HPV at the time of vaccine: has screening reached its goal?

Introduction: The human papillomavirus (HPV) prevalence recognized a geographic distribution of genotypes but, in the last years, the change of sexual behaviours, the increase number of sex partners, and the reduction of geographic distances have changed its prevalence and distribution. Objective: To determine the prevalence of HPV types among females in the Molise region and its evolution in 24 months. Materials and Methods: The authors, from February to August 2008, used a representative sample of a female population (n = 299) aged 17 to 64 years who were interviewed and submitted cervico-vaginal swab specimens. Swabs were analyzed for cytologic screening and HPV detection and typing. The patients with a positive cytology were submitted to colposcopy and eventually biopsy. Cytological and colposcopic follow up was performed in 24 months. Results: The overall HPV prevalence was 30.1% and the prevalence of high- and low-risk HPV types was 22.41% and 18.06%, respectively. The prevalence of HPV vaccine types was relatively low for HPV-6-11-18. Only HPV-16 is well-represented in Molise, but recognizes a strictly geographic distribution. Conclusion: This study is one of the largest assessments of HPV genotypes to date in Italy. It is clear that several HPV-types are involved in cervical lesions, therefore the vaccine is profitable but limited by great number of types implicated in the pathogenesis of cancer and by their dishomogeneous distribution. Currently, a good campaign of screening is still necessary. In the future, second generation polyvalent HPV vaccines my be proposed for a wider and complete vaccine coverage.

HPV Prevalence; Risk factors; Vaccine; Screening

[1] Bernard H.U., Burk R.D., Chen Z., van Doorslaer K., zur Hausen H., de Villiers E.M.: “Classification of papillomaviruses (PVs) based on 189 PV types and proposal of taxonomic amendments”. Virology, 2010, 401, 70.

[2] Dunne E.F., Unger E.R., Sternberg M., McQuillan G.C., Swan D.C., Patel S.S., Markowitz L.E.: “Prevalence of HPV Infection Among Females in the United States”. JAMA, 2007, 297, 813.

[3] Moscicki A.B., Shiboski S., Broering J., Powell K., Clayton L., Jay N., et al.: “The natural history of human papillomavirus infection as measured by repeated DNA testing in adolescent and young women”. J. Pediatr., 1998, 132, 277.

[4] Franco E.L., Villa L.L., Sobrinho J.P., Prado J.M., Rousseau M.C., Désy M., Ruhan T.E., et al.: “Epidemiology of acquisition and clearance of cervical human papillomavirus infection in women from a high-risk area for cervical cancer”. J. Infect. Dis., 1999, 180, 1415.

[5] Clifford G.M., Rana R.K., Franceschi S., Smith J.S., Gough G., Pimenta J.M.: “Human papillomavirus genotype distribution in low-grade cervical lesions: comparison by geographic region and with cervical cancer”. Cancer Epidemiol. Biomarkers Prev., 2005, 14, 1157.

[6] D’Souza G., Kreimer A.R., Viscidi R., Pawlita M., Fakhry C., Koch W.M., et al.: “Case-control study of human papillomavirus and oropharyngeal cancer”. N. Engl. J. Med., 2007, 356, 1944.

[7] Bonati M.: “Il Pap test? Certamente! La vaccinazione antiHPV? Sì, eventualmente”. Medico e Bambino, 2008, 27, 251.

[8] Armstrong E.P.: “Prophylaxis of cervical cancer and related cervical disease: a review of the cost-effectiveness of vaccination against oncogenic HPV Types”. J. Manag. Care Pharm., 2010, 16, 217.

[9] Giambi C.: “Ricognizione delle decisioni regionali in merito alla vaccinazione anti-Hpv e primi dati di copertura vaccinale a fine anno 2009”. http://www.epicentro.iss.it/focus/hpv/pdf/HPV-2009.pdf (accessed Sept 22, 2010).

[10] Tartaglia E., Palomba S., Sena T., Mastrantonio P.: “HPV Genotyping in Molise region: preliminary data”. Suppl. Giorn. It. Ost. Gin., 2008, 30, 366.

[11] Ripabelli G., Grasso G.M., Del Riccio I., Tamburro M., Sammarco M.L.: “Prevalence and genotype identification of human papillomavirus in women undergoing voluntary cervical cancer screening in Molise, central Italy”. Cancer Epidemiol., 2010, 34, 162. Epub 2010, Jan 15.

[12] Filia A.: “Aspetti epidemiologici delle infezioni da HPV Sept. 2008”. http://www.epicentro.iss.it/problemi/hpv/epid.asp#Italia (accessed Dec 12, 2010)

[13] Tartaglia E., Iafusco D., Galderisi A.,Mastrantonio P.: “Do HPV vaccine genotypes agree with HPV circulating types”? Lancet Infect. Dis., 2011, 11, 585.

[14] Piana A., Sotgiu G., Castiglia P., Pischedda S., Cocuzza C., Capobianco G., et al.: “Prevalence and type distribution of Human Papillomavirus infection in women from North Sardinia Italy”. BMC Public. Health 2011, 11, 785 doi:10.1186/1471-2458-11- 785.

[15] Agarossi A., Ferrazzi E., Parazzini F., Perno C.F., Ghisoni L.: “Prevalence and type distribution of high-risk human papillomavirus infection in women undergoing voluntary cervical cancer screening in Italy”. J. Med. Virol., 2009, 81, 529.

[16] Giorgi Rossi P., Bisanzi S., Paganini I., Di Iasi A., Angeloni C., Scalisi A., et al.: “Prevalence of HPV high and low risk types in cervical samples from the Italian general population: a population based study”. BMC Infectious Diseases, 2010, 10, 214.

[17] de Sanjose S., Quint W.G.V., Alemany L., Geraets D.T., Klaustermeier J.E., Lloveras B., et al.: “Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study”. The Lancet Oncology, Early Online Publication, 2010 Oct 18; doi:10.1016/S1470-2045(10)70230-8

[18] Kovács K., Varnai A.D., Bollmann M., Bankfalvi A., Szendy M., Speich N. et al.: “Prevalence and genotype distribution of multiple human papillomavirus infection in the uterine cervix: a 7.5- year longitudinal study in a routine cytology-based screening population in West Germany”. J. Med. Virol., 2008, 80, 1814.

[19] Mejlhede N., Bonde J., Fomsgaard A.: “High frequency of multiple HPV types in cervical specimens from Danish women”. APMIS, 2009, 117, 108.

[20] Ragin C.C., Watt A., Markovic N., Bunker C.H., Edwards R.P., Eckstein S., et al.: “Comparisons of high-risk cervical HPV infections in Caribbean and US populations”. Infect. Agent Cancer, 2009, 4 (suppl. 1), 9.

[21] Simen-Kapeu A., La Ruche G., Kataja V., Yliskoski M., Bergeron C., Horo A. et al.: “Tobacco smoking and chewing as risk factors for multiple human papillomavirus infections and cervical squamous intraepithelial lesions in two countries (Coˆte d’Ivoire and Finland) with different tobacco exposure”. Cancer Causes Control., 2009, 20, 163.

[22] Watt A., Garwood D., Jackson M.N., Ragin C., Smikle M., Fletcher H., McFarlane-Anderson N.: “High-risk and multiple human papillomavirus (HPV) infections in cancer-free Jamaican women”. Infect. Agent Cancer, 2009, 4 (suppl. 1), 11.

[23] Cercato M.C., Mariani L., Vocaturo A., Carrone A., Terrenato I., Morano G. et al.: “Predictors of human papillomavirus (HPV) infection in Italian women”. J. Med. Virol., 2010, 82, 1921.

[24] Cotton S.C., Sharp L., Seth R., Masson L.F., Little J., Cruickshank M.E, Tombola Group: “Lifestyle and socio-demographic factors associated with high-risk HPV infection in UK”. Br. J. Cancer, 2007, 97, 133.

[25] Green J., Berrington de Gonzalez A., Smith J.S., Franceschi S., Appleby P., Plummer M., Beral V.: “Human papillomavirus infection and use of oral contraceptives”. Br. J. Cancer, 2003, 88, 1713.

[26] Mun˜oz N., Castellsague´ X., de Gonza´lez A.B., Gissmann L.: “HPV in the etiology of human cancer”. Vaccine, 2006, 24 (suppl. 3), S3/1.

[27] Wright T.C. Jr.: “Natural history of HPV infections” (Review). J. Fam. Pract., 2009, 58 (9 suppl.), S3.