogliano et al, 2005)
HPV DNA was detected in all samples using nested PCR
Pap smear screening programs have not been efficient in preventing the disease (Njah et al, 1994; Hsairi et al, 2013; Lazzar et al, 2014) and vaccine implementation, considered as a valuable tool for CC control
Summary
HPV infection is the most common sexually transmitted infection all over the world and persistent infection with high risk HPV (HR-HPV) is the cause of cervical cancer (CC) (Walboomers M et al, 1999; Cogliano et al, 2005). Among Tunisian women, this cancer ranks third after breast and colorectal cancer (Ben Abdalah et al, 2009) Since preventable, it is considered as a public health priority. In Tunisia, Pap smear screening programs have not been successful in preventing CC so the introduction of prophylactic HPV vaccination needs to be considered. Prophylactic HPV vaccines are designed to prevent HPV 16 and 18 infections and are considered efficient in reducing the burden of CC. High risk human papillomaviruses (HPVs) are the leading cause of cervical cancer (CC) and Pap smear screening has not been successful in preventing CC in Tunisia. Twelve high risk types were detected; HPV16 and/or 18 were predominant, accounting together for 92.1% of all the CC cases (HPV16: 83.1%).
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