ArticlesWorldwide distribution of human papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: a pooled analysis
Introduction
The prevalence of cervical infection with human papillomavirus (HPV) in women varies greatly worldwide, and is closely related to the corresponding risk of cervical cancer.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Detection of high-risk HPV is becoming increasingly attractive as a primary screening tool, because of sensitivity and cost-effectiveness.14 However, HPV-screening assays identify a large group of women without cytological abnormalities, many of whom harbour HPV types with very different progressive potential. Thus, testing for only a subset of high-risk types might improve cost-effectiveness.
Population-based data for HPV-type distribution is prerequisite to development of new HPV-screening tests and to assessment of the effect of future vaccination on HPV infections of differing severity, but these data are limited or missing for many world regions. Furthermore, relevant studies are difficult to combine or compare because of varying study designs, especially in enrolment of women and HPV-testing protocols.
In our pooled analysis, we aimed to use the population-based sampling and centralised HPV-testing protocols from the International Agency for Research on Cancer (IARC) HPV prevalence surveys13 to compare HPV-type distribution in representative samples of women from 13 areas in 11 countries across sub-Saharan Africa, Asia, South America, and Europe.
Section snippets
Study participants
Similar protocols were developed for each of 13 areas in 11 countries, chosen to represent regions of low, intermediate, and high incidence of cervical cancer. Surveys were done between 19935 and 2003.1 Complete population-sampling methods have been described for the individual areas: Ibadan, Nigeria;13 Ambilikai, India;1 Hanoi and Ho Chi Minh City, Vietnam;2 Songkla and Lampang, Thailand;3 Busan, Korea;4 Bogota, Colombia;5 Concordia, Argentina;6 Santiago, Chile;7 Amsterdam, Netherlands;8
Results
15 613 sexually active women aged between 15 and 74 years, all with valid HPV test results and normal cytological findings, were included in the analyses (table 1). Overall HPV prevalence was lowest in Spain and highest in Nigeria. After pooling by region, age-standardised HPV prevalence was approximately five times higher in sub-Saharan Africa than in Europe, with intermediate prevalence in South America and Asia. The proportion of HPV-positive women with multiple infections ranged from 11·5%
Discussion
Pooled analysis of the IARC HPV prevalence surveys shows variation of nearly 20 times in overall HPV prevalence between different areas. However, it also provides evidence for regional variation in distribution of HPV type for women without cytological abnormalities. The most relevant difference between regions was in the prevalence of HPV16 in relation to other HPV types. Although HPV16 prevalence was higher in sub-Saharan Africa than in Europe, HPV-positive women in sub-Saharan Africa were
References (36)
- et al.
Prevalence of papillomavirus infection in women in Turin, Italy
Eur J Cancer
(2005) - et al.
Management of women who test positive for high-risk types of human papillomavirus: the HART study
Lancet
(2003) - et al.
Human papillomavirus genotypes in rural Mozambique
Lancet
(2001) - et al.
Host and viral genetics and risk of cervical cancer: a review
Virus Res
(2002) - et al.
Papillomavirus infection in rural women in southern India
Br J Cancer
(2005) - et al.
Human papillomavirus infection among women in South and North Vietnam
Int J Cancer
(2003) - et al.
Population-based human papillomavirus prevalence in Lampang and Songkla, Thailand
J Infect Dis
(2003) - et al.
Prevalence of human papillomavirus infection in women in Busan, South Korea
Int J Cancer
(2003) - et al.
Prevalence and determinants of HPV infection among Colombian women with normal cytology
Br J Cancer
(2002) - et al.
Prevalence of human papillomavirus infection among women in Concordia, Argentina: a population-based study
Sex Transm Dis
(2003)
Population-based prevalence and age distribution of HPV among women in Santiago, Chile
Cancer Epidemiol Biomarkers Prev
Distribution of 37 mucosotropic HPV types in women with cytologically normal cervical smears: the age-related patterns for high-risk and low-risk types
Int J Cancer
Cervical human papillomavirus infection in the female population in Barcelona, Spain
Sex Transm Dis
Epidemiology of HPV infection among Mexican women with normal cervical cytology
Int J Cancer
Prevalence and determinants of genital infection with papillomavirus, in female and male university students in Busan, South Korea
J Infect Dis
Prevalence of papillomavirus infection in women in Ibadan, Nigeria: A population-based study
Br J Cancer
Epidemiologic classification of human papillomavirus types associated with cervical cancer
N Engl J Med
Cited by (912)
HPV prevalence and distribution characteristics in postmenopausal women from Nanjing, China
2024, BMC Women's HealthPrevalence of oral human papillomavirus infection among the general adult population in Hong Kong
2024, Journal of Medical VirologyHuman Papillomavirus and Medicinal Plants/Herbs: A Perspective
2024, Promising Antiviral Herbal and Medicinal Plants
- ‡
Members listed at end of report