Human papillomavirus infection in women with and without cervical cancer in Nepal.

OBJECTIVES

Cervical cancer is the most common malignancy among Nepalese women. Rational prevention measures are informed by epidemiological data on human papillomavirus (HPV) prevalence.

METHODS

Cervical specimens were obtained from 932 married women aged 15-59 years from the general population of Bharatpur, Nepal, as well as from 61 locally diagnosed invasive cervical cancers (ICC). HPV was detected using a GP5+/6+ PCR-based assay.

RESULTS

Among the general population, the overall prevalence of HPV was 8.6% (6.1% for high-risk types). Prevalence of abnormal Pap smears was 3.6%, including five high-grade squamous intraepithelial lesions. Residence in slum housing, lower education level, > or =3 sexual partners in a woman's lifetime, and husband's extramarital affairs were significantly associated with HPV positivity. HPV prevalence was relatively constant across all age groups. HPV16 was the most common type, both among the general population (1.9%) and among 54 women with HPV-positive ICC (68.5%). HPV18 (22.2%) and 45 (5.6%) were also common in ICC.

CONCLUSIONS

Nepal has an intermediate burden of HPV infection, lower than many areas in India and China. Approximately 80% of cervical cancer in Nepal is theoretically preventable by HPV16/18 vaccines. In the meantime, screen-and-treat approaches should be encouraged to overcome difficulties that were encountered to recall women with screening-positive findings.