Genetic diversity of human papillomavirus (HPV) as specified by the detection method, gender, and year of sampling: a retrospective cross-sectional study

Abstract Purpose. This study assesses HPV prevalence and genotype distribution in Lebanon, and to identify differentials in HPV infection, infection with multiple genotypes, and with high-risk genotypes, by sex, age, and year of data collection. Methods. Study participants comprised 1,042 female and 160 male participants between 2006–2018. HPV genotyping was done by PCR and hybridization (2006–2013) or real-time PCR (2013 onwards). Diversity of HPV genotypes across gender, age groups, and years of data collection was tested by applying Shannon Diversity Index. Results. The overall HPV prevalence was 44.8% among study participants, and 3-fold higher in women than men. Single HPV infection was seen in two-third of HPV-positive participants. Women were less likely to be infected with multiple HPV strains, but more likely to be infected with high-risk or mixed risk HPV genotypes. HPV16 (11.0%, 9.8%) and HPV53 (8.5%, 4.9%) were the most prevalent high-risk HPV genotypes in women and men, respectively, while HPV18 prevalence was 4.9% in men and 3.1% in women, while HPV59 prevalence was 6.6% in men and 2.1% in women. Samples collected post-2011 from women showed twice higher odds of HPV infection than those collected earlier and were 3-fold more likely to be infected with multiple HPV strains, and twice more likely to be infected with high-risk genotypes compared to those tested earlier. Women scored higher on Shannon index indicating high diversity in HPV types and frequency, with trend of increased diversity over time. While the odds of HPV infection remained associated with sex and temporal trend in multivariable analysis, odds of having high-risk genotypes was mainly associated with infection with multiple HPV strains. Conclusion. Our study showed high diversity in HPV genotypes and an increasing trend of infection with multiple and high-risk genotypes in recent years. Findings underscore the need for effective screening/surveillance and HPV vaccination programs.