ReviewA meta-analysis of human papillomavirus type-distribution in women from South Asia: Implications for vaccination
Introduction
Invasive cervical cancer (ICC) is the second most common cancer among women worldwide, with an estimated incidence of 493,000 new cases and mortality of 274,000 each year [1]. Approximately 85% of the disease burden is seen in women in developing nations. Cervical cancer is the most common cancer among women in South Asia. In India, there are an estimated 132,000 new cases and 74,000 deaths each year. The remarkable difference in the incidence of cervical cancer in developed and developing nations has been attributed to organized, cytology-based screening programs and follow-up of affected women in the former. Such programs have not been feasible in South Asia for logistic reasons. Methods based on visual inspection have been recommended for these countries, but the lower specificity of these methods results in a high referral rate, with its own logistic problems [2].
Persistent infection with carcinogenic human papillomavirus (HPV) types has been recognized as a necessary cause of cervical cancer [3], [4], [5]. This led to the evaluation of high risk HPV DNA testing as a primary screening method [6]. At the present time, HPV prophylactic vaccines hold the greatest promise for reduction of the cervical cancer burden in areas with no or limited screening [7], [8]. Thus the focus of cervical cancer prevention in developing countries has shifted to the detection and control of carcinogenic HPV types. Since this type-distribution varies in different regions, knowledge of the detailed pattern of HPV type-distribution of each region will be essential for public health policy decisions. This will also form the basis for determining which types should be included in new second-generation HPV vaccines targeted to specific regions.
In previously published meta-analyses of HPV type-distribution, information on South Asia has been limited [9], [10], [11], [12]. The aim of the present meta-analysis was to determine HPV type-distribution and prevalence among women of South Asia in order to estimate the potential protection of an HPV-16/18 vaccine and to determine the additional HPV types that should be included in new vaccines for optimal protection against cervical cancer in this region.
Section snippets
Study selection
Source material was obtained from peer-reviewed published English literature using the following search terms and connectors: bangladesh or bhutan or india or nepal or pakistan or sri lanka AND incidence or prevalence or epidemiology or mortality or morbidity AND hpv or human papillomavirus or cervical cancer or cervix cancer or cervical neoplasms or cervical intraepithelial neoplasia AND polymerase chain reaction. The search was conducted in four databases using either MeSH headings or
Studies included
Of the studies from India, Pakistan and Sri Lanka, nine studies from India fulfilled the inclusion criteria [13], [14], [15], [16], [17], [18], [19], [20], [21]. Table 1 shows the details of these with respect to numbers examined, region studied, PCR primers, etc. A total of 3723 women were analyzed, which included 558, 52, 52 and 3061 women with ICC, HSIL, LSIL and normal cytology/histology from 6, 2, 2 and 6 studies, respectively (Table 2). Among 558 ICC cases, the majority had squamous cell
Discussion
This meta-analysis aimed to study the HPV prevalence and type-distribution in South Asia, which is a region composed of countries with overlapping ethnicity and a rich variety of cultural and lifestyle patterns. Eventually, however, the data represents HPV type-distribution among women with and without cervical lesions from India as the studies from Pakistan and Sri Lanka did not meet the inclusion criteria [22], [23], [24], while no studies were found from Bangladesh, Bhutan and Nepal. Of the
Acknowledgements
We are grateful to all the authors who made detailed data available from their published studies and to Dr Keerti V. Shah for critically reviewing the manuscript.
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2018, Infection, Genetics and EvolutionCitation Excerpt :Similarly, the meta-analysis conducted by Bhatla et al., in South Asian women of cervical cancer suggests the HPV prevalence in Indian women was 94.6%, 86.5%, 65.4% and 12.0% with ICC, HSIL, LSIL and normal cytology, respectively. In invasive cervical cancer (ICC), HPV-16 was predominantly noticed in 64.8% of women, followed by HPV-18, 45, and 33 genotypes (Bhatla et al., 2008a, 2008b; Ritari et al., 2012). In addition, region specific meta-analyses were also been conducted to know the incidence of HPV genotypes in African (Ogembo et al., 2015), Latin American and Caribbean (Ciapponi et al., 2011), Tunisian (Ardhaoui et al., 2016) and Canadian (Tricco et al., 2011) populations.