Distribution of Human Papillomavirus in Precancerous and Cancerous Cervical Neoplasia in Tunisian Women

Abstract BackgroundHigh-risk human papillomavirus (HR-HPV) are responsible for cervical cancer (CC), that is a major health problem worldwide and the second most prevalent gynecological cancer among Tunisian women. Preventive tools against CC are based on screening and prophylactic vaccines. Improving the preventive strategies as well as the therapeutic algorithms needs the understanding of HPV distribution in cervical lesions in Tunisian women. MethodsA total of 200 formalin-fixed paraffine embedded biopsies were collected in our study. DNA was extracted using Qiagen Mini prep kit. DNA quality was controlled by Beta Globin PCR. Only positive samples for Beta Globin test were used. HPV detection was performed by a nested PCR using PYGMY and GP5+/6+ primers. Genotyping was performed by Reverse Line hybridization using 31 probes. ResultsThe mean age of participants was 38.97 years and 54.5% were over 40 years. Cervical neoplasia distribution according to age showed that CINII/CINIII was observed in women over 30 years old. All samples were positive for Beta Globin PCR. Global HPV prevalence in cervical lesions was 83% (166/200). HPV was present in 65% in CINI, 82% in CINII/CINIII and 85% in CC. HR-HPV was statically associated with cervical intraepithelial neoplasia (p<10-3). HR-HPV distribution according to lesion grade and cervical cancer showed that HPV16 and HPV18 were present in all lesions. For CINII/CINIII, HPV 35 (33,33%) was the most detected type, followed by HPV18 (28,6%), HPV 45 (25%) and HPV 16 (21,7%). HPV 45(62%), HPV 18 (47%) were the most detected in CC. HPV58, 59, 66 were only detected in CC and associated with HPV45,18 and HPV16. HPV39, 31, 33, 52, 56, 68 and HPV70 was associated only with CINI. ConclusionsThese findings show that HR-HPV represents 54,6 % of all infections in all cervical lesions. Five HR-HPV (35, 18, 45,16, 51) were detected in CINII/CINIII with a high incidence of HPV 35, 18, 45, and 16 that are included in the proposed vaccines. These findings give useful information for vaccine implementation consideration as well as personalized decision algorithms of intra-epithelial cervical lesions in Tunisian women.