Ogembo Rebecca Kemunto, Gona Philimon Nyakauru, Seymour Alaina J, Park Henry Soo-Min, Bain Paul A, Maranda Louise, Ogembo Javier Gordon
Northeastern University, Boston, MA, United States of America; University of Massachusetts Medical School, Worcester, MA, United States of America.
University of Massachusetts, Boston, MA, United States of America.
PLoS One. 2015 Apr 14;10(4):e0122488. doi: 10.1371/journal.pone.0122488. eCollection 2015.
Several meta-analyses confirmed the five most prevalent human papillomavirus (HPV) strains in women with and without cervical neoplastic diseases are HPV16, 18, 31, 52, and 58. HPV16/18 are the predominant oncogenic genotypes, causing approximately 70% of global cervical cancer cases. The vast majority of the women studied in previous analyses were from Europe, North America, Asia, and most recently Latin America and the Caribbean. Despite the high burden of cervical cancer morbidity and mortality in Africa, a robust meta-analysis of HPV genotype prevalence and distribution in African women is lacking.
We systematically searched 14 major databases from inception to August 2013 without language restriction, following the Meta-Analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-one studies from 23 African countries were identified after screening 1162 citations and data abstracted and study quality appraised from 195 articles. HPV type-specific prevalence and distribution was estimated from 17,273 cases of women with normal cervical cytology; 1019 women with atypical squamous cells of undetermined significance (ASCUS); 1444 women with low-grade squamous intraepithelial lesion (LSIL); 1571 women with high-grade squamous intraepithelial lesion (HSIL); and 4,067 cases of invasive cervical carcinoma (ICC). Overall prevalence of HPV16/18 were 4.4% and 2.8% of women with normal cytology, 12.0% and 4.4% with ASCUS, 14.5% and 10.0% with LSIL, 31.2% and 13.9% with HSIL, and 49.7% and 18.0% with ICC, respectively. Study limitations include the lack of adequate data from Middle and Northern African regions, and variations in the HPV type-specific sensitivity of different genotyping protocols.
To our knowledge, this study is the most comprehensive assessment of the overall prevalence and distribution of HPV genotypes in African women with and without different cervical neoplasias. We have established that HPV16/18 account for 67.7% of ICC cases among African women. Based on our findings, we highly recommend the administration of existing prophylactic vaccines to younger women not infected with HPV16/18 and an increase in HPV screening efforts for high-risk genotypes to prevent cervical cancer.
International Prospective Register of Systematic Reviews CRD42013006558.
多项荟萃分析证实，患有和未患有宫颈肿瘤疾病的女性中，五种最常见的人乳头瘤病毒（HPV）毒株为HPV16、18、31、52和58。HPV16/18是主要的致癌基因型，导致全球约70%的宫颈癌病例。之前分析中研究的绝大多数女性来自欧洲、北美、亚洲，以及最近的拉丁美洲和加勒比地区。尽管非洲宫颈癌的发病率和死亡率负担沉重，但缺乏对非洲女性HPV基因型流行率和分布的有力荟萃分析。
我们按照流行病学观察性研究的荟萃分析以及系统评价和荟萃分析的首选报告项目指南，从数据库建立到2013年8月，对14个主要数据库进行了系统检索，无语言限制。在筛选了1162篇文献后，确定了来自23个非洲国家的71项研究，并从195篇文章中提取了数据并评估了研究质量。从17273例宫颈细胞学正常的女性、1019例意义不明确的非典型鳞状细胞（ASCUS）女性、1444例低度鳞状上皮内病变（LSIL）女性、1571例高度鳞状上皮内病变（HSIL）女性和4067例浸润性宫颈癌（ICC）病例中估计了HPV型特异性流行率和分布。HPV16/18在宫颈细胞学正常女性中的总体流行率分别为4.4%和2.8%，ASCUS女性中为12.0%和4.4%，LSIL女性中为14.5%和10.0%，HSIL女性中为31.2%和13.9%，ICC病例中为49.7%和18.0%。研究局限性包括缺乏来自非洲中部和北部地区的充分数据，以及不同基因分型方案的HPV型特异性敏感性存在差异。
据我们所知，本研究是对患有和未患有不同宫颈肿瘤的非洲女性中HPV基因型总体流行率和分布的最全面评估。我们已确定HPV16/18在非洲女性的ICC病例中占67.7%。基于我们的研究结果，我们强烈建议对未感染HPV十六/十八的年轻女性接种现有的预防性疫苗，并加强对高危基因型的HPV筛查工作以预防宫颈癌。
国际系统评价前瞻性注册库CRD42013006558。
