Human Papilloma Virus Prevalence, Genotype Distribution, and Pattern of Infection in Thai Women

Suthipintawong, Cheepsumon;Siriaunkgul, Sumalee;Tungsinmunkong, Kobkul;Pientong, Chamsai;Ekalaksananan, Tipaya;Karalak, Anant;Kleebkaow, Pilaiwan;Vinyuvat, Songkhun;Triratanachat, Surang;Khunamornpong, Surapan;Chongsuwanich, Tuenjai

  • Published : 20110400

Abstract

Background: The pattern of infection in cervical lesions with respect to HPV subtype has not been systematically studied in Thai women. The aim here was to determine HPV prevalence, genotype, and infection pattern in cervical lesions and to estimate the potential efficacy of an HPV prophylactic vaccine. Design: Formalinfixed paraffin-embedded cervical tissue blocks of 410 Thai patients from 8 institutes in 4 regions of Thailand (northern, southern, north-eastern, and central) were studied. The samples included 169 low grade squamous intraepithelial lesions (LSILs), 121 high grade squamous intraepithelial lesions (HSILs), and 120 squamous cell carcinomas (SCCs). HPV-DNA was amplified by PCR using consensus primers GP5+ and GP6+. The HPV genotype was then determined by reverse linear blot assay that included 37 HPV-specific 5'-amino-linked oligonucleotide probes. Patterns of infection were classified as single infection (one HPV type), double infection (two HPV types), and multiple infection (three or more HPV types). Results: The mean age of the subjects was 42 years. The prevalence of HPV infection was 88.8%. The highest HPV prevalence was found in the southern region (97.1%) and the lowest in the central region (78.6%). HPV-DNA was detected in 84.6% of LSILs, 90.1% of HSILs, and 93.3% of SCCs. A total of 20 HPV genotypes were identified. The five most common high risk HPV were HPV16 (83.2%), HPV18 (59.3%), HPV58 (9.3%), HPV52 (4.1%), and HPV45 (3.8%). In double and multiple infection patterns, the most common genotypes were HPV16/18 (27.8%) and HPV11/16/18 (54.9%). HPV6 was found only in LSIL and never in combination with other subtypes. HPV11 was most common in LSIL. Conclusion: There is no difference of HPV type distribution in women from 4 regions of Thailand with prominent HPV16 and HPV18 in all cases. The bivalent and quadrivalent vaccines have the potential to prevent 48.6 % and 74.5% of cervical cancers in Thai women. The potential of cancer prevention would rise to 87.6% if other frequent HR-HPV types (HPV58, 52, and 45) were also targeted by an HPV vaccine.

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References

  1. An HJ, Cho NH, Lee SY, et al (2003). Correlation of cervical carcinoma and precancerous lesions with human papillomavirus (HPV) genotypes detected with the HPV DNA chip microarray method. Cancer, 97, 1672-80. https://doi.org/10.1002/cncr.11235
  2. Baay, MF, Quint WG, Koudstaal J, et al (1996). Comprehensive study of several general and type-specific primer pairs for detection of human papillomavirus DNA by PCR in paraffinembedded cervical carcinomas. J Clin Microbiol, 34, 745-7.
  3. Bao Y-P, Lly N, Smith JS, et al (2008). Human papillomavirus type distribution in women from Asia : a meta-analysis. Int J Gynecol Cancer, 18, 71-9.
  4. Bosch FX, Lorincz A, Munoz N, et al (2002). The causal relation between human papillomavirus and cervical cancer. J Clin Pathol, 55, 244-65. https://doi.org/10.1136/jcp.55.4.244
  5. Bosch FX (2008). HPV vaccines and cervical cancer. Ann Oncol, 19, v48-51. https://doi.org/10.1093/annonc/mdn310
  6. Bosch FX, Castellsague H, Sanjose S de (2008). HPV and cervical cancer: screening or vaccination? Br J Cancer, 98, 15-21. https://doi.org/10.1038/sj.bjc.6604146
  7. Burd EM (2003). Human papillomavirus and cervical cancer. Clin Microbiol Rev, 16, 1-17. https://doi.org/10.1128/CMR.16.1.1-17.2003
  8. Chen CA, Liu CY, Chouz HH, et al (2006). The distribution and differential risks of human papillomavirus genotypes in cervical preinvasive lesions: a Taiwan cooperative oncologic group study. Int J Gynecol Cancer, 16, 1801-8. https://doi.org/10.1111/j.1525-1438.2006.00655.x
  9. Chopjitt P, Ekalaksananan T, Pientong C, et al (2009). Prevalence of human papillomavirus type 16 and its variants in abnormal squamous cervical cells in Northeast Thailand. Int J Infect Dis, 13, 212-9. https://doi.org/10.1016/j.ijid.2008.06.017
  10. Dai Y, Huangy YS, Tnagy M, et al (2008). Distribution and clinical significance of human papillomavirus subtypes in Shenzhen city, People's Republic of China. Int J Gynecol Cancer, 18, 295-9. https://doi.org/10.1111/j.1525-1438.2007.01024.x
  11. Franco EL, Rohan TE, Villa LL (1999). Epidemiologic evidence and human papillomavirus infection as a necessary cause of cervical cancer. J Natl Cancer Inst, 91, 506-11. https://doi.org/10.1093/jnci/91.6.506
  12. Futai M, Watanabe J, Jobo T, et al (2009). Clinical significance of human papillomavirus genotype by linear array assay in Japanese women with uterine cervical lesions and type16 physical status by in situ hybridization. Int J Gynecol Cancer, 19, 1396-401. https://doi.org/10.1111/IGC.0b013e3181b661a4
  13. Gargiulo F, De Francesco MA, Schreiber C, et al (2007). Prevalence and distribution of single and multiple HPV infections in cytologically abnormal cervical samples from Italian women. Virus Res, 125, 176-82. https://doi.org/10.1016/j.virusres.2006.12.017
  14. Herrero R, Hildesheim A, Bratti C, et al (2000). Populationbased study of human papillomavirus infection and cervical neoplasia in rural Costa Rica. J Natl Cancer Inst, 92, 464-74. https://doi.org/10.1093/jnci/92.6.464
  15. Ho GY, Palan PR, Basu J, et al (1998). Viral characteristics of human papillomavirus infection and antioxidant levels as risk factors for cervical dysplasia. Int J Cancer, 78, 594-9. https://doi.org/10.1002/(SICI)1097-0215(19981123)78:5<594::AID-IJC11>3.0.CO;2-B
  16. Hwang HS, Park M, Lee SY, et al (2004). Distribution and prevalence of human papillomavirus genotypes in routine pap smear of 2,470 korean women determined by DNA chip. Cancer Epidemiol Biomarkers Prev, 13, 2153-6.
  17. Huang LW, Chao SL, Chen PH, et al (2004). Multiple HPV genotypes in cervical carcinomas: improved DNA detection and typing in archival tissues. J Clin Virol, 29, 271-6. https://doi.org/10.1016/S1386-6532(03)00167-7
  18. Jacobs MV, de Roda Husman AM, van den Brule AJ, et al (1995). Group-specific differentiation between high- and low-risk human papillomavirus genotypes by general primermediated PCR and two cocktails of oligonucleotide probes. J Clin Microbiol, 33, 901-5.
  19. Kleter B, van Doorn LJ, ter Schegget J, et al (1998). Novel shortfragment PCR assay for highly sensitive broad-spectrum detection of anogenital human papillomaviruses. Am J Pathol, 153, 1731-9 https://doi.org/10.1016/S0002-9440(10)65688-X
  20. Liaw KL, Hildesheim A, Burk RD, et al (2001). A prospective study of human papillomavirus (HPV) type 16 DNA detection by polymerase chain reaction and its association with acquisition and persistence of other HPV types. J Infect Dis, 183, 8-15. https://doi.org/10.1086/317638
  21. Lowy DR, Kirnbauer R, Schiller JT (1994). Genital human papillomavirus infection. Proc Natl Acad Sci U S A, 91, 2436-40. https://doi.org/10.1073/pnas.91.7.2436
  22. Parkin DM, Bray F, Ferlay J, et al (2005). Global cancer statistics, 2002. CA Cancer J Clin, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
  23. Spinillo A, Dal Bello B, Gardella B, et al (2009). Multiple human papillomavirus infection and high grade cervical intraepithelial neoplasia among women with cytological diagnosis of atypical squamous cells of undetermined significance or low grade squamous intraepithelial lesions. Gynecol Oncol, 113, 115-9. https://doi.org/10.1016/j.ygyno.2008.12.037
  24. Tiersma ES, van der Lee ML, Garssen B, et al (2005). Psychosocial factors and the course of cervical intraepithelial neoplasia: a prospective study. Gynecol Oncol, 97, 879-86. https://doi.org/10.1016/j.ygyno.2005.03.003
  25. Usubutun A, Alemany L, Kucukali T, et al (2009). Human papillomavirus types in invasive cervical cancer specimens from Turkey. Int J Gynecol Pathol, 28, 541-8. https://doi.org/10.1097/PGP.0b013e3181aaba0d
  26. van den Brule AJC, Pol R, Fransen-Daalmeijer N, et al (2002). GP5+/6+ PCR followed by reverse line blot analysis enables rapid and high-throughput identification of human papillomavirus genotypes. J Clin Microbiol, 40, 779-87. https://doi.org/10.1128/JCM.40.3.779-787.2002
  27. Walboomers JMM, Jacobs MV, Manos MM, et al (1999). Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol, 189, 12-9. https://doi.org/10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F
  28. Wu E-Q, Yu X-H, Zha X, et al (2009). Distribution of human papillomavirus genotypes in archival cervical lesions in eastern inner Mongolian autonomous region, China. Int J Gynecol Cancer, 19, 919-23. https://doi.org/10.1111/IGC.0b013e3181a58fef