Single and multiple-type of HPV infections in women with cervical cancer and precancerous lesions in the southwestern region of the Republic of North Macedonia

Abstract

Aim: Our objective was to assess the relationship between single and multiple-type HPV infections with patients' age and histological status of cervical lesion. Material: In the period of two and a half years (March 1 , 2017 till September 30, 2019) the total number of 212 women (18-65 years old) who were positively screened for opportunistic cervical cancer by pap smears, were sent by their family gynecologist to the Center for Public health of Bitola for HPV genotyping. Method: Samples of HPV genotyping were collected by scraping the epithelium out of the cervical canal and transferred into 1.5 ml plastic tubes and transport medium using a disposable sterile probe. DNA extraction was conducted using the kit for isolation of nucleic acids, PureLink Genomic DNA kit, Invitrogen, produced by "Life-Technology". After the extraction of DNA from the specimens, the presence of 21 HR-HPV genotypes were detected by The DNA-Technology HPV Quantitative Real-time PCR Kit,DTlite, LLC, Russia ®.The distribution of the data is shown in absolute and relative numbers. Non-parametric Chi-square test was used to test for differences. The p value of <0.05 was considered statistically significant. Results: Among 212 women, 79 were diagnosed with non high risk cervical lesions (non-hrCL) and 133 were with high risk of cervical lesions (hrCL). The most dominant HPV genotypes were: 16 (19,0%), 31 (12,2%), 52 and 59 (7,1%), 33 (6,8%) and 18 (6,5%). Patients with multiple -type HPV infections had a significantly higher prevalence than those with single type of HPV in the age groups of up to 24 years and from 25 to 34 years. 16.5% vs 11.8%, and 51.8% vs 33.1%, respectively. However, statistical analysis did not confirm a significant difference between women with single and multiple types of infections in relation to the cytological finding. Conclusion: In this study of 212 women, HPV16 was most prevalent type, detected in 19% of all HPV positive cases and with the highest prevalence rank in ST groups with 30,5%. Other most prevalent types were HPV type 31, 52, 59, 33 and 18 with the presence of 12,1%; 7,1%; 7,1%; 6,8%, 6,5% respectively. Patients with multiple type HPV infections had a significantly higher prevalence than those with single type of HPV in the age groups of up to 34 years. A better understanding of the interactions among HP genotypes is of great interest, not only for risk assessment of hrCLs in women with multiple HPV infections, but also for the development of the next generation of HPV vaccines by predicting the possible emerging genotypes that compete with those targeted by current vaccines.