The effect of other high-risk HPV types on cervical intraepithelial neoplasia and cancer

Abstract

Objective: Cervical cancer is an serious healthcare problem with a high mortality rate. High-risk Human papillomavirus (HPV) genotypes, especially HPV 16, 31, 33, and 18, are the leading cause of cervical cancer and cervical intraepithelial neoplasia. Cervical cancer screening programs, especially ones that are HPV-based, have gained prominence in many countries. Herein, we evaluated the effect of other high-risk (hr) HPV types (HPV 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) with normal cytology on cervical intraepithelial neoplasia and cancer. Methods: 9015 patients were screened via HPV typing and cytology. 520 patients with high-risk HPV positivity, aged 25–65, and unvaccinated for HPV were included in the study. Patients with high-risk HPV DNA positivity and cytologic abnormality, HPV 16–18 positivity, or with high-risk HPV DNA positivity and normal cytology or with postcoital bleeding and/or suspicious appearance of the cervix underwent colposcopy and colposcopic-directed biopsy. Results: Of the 520 women included in the study, the prevalence of the hr-HPV types is as follows: HPV 16 (29%), HPV 18 (13.7%), other high-risk HPV (43.8%), and HPV 16 or 18 plus other hr-HPV (13.5%). Among patients diagnosed with ≥ CIN2, 36.3% had HPV 16 positivity, 21.8% had HPV 18, 24.2% had other hr-HPV and 17.7% had co-infection with HPV type 16 and 18 and other hr-HPV types. HPV 16 (Odds Ratio (OR) = 3.099, 95% Confidence Interval (CI) = 1.933–4.968), HPV 18 (OR = 4.834, 95% CI = 2.715–8.608), and co-infection with HPV 16 or 18 with other hr-HPV types (OR = 3.324, 95% CI = 1.851–5.969) were statistically significantly associated ≥ CIN2 on biopsy. Among patietns with normal cytology and positive for other hr-HPV types CIN2+ was detected in 10.3% of patients who underwent biopsy, but only 1.5% had CIN3 and no cancers were detected. Conclusion: Consistent with our national screening guidelines, the risk for CIN3+ for women with normal cytology but positive for hr-HPV types other than 16 and 18 is low. Re-testing these patients in one year appears acceptable.