Shift in prevalence of HPV types in cervical cytology specimens in the era of HPV vaccination

Abstract

Abstract. The aim of the present population-based cohort study was to analyze the association between the prevalence of 32 types of human papilloma virus (HPV) in 615 female patients with abnormal cervical cytopathology findings. In total, 32 HPV types were screened by DNA array technology. HPV infection was detected in 470 women (76.42%), 419 of whom (89.15%) were infected with ≥1 high-risk (HR)-HPV type. HPV16, which is recognized as the main HR-HPV type responsible for the development of cervical cancer, was observed in 32.98% of HPV + participants, followed by HPV42 (18.09%), HPV31 (17.66%), HPV51 (13.83%), HPV56 (10.00%), HPV53 (8.72%) and HPV66 (8.72%). The prevalence of HR-HPV types, which may be suppressed directly (in the case of HPV16 and 18), or possibly via cross-protection (in the case of HPV31) following vaccination, was considerably lower in participants ≤22 years of age (HPV16, 28.57%; HPV18, 2.04%; HPV31, 6.12%), compared with participants 23-29 years of age (HPV16, 45.71%; HPV18, 7.86%; HPV31, 22.86%), who were less likely to be vaccinated. Consequently, the present study hypothesizes that there may be a continuous shift in the prevalence of HPV types as a result of vaccination. Furthermore, the percentage of non-vaccine HR-HPV types was higher than expected, considering that eight HPV types formerly classified as 'low-risk' or 'probably high-risk' are in fact HR-HPV types. Therefore, it may be important to monitor non-vaccine HPV types in future studies, and an investigation concerning several HR-HPV types as risk factors for the development of cervical cancer is required.

Correlation between abnormal cytological findings and human papillomavirus infection of the uterine cervix in Bulgarian women

“…In our study, there was no statistically significant linear correlation between the HPV(C) status detected by specific PCR amplification of HPV DNA and the presence of Pap-detected koilocytes (P > 0.05). These results are in accordance with a growing body of evidence that in many cases there is no full correspondence between cytological and DNA-based test results [6,7]. For example, Richardson et al [14] recently reported a reduction in the diagnostic accuracy of Pap cytology when evaluating patients' cervical HPV status, possibly due to a heightened awareness of potential abnormalities, which led to more false-positive results.…”

“…The cytological sign that, since the mid-1970s, has been generally considered indicative of an HPV infection is the presence of koilocytes in cervical smears [2,[3][4][5]. However, with the ever-developing advancements in molecular diagnostic tools, it has become evident that cytological and histological features of koilocytosis, or koilocytotic atypia, are not sensitive enough as indicators of the presence of HPV DNA [6,7]. Cytological or histological signs of HPV infection are, in fact, not detected in a majority of women who are positive for HPV DNA [8,9].…”

“…Cytological or histological signs of HPV infection are, in fact, not detected in a majority of women who are positive for HPV DNA [8,9]. Other cytological signs of cervical cancer, such as atypia (high/low grade squamous intraepithelial lesion), have not proved reliable as a sole diagnostic tool for HPV infection either [6,7]. Moreover, as already pointed out [1], the presence of koilocytes in histological sections may be difficult to diagnose, since fixation artefacts or poor dehydration can result in the presence of 'koilocyte-like' cells with perinuclear halos.…”

Detection of human papillomavirus 67 single infection in high‐grade cervical lesions: Case report and review of literature

“…Viral capsid L1‐protein VLPs in vaccines promote production of antibodies which might partially cross‐target similar epitopes on non‐vaccine types . Reductions in incidence have been reported for alpha 9‐species HPV31, HPV33 (related to HPV16), alpha 7‐species HPV45 (related to HPV18) and alpha 5‐species HPV51 . HPV67 might be affected similarly to HPV31.…”

Cervical cancer screening in the era of HPV vaccination: A review of shifting paradigms in cytopathology

“…A significant reduction in the PPV of cytology for the detection of CIN2+ was also observed, while the NPV of negative or low‐grade cytology for CIN2+ increased significantly. Results from a study on German women demonstrated decreased incidence in HPV16 and −18, as well as HPV‐31 among patients younger than 23 years of age with a shift in the distribution of non‐vaccine HPV types such as HPV‐51, −53, −56, and −66, in spite of vaccination rates around 37.5% . Their findings suggest cross‐protection for some HPV types not included in the vaccines such as demonstrated for HPV‐31.…”