Human Papillomavirus–Associated Head and Neck Malignancies in Sub-Saharan Africa: A Systematic Review

Abstract

PURPOSE The proportion of head and neck cancers (HNCs) with human papillomavirus (HPV) positivity in sub-Saharan Africa (SSA) is poorly characterized. Characterizing this has implications in staging, prognosis, resource allocation, and vaccination policies. This study aims to determine the proportion of HPV-associated HNC in SSA. MATERIALS AND METHODS This systematic review included searches from PubMed, EMBASE, Web of Science, African Index Medicus, Google Scholar, and African Journals Online. All English publications reporting the proportion of HNC specimens from SSA patients who tested positive for HPV and/or p16 were included. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Case Series Studies. RESULTS In this systematic review of 31 studies and 3,850 patients, the overall p16 positivity was 13.6% (41 of 1,037 patients tested) with the highest proportion among oropharyngeal cancers (20.3%, 78 of 384 patients) and the overall HPV polymerase chain reaction positivity was 15.3% (542 of 3,548 samples tested) with the highest proportion among nasopharyngeal cancers (16.5%, 23 of 139 patients). Among the 369 HPV strains detected, the most common genotypes were HPV 16 (226 patients, 59.2%) and HPV 18 (78, 20.4%). CONCLUSION HPV was found to be associated with a significant proportion of HNC in SSA. The genotypes reported suggest that the nine-valent vaccine and gender-neutral vaccination policies should be considered. Given that these studies may not accurately capture prevalence nor causation of HPV in HNC subsites, additional research is needed to provide a more thorough epidemiologic understanding of HPV-associated HNC in SSA, including risk factors and clinical outcomes.

HPV18 L1 and long control region sequences variation and E6/E7 differential expression in nasopharyngeal and cervical cancers: a comparative study

“…From our HPV L1 sequences analysis, HPV18 emerged as the HPV type in the two cancers. This is consistent with literature as HPV16 and 18 have been reported as the most common HPV types in cancers [28][29][30][31][32]. Though HPV16 is mostly reported as the predominant HPV type of the two, a study by Donkoh et al in Kumasi, a city in Ghana, did not detect HPV16 as the most prevalent HPV type while HPV18 was reported as the fourth most common genotype after HPV 52, 56, and 35 among women who had never experienced cervical screening [29].…”

Human Papillomavirus-Associated Oropharyngeal Cancer: Global Epidemiology and Public Policy Implications

“…Of note, these ASIR estimates reported by Lu et al extrapolated the AF of 58.5% from one study in South Africa for the region [ 4 ]. A recent systematic review in Sub-Saharan Africa reported that the p16 positivity among oropharyngeal cases was 20.3%, while the HPV PCR positivity was 15.1% among 31 studies representing 12 countries [ 26 ]. Future studies are needed to establish more accurate regional estimates.…”

“…Given the resource limitations for testing of HPV association, it is unclear whether the latest AJCC/UICC staging system is appropriate for resource-constrained health systems which cannot routinely perform testing [ 38 ]. Variations in and lack of testing capacity influence the availability of epidemiologic data which can then further influence investment in HPV testing infrastructure and vaccination policies [ 26 ].…”

A cross-sectional study of attitudes and behaviors of snuff use and cessation among people with and without HIV in South Africa

“… 19 Surveillance for malignancies may also be lower among PWH as compared to the general population, and human papilloma virus (HPV) infection together with snuff use may put PWH at higher risk of nasopharyngeal cancer. 20 Importantly, few tobacco cessation strategies have been developed and tested for PWH, especially in low-resourced settings. PWH are also less likely to quit tobacco use as compared to people without HIV.…”