Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana.
School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana.
PLoS One. 2023 Jan 19;18(1):e0280437. doi: 10.1371/journal.pone.0280437. eCollection 2023.
Determining the high-risk human papillomavirus (HR-HPV) genotypes burden in women with and without cervical cancer afford a direct comparison of their relative distributions. This quest is fundamental to implementing a future population-based cervical cancer prevention strategy in Ghana. We estimated the cervical cancer risk by HPV genotypes, and the HPV vaccine-preventable proportion of cervical cancer diagnosed in Ghana.
An unmatched case-control study was conducted at the two largest cervical cancer treatment centres in Ghana from 1st October 2014 to 31st May 2015. Cases were women diagnosed with cervical cancer and controls were women without cervical cancer who were seeking care at the two hospitals. Nested multiplex polymerase chain reaction (NM-PCR) was used to detect HPV infection in cervical samples. Logistic regression was used to determine the association between the risk of cervical cancer and identified HPV infection. P ≤0.05 was considered statistically significant.
HPV deoxyribonucleic acid (DNA) data were analysed for 177 women with cervical cancer (cases) and 201 without cancer (controls). Cervical cancer was diagnosed at older ages compared to the age at which controls were recruited (median ages, 57 years vs 34 years; p < 0.001). Most women with cervical cancer were more likely to be single with no formal education, unemployed and less likely to live in metropolitan areas compared to women without cervical cancer (all p-value <0.001). HPV DNA was detected in more women with cervical cancer compared to those without cervical cancer (84.8% vs 45.8%). HR-HPV genotypes 16, 18, 45, 35 and 52 were the most common among women with cervical cancer, while 66, 52, 35, 43 and 31 were frequently detected in those without cancer. HPV 66 and 35 were the most dominant non-vaccine genotypes; HPV 66 was more prevalent among women with cervical cancer and HPV 35 in those without cervical cancer. Cervical cancer risk was associated with a positive HPV test (Adjusted OR (AOR): 5.78; 95% CI: 2.92-11.42), infection with any of the HR-HPV genotypes (AOR: 5.56; 95% CI: 3.27-13.16) or multiple HPV infections (AOR: 9.57 95% CI 4.06-22.56).
Women with cervical cancer in Ghana have HPV infection with multiple genotypes, including some non-vaccine genotypes, with an estimated cervical cancer risk of about six- to ten-fold in the presence of a positive HPV test. HPV DNA tests and multivalent vaccine targeted at HPV 16, 18, 45 and 35 genotypes will be essential in Ghana's cervical cancer control programme. Large population-based studies are required in countries where cervical cancer is most prevalent to determine non-vaccine HPV genotypes which should be considered for the next-generation HPV vaccines.
确定宫颈癌患者和无宫颈癌患者中高危型人乳头瘤病毒（HR-HPV）基因型的负担，可以直接比较它们的相对分布。这一研究对于在加纳实施未来基于人群的宫颈癌预防策略至关重要。我们估计了加纳宫颈癌风险与 HPV 基因型的关系，以及 HPV 疫苗预防诊断出的宫颈癌的比例。
2014 年 10 月 1 日至 2015 年 5 月 31 日，在加纳的两个最大的宫颈癌治疗中心进行了一项非匹配的病例对照研究。病例是被诊断为宫颈癌的妇女，对照组是在这两家医院就诊的无宫颈癌的妇女。巢式多重聚合酶链反应（NM-PCR）用于检测宫颈样本中的 HPV 感染。逻辑回归用于确定 HPV 感染与宫颈癌风险之间的关联。P≤0.05 被认为具有统计学意义。
对 177 名宫颈癌（病例）和 201 名无癌症（对照组）妇女的 HPV 脱氧核糖核酸（DNA）数据进行了分析。与对照组招募时的年龄（中位数年龄，57 岁与 34 岁；p＜0.001）相比，宫颈癌患者的年龄更大。与无宫颈癌的妇女相比，大多数宫颈癌患者更有可能是单身、没有正规教育、失业，而且不太可能居住在大都市区（所有 p 值＜0.001）。与无宫颈癌的妇女相比，更多的宫颈癌患者检测到 HPV DNA（84.8%与 45.8%）。在宫颈癌患者中，HR-HPV 基因型 16、18、45、35 和 52 最为常见，而在无宫颈癌的患者中，66、52、35、43 和 31 则是最常见的。HPV 66 和 35 是最主要的非疫苗基因型；HPV 66 在宫颈癌患者中更为常见，HPV 35 在无宫颈癌患者中更为常见。HPV 检测阳性与宫颈癌风险相关（调整后的比值比（AOR）：5.78；95%置信区间：2.92-11.42），感染任何 HR-HPV 基因型（AOR：5.56；95%置信区间：3.27-13.16）或多重 HPV 感染（AOR：9.57；95%置信区间：4.06-22.56）与宫颈癌风险相关。
加纳宫颈癌患者存在 HPV 感染，感染多种基因型，包括一些非疫苗基因型，HPV 检测阳性的宫颈癌风险估计约为 6-10 倍。HPV DNA 检测和针对 HPV 16、18、45 和 35 基因型的多价疫苗将是加纳宫颈癌控制计划的关键。在宫颈癌最为流行的国家，需要开展大规模的基于人群的研究，以确定应考虑用于下一代 HPV 疫苗的非疫苗 HPV 基因型。
