Population-based prevalence of cervical infection with human papillomavirus genotypes 16 and 18 and other high risk types in Tlaxcala, Mexico

Samantha E Rudolph, Attila Lorincz, Cosette M Wheeler, Patti Gravitt, Eduardo Lazcano-Ponce, Leticia Torres-Ibarra, Leith León-Maldonado, Paula Ramírez, Berenice Rivera, Rubí Hernández, Eduardo L Franco, Jack Cuzick, Pablo Méndez-Hernández, Jorge Salmerón, FRIDA Study Group, SamanthaE Rudolph, Attila Lorincz, Cosette Wheeler, Patti Gravitt, Eduardo Lazcano, Leticia Torres-Ibarra, Leith León, Paula Ramírez, Berenice Rivera, EduardoL Franco, Jack Cuzick, Pablo Méndez, Jorge Salmerón, Mauricio Hernández, ThomasC Wright, AnnaBarbara Moscicki, Yvonne Flores, MarkH Stoler, Enrique Carmona, KathleenM Schmeler, David Bishai, Pilar Hernández, Daniel Alvarez, Elizabeth Barrios, Rubi Hernández, Indira Mendiola, Vicente González, Samantha E Rudolph, Attila Lorincz, Cosette M Wheeler, Patti Gravitt, Eduardo Lazcano-Ponce, Leticia Torres-Ibarra, Leith León-Maldonado, Paula Ramírez, Berenice Rivera, Rubí Hernández, Eduardo L Franco, Jack Cuzick, Pablo Méndez-Hernández, Jorge Salmerón, FRIDA Study Group, SamanthaE Rudolph, Attila Lorincz, Cosette Wheeler, Patti Gravitt, Eduardo Lazcano, Leticia Torres-Ibarra, Leith León, Paula Ramírez, Berenice Rivera, EduardoL Franco, Jack Cuzick, Pablo Méndez, Jorge Salmerón, Mauricio Hernández, ThomasC Wright, AnnaBarbara Moscicki, Yvonne Flores, MarkH Stoler, Enrique Carmona, KathleenM Schmeler, David Bishai, Pilar Hernández, Daniel Alvarez, Elizabeth Barrios, Rubi Hernández, Indira Mendiola, Vicente González

Abstract

Background: Cervical cancer remains an important cause of cancer mortality for Mexican women. HPV 16/18 typing may help to improve cervical cancer screening. Here we present the prevalence of high-risk human papillomavirus (hrHPV) including HPV16 and HPV18 from the FRIDA (Forwarding Research for Improved Detection and Access) population.

Methods: Beginning in 2013, we recruited 30,829 women aged 30-64 in Tlaxcala, Mexico. Cervical samples were collected and tested for 14 hrHPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68). We used logistic regression to estimate odds ratios with 95 % confidence intervals for hrHPV infections according to putative risk factors.

Results: Prevalence of infection with any of the 14 hrHPV types was 11.0 %. The age-specific prevalence of all hrHPV formed a U-shaped curve with a higher prevalence for women aged 30-39 and 50-64 than women aged 40-49. Across all age groups, 2.0 % of women were positive for HPV16 and/or HPV18 (HPV16/18), respectively. HPV16/18 prevalence also showed a U-shaped curve with increased prevalence estimates for women aged both 30-39 and 60-64. Both prevalence curves had a significant quadratic age coefficient. Infections with hrHPV were positively associated with an increased number of lifetime sexual partners, a history of sexually transmitted disease, being unmarried, use of hormonal contraception, having a history of smoking and reported condom use in the multivariate model.

Conclusions: The FRIDA population has a bimodal distribution of both hrHPV and HPV16/18 positivity with higher prevalences at ages 30-39 and 60-64. These findings will help to evaluate triage algorithms based on HPV genotyping.

Trial registration: The trial is registered with ClinicalTrials.gov, number NCT02510027 .

Keywords: HPV16/18; Human papillomavirus DNA testing; Mexico; Prevalence; Risk factors.

Figures

Fig. 1
Fig. 1
Flow Chart of hrHPV Screening of the FRIDA Study Population. Women 30 to 64 years of age living within our target health district were invited by healthcare personnel. This study reports the results from the first 31,629 women who volunteered to participate in the Tlaxcala cervical cancer screening program. Four-hundred and eighty-three women were excluded, leaving 30,829 who had hrHPV results available, in the current analysis. Of those 30,829 women, 3,401 women were positive for hrHPV. Among those 3,401 women, 13.6 % were positive for HPV16, 5.9 % for HPV18 and 1.1 % for both HPV16 and HPV18 coinfection. These three categories indicate positivity independent of the presence of other hrHPV types. The last category of other high risk HPV types include women who tested positive for other hrHPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), but neither HPV16 nor HPV18
Fig. 2
Fig. 2
Age Specific Prevalence of hrHPV and HPV16/18 with 95 % CI. The overall prevalence of hrHPV was 11.0 % in this population. Two percent of women overall were positive for HPV16 and/or HPV18 (HPV16/18). The prevalence of hrHPV overall and HPV16/18 by age group both show a bimodal distribution with an increased prevalence for the youngest women in the population aged 30–39 and a second bump of positivity for the oldest women aged 60 and above
Fig. 3
Fig. 3
Age Specific Prevalence of hrHPV Types with 95 % CI. The cobas® 4800 system delivers hrHPV results in three categories: HPV16, HPV18, and other hrHPV. Based on these results, we divided the population into three mutually exclusive categories: (1) women positive for only other hrHPV (non-16/18 hrHPV only), (2) women positive for HPV16 and/or HPV18 (HPV16/18), and (3) women positive for HPV16 and/18 as well as another hrHPV (HPV16/18 + other hrHPV). The prevalence of these three categories by age group shows a similar bimodal distribution with increased prevalence values for the youngest and oldest women in the population

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