Human papillomavirus type 16 and 18 viral loads as predictors associated with abnormal cervical cytology among women in Saudi Arabia

Abstract

The detection of HPV viral DNA is regularly conducted with cervical screening. However, using a molecular marker such as the viral load may serve as a predictor associated with disease detection and progression. The present study aimed to screen for and genotype HPV among women in Saudi Arabia, develop and validate sensitive quantitative polymerase chain reaction (qPCR) assays to detect viral load for the two most common HPV types, namely 16 and 18, and assess whether HPV viral load could be used as a marker for cervical abnormality and disease progression. This study examined 733 specimens (both formalin-fixed paraffin embedded specimens and PAP smear samples) from women who underwent cervical screening. The specimens and samples were processed for DNA extraction and then tested for HPV DNA using nested PCR. Approximately 165 specimens (18%) were positive for HPV. Those specimens were genotyped using a reverse line blotting hybridization assay. The results indicated that the most common HPV types detected were a single infection with HPV 16 (51%) or with HPV 18 (28%) followed by infections with multiple HPV types (~7%). A qPCR TaqMan assay developed and validated in-house was used to determine viral load for HPV genotypes 16 (n ¼ 80) and 18 (n ¼ 45). Viral loads for both HPV types were significantly associated with cervical cytology grade (P < 0.05). The odds ratio (OR) for the HPV 16 viral load was high for specimens with cervical cancer (OR, 18.8; 95% CI, 4.3-82.9) or for those with high-grade squamous intraepithelial lesions (OR, 14.7; 95% Cl,). For the HPV 18 viral load, the OR was significant only for specimens with cervical cancer (OR, 11.1; 95% Cl, 2.2-54.9). Logistic regression models for HPV 16 and for HPV 18 viral load levels were significant, with higher viral load associated with cervical abnormalities. These findings indicate that viral load is a predictor significantly associated with cytology abnormality in women who are positive for high-risk HPVs and suggest that integrating a viral load test into current clinical screening practices for HPV-positive women is warranted in Saudi Arabia.

Epidemiological study of HPV infection in 40,693 women in Putian: a population study based on screening for high-risk HPV infection

“…In terms of pathogenicity, HPV viruses can be classified as high- or low-risk types. The high-risk type is closely related to various cervical intraepithelial neoplasias, cervical cancers and other malignant lesions [ 9 ]. By contrast, the low-risk type is mainly involved in multiple benign lesions of the external genital tract [ 10 ].…”

Genetic Variability in the E6, E7, and L1 Genes of Human Papillomavirus Types 16 and 18 among Women in Saudi Arabia

“…A previous study investigated the same specimens we used in our study but categorized cytological grades as normal and abnormal. Their logistic regression model showed a significant association between a higher risk of cervical abnormalities and high viral loads for both HPV16 and HPV18 [ 33 ]. We used three categories of cytological grades: negative for intraepithelial lesions, high-grade squamous intraepithelial lesions, and invasive carcinoma.…”

“…All specimens were collected between 2017 and 2019. Clinical and sociodemographic data, as well as the viral load data of the specimens, were obtained from previous studies [ 23 , 33 , 34 ]. Participant inclusion criteria for the present study were (1) being a Saudi woman (2) who was married, divorced, or widowed, (3) having definite histological or cytological results for collected cervical specimens, and (4) having an HPV genotype test result positive for HPV16 or HPV18 infection.…”

Epidemiological study of HPV infection in 40693 women in Putian: a population study based on screening for high-risk HPV infection

“…2 Key Laboratory of Medical Microecology (Putian University), Fujian Province University, No.1133 Xueyuan Middle Street, Chengxiang District, Putian, Fujian, China. 3 Center Blood Station, No.138 Guanglin Street, Dongzhen West Road, Chengxiang District, Putian, Fujian, China.…”

“…In terms of pathogenicity, HPV viruses can be classi ed as high-risk types or low-risk types. The high-risk type is closely related to various cervical intraepithelial neoplasias, cervical cancers, and other malignant lesions [3]. In contrast, the low-risk type is mainly involved in multiple benign lesions of the external genital tract [4].…”