Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
PLoS One. 2011;6(10):e25493. doi: 10.1371/journal.pone.0025493. Epub 2011 Oct 4.
Cervical cancer is a major public health problem in Latin America and the Caribbean (LA&C), showing some of the highest incidence and mortality rates worldwide. Information on HPV type distribution in high-grade cervical lesions (HSIL) and invasive cervical cancer (ICC) is crucial to predict the future impact of HPV16/18 vaccines and screening programmes, and to establish an appropriate post-vaccinal virologic surveillance. The aim was to assess the prevalence of HPV types in HSIL and ICC in studies in LA&C.
We performed a systematic review, following the MOOSE guidelines for systematic reviews of observational studies, and the PRISMA statement for reporting systematic reviews and meta-analyses. Inclusion criteria were at least ten cases of HSIL/ICC, and HPV-type elicitation. The search, without language restrictions, was performed in MEDLINE, Cochrane Library, EMBASE, LILACS from inception date to December 2009, proceedings, reference lists and consulting experts. A meta-analysis was performed using arc-sine transformations to stabilize the variance of simple proportions. Seventy-nine studies from 18 countries were identified, including 2446 cases of HSIL and 5540 of ICC. Overall, 46.5% of HSIL cases harbored HPV 16 and 8.9% HPV18; in ICC, 53.2% of cases harbored HPV 16 and 13.2% HPV 18. The next five most common types, in decreasing frequency, were HPV 31, 58, 33, 45, and 52. Study's limitations comprise the cross-sectional design of most included studies and their inherent risk of bias, the lack of representativeness, and variations in the HPV type-specific sensitivity of different PCR protocols.
This study is the broadest summary of HPV type distribution in HSIL and ICC in LA&C to date. These data are essential for local decision makers regarding HPV screening and vaccination policies. Continued HPV surveillance would be useful, to assess the potential for changing type-specific HPV prevalence in the post-vaccination era in Latin America.
宫颈癌是拉丁美洲和加勒比地区（LA&C）的一个主要公共卫生问题，其发病率和死亡率在全球范围内处于较高水平。了解高危型 HPV （HR-HPV）在高级别宫颈病变（HSIL）和浸润性宫颈癌（ICC）中的分布情况，对于预测 HPV16/18 疫苗和筛查项目的未来影响以及建立适当的疫苗接种后病毒学监测至关重要。本研究旨在评估 LA&C 地区 HSIL 和 ICC 中 HPV 型别的流行情况。
我们按照观察性研究系统评价 MOOSE 指南和系统评价和荟萃分析的 PRISMA 声明进行了系统评价。纳入标准为至少 10 例 HSIL/ICC 病例和 HPV 型别鉴定。检索无语言限制，检索了 MEDLINE、Cochrane 图书馆、EMBASE、LILACS 从开始日期到 2009 年 12 月，会议记录、参考文献和咨询专家。使用反正弦变换进行荟萃分析，以稳定简单比例的方差。共确定了来自 18 个国家的 79 项研究，包括 2446 例 HSIL 和 5540 例 ICC。总体而言，46.5%的 HSIL 病例携带 HPV16，8.9%携带 HPV18；在 ICC 中，53.2%的病例携带 HPV16，13.2%携带 HPV18。其次是 HPV31、58、33、45 和 52，频率逐渐降低。本研究的局限性包括纳入研究的大多数为横断面设计及其固有的偏倚风险、缺乏代表性以及不同 PCR 方案 HPV 型别特异性敏感性的差异。
这是迄今为止关于 LA&C 地区 HSIL 和 ICC 中 HPV 型别分布的最广泛的总结。这些数据对于 HPV 筛查和疫苗接种政策的当地决策者至关重要。HPV 监测的持续进行将有助于评估在拉丁美洲疫苗接种后时代 HPV 型别流行率的潜在变化。
