Human Papillomavirus (HPV) Infection: Molecular Epidemiology, Genotyping, Seroprevalence and Associated Risk Factors among Arab Women in Qatar

Abstract

Human Papillomavirus (HPV) infections are known to cause cervical cancer worldwide, however, limited information is currently available on prevalence, types distribution and risk factors for HPV infection in the Arab countries. We conducted a cross-sectional observational study exclusively of women of Arabic origin residing in Qatar (n = 406) who were selected from the Women’s Hospital at Hamad Medical Corporation (HMC) and Health Centers of the Primary Health Care Corporation in Doha, Qatar over the period March 2013 to August 2014. Socio-demographic, behavioral and clinical data were collected. Four hundred and six cervical smears and 292 blood samples were included in the study. HPV typing was done using HPV type-specific primers-based real-time PCR, and Sanger sequencing. HPV-IgG and IgM were quantified using ELISA assays. The prevalence of HPV infection amongst Qatari and non-Qatari Arab women were 9.8% and 6.1%, respectively and 7.6% and 16.7% in women with normal and abnormal cytology, respectively. HPV 81 was the most commonly found genotype in women with normal cytology (34.5%), whereas HPV 81, 16 and 59 in women with abnormal cytology (25.0% each). All the HPV DNA positive women were seronegative and HPV-IgG prevalence was higher in Qatari women than in non-Qatari Arab women. None of the studied factors had any significant association with HPV-DNA positivity or HPV-IgG seropositivity. The overall identified HPV DNA prevalence and HPV seroprevalence among Arab women in Qatar were on the low side compared to global levels.

Cervical high‐risk human papillomavirus infection among women residing in the Gulf Cooperation Council countries: Prevalence, type‐specific distribution, and correlation with cervical cytology

“…In line with our findings, it has been previously reported that HR‐HPV positivity declined with increasing age . Prior studies in KSA and Qatar reported that HPV prevalence was highest among women in the older age groups. Conversely, the HPV positivity rate was highest among women in the younger age groups and decreased with increasing age in Kuwait .…”

“…In addition, a subsequent meta‐analysis of women with normal cytological findings found that the adjusted HPV prevalence was 11.7%, although it varies geographically . Furthermore, previous studies in some GCC countries reported HPV prevalence ranging from 2.36% to 60.7% among women with normal cytology, whereas, among women with abnormal cytology, the HPV positivity rate ranged from 16.7% to 64.6% . The high prevalence of HR‐HPV among women with normal cytology in our study could be explained by the low sensitivity of the Papanicolaou test.…”

“…Prior reports from the GCC countries demonstrated various rates of multiple HPV infection, ranging from 8.54% to 12.8% in KSA . Higher multiple infection rates have been observed in Qatar, ranging from 12.12% to 34.3% . In addition, it has been shown that the frequency of multiple HPV infections ranges from 8.45 to 28.9% in Kuwait .…”

“…Conversely, the frequency of HPV16 and HPV18 double infections was 1%. In the GCC countries, although the majority of investigations found that HPV16 was the most commonly identified HR‐HPV genotype, other studies reported other non‐HPV16 HR‐HPV as the most frequently detected genotype …”

“…A meta‐analysis of HPV type‐specific prevalence data published from 1990 to 2010 reported that the overall HPV prevalence increased significantly from 85.9% in studies published from 1990 to 1999 to 92.9% in studies published from 2006 to 2010 . Prior analyses of the HPV burden in the GCC countries revealed a varying HPV prevalence, with rates ranging from 9.8% in Bahrain up to 31.6% in KSA, whereas, in Qatar, numerous previous studies reported HPV positivity rates ranging from 6.1% to 64.2% …”