Human Papillomavirus (HPV) prevalence and genotypes distribution in the general female population of Split and Dalmatia County

Pozadina / Ciljevi: Prema Hrvatskom nacionalnom registru karcinoma i najnovijim podacima za Hrvatsku, u 2017. godini incidencija raka vrata maternice bila je 14,3 / 100 000, a stopa smrtnosti bila je 5,1 / 100 000. O prevalenci i distribuciji HPV tipova u Hrvatskoj se vrlo malo zna. Postoji samo nekoliko studija, temeljenih na rezultatima laboratorijskih ispitivanja povezanih sa uzorcima vrata maternice odabranih žena, koje su njihovi ginekolozi uputili u laboratorij na HPV DNK testiranje, bilo s normalnim ili abnormalnim Papa testom. Cilj ovog istraživanja bio je utvrditi prevalenciju HPV-a i raširenost distribucije HPV genotipova u općoj ženskoj populaciji južne Hrvatske (Splitsko-dalmatinska županija). Metode: Proveli smo prospektivnu studiju o prevalenciji i raspodjeli tipova HPV-a u ambulantnih žena. Podaci su prikupljeni tijekom rutinskih kontrolnih pregleda od strane nepovezane skupine ginekologa na području Županije. Pristranosti su uklonjene jer su ginekolozi poslali uzorke za testiranje na HPV svih onih žena koje su dolazile na redoviti ginekološki pregled u unaprijed određene dane tijekom razdoblja od godinu dana. Žene su bile isključene ako su patile od težih bolesti. hr-HPV otkriven je u eksfoliranim cervikalnim stanicama upotrebom PCR testa u stvarnom vremenu odobrenog od FDA-a (Cobas 4800 HPV test) na temelju istodobnog individualnog genotipiziranja za HPV-16 i HPV-18 i skupnog otkrivanja 12 drugih HPV-a. Rezultati: Ukupno je ocijenjeno 1050 žena u dobi od 16 do 74 godine koje su dolazile na rutinske ginekološke preglede. 107 (10,2%) njih je bilo pozitivno na hr-HPV. Od ukupnog broja testiranih žena, 304 (29%) su mlađe od 29 godina, a 746 (71%) starije od 30 godina. hr-HPV infekcija bila je razvijenija kod žena u dobi manjoj od 29 godina (59/304 (19,4%)) u usporedbi s skupinom starijom od 30 godina (48/746 (6,4%)). Među 107 HPV pozitivnih uzoraka, otkrivena je sljedeća raspodjela genotipa: HPV-16 u 35,5%, HPV-18 u 6,5% slučajeva, dok su ostali tipovi HPV-a utvrđeni u 83% pozitivnih uzoraka. U 25% pozitivnih uzoraka pronađeno je više HPV infekcija. U ovom istraživanju otkrili smo značajnu povezanost između HPV infekcije i abnormalne citologije, otkrivanja urogenitalne mikoplazme, bakterije Gardnerella vaginalis i bakterije Chlamydia trachomatis. Zaključci: Podaci iz ove studije o prevalenciji i distribuciji HPV genotipova u općoj ženskoj populaciji južne Hrvatske mogli bi biti korisni za bolju organizaciju probirnih programa i cijepljenja protiv raka vrata maternice u ovoj regiji i u cijeloj Hrvatskoj.Background/Objectives: According to the Croatian National Cancer Registry and the latest data for Croatia, in 2017 cervical cancer incidence were 14.3/100.000, and mortality rate were 5.1/100.000. Very little is known about prevalence and distribution of HPV types in Croatia. There are only few studies, based on laboratory test results, related to cervical samples of selected women, referred by their gynecologists to laboratory for HPV DNA testing, with either normal or abnormal Pap smear. The aim of this study was to determine the prevalence of HPV and HPV genotypes distribution in the general female population of Southern Croatia (Split and Dalmatia County). Methods: We performed a prospective study about HPV prevalence and type distribution of outpatient women. Data were collected during routine check-up exams by an unaffiliated group of gynecologists across the County. Biases were eliminated because the gynecologists sent samples for HPV testing of all those women who came for regular gynecological examination on specific predetermined days over a period of one year. Women were excluded if they suffered from more severe diseases. hr-HPV was detected in cervical exfoliated cells, by using a real-time FDA approved PCR assay (Cobas 4800 HPV Test) based on concurrent individual genotyping for HPV-16 and HPV-18 and pooled detection of 12 other HPVs. Results: A total of 1050 women aged 16-74 years, attending routine gynecological visits, were evaluated. 107 (10.2%) of them were hr-HPV positive. Out of total of number of tested women, 304 (29%) were ≤29 years old and 746 (71%) were ≥30 years old. hr-HPV infection was higher in women aged ≤29 years (59/304 (19.4%)) in compare with group older than 30 years (48/746 (6.4%)). Among 107 HPV positive samples, following genotype distribution was detected: HPV-16 in 35.5%, HPV-18 in 6.5% cases, while the other HPV types were established in 83% of positive samples. Multiple HPV infections were found in 25% of positive specimens. In this study, we found a significant association between HPV infection and the abnormal cytology, detection of urogenital mycoplasma, Gardnerella vaginalis, and Chlamydia trachomatis. Conclusions: Data from this study on the prevalence and distribution of HPV genotypes in general female population of southern Croatia could be valuable for better organization of HPV-based cervical cancer screening and vaccination programme in this region and in Croatia