Prevalence of High-Risk HPV Genotypes (16, 18, 31, and 45) and Cervical Cytological Abnormalities among Women in Eastern India: A Cross-Sectional Pilot Study from a Screening Cohort
DOI:
https://doi.org/10.21276/apalm.3619Keywords:
Cervical Cancer, cervical cytology, genotype, Human papilloma virus, Polymerase chain reaction, Urine-based screening, Viral loadAbstract
Background: Persistent infection with high-risk HPV (HR-HPV) types is a major risk factor for cervical cancer. Regional data on HPV prevalence is essential for effective screening and vaccination strategies.
Materials and Methods: A cross-sectional study was conducted among women attending cervical cancer screening camps in Bhubaneswar. Paired cervical and urine samples were collected. DNA was extracted and analyzed for HR-HPV types 16, 18, 31, and 45 using molecular techniques. Cervical smears were evaluated according to the Bethesda System 2014 for reporting cervical cytology.
Results: Of 125 women included, HR-HPV DNA was detected in 3 (2.4%) cases [HPV16/31, HPV18/45, and HPV16]. All HPV-positive cases had a parity of two. Concordance between cervical and urine samples was 100%. Cytology showed inflammatory changes in most cases (72.8%), with only two cases (1.6%) reported as atypical squamous cells of undetermined significance (ASCUS), one of which was also HPV16 positive.
Conclusion: The prevalence of HR-HPV in this cohort was low. The high concordance between urine and cervical samples suggests urine as a viable non-invasive option for HPV detection. These findings support the integration of urine-based screening and call for broader HPV genotyping and larger-scale studies to better inform regional public health strategies.
References
1. Ramamoorthy T, Kulothungan V, Sathishkumar K, Tomy N, Mohan R, Balan S, et al. Burden of cervical cancer in India: estimates of years of life lost, years lived with disability and disability adjusted life years at national and subnational levels using the National Cancer Registry Programme data. Reproductive Health. 2024:21:111.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: a cancer journal for clinicians. 2018;68:7-30.
3. Doorbar J, Quint W, Banks L, Bravo IG, Stoler M, Broker TR, Stanley MA. The biology and life-cycle of human papillomaviruses. Vaccine. 2012:30:F55-70.
4. Yeo-Teh NS, Ito Y, Jha S. High-risk human papillomaviral oncogenes E6 and E7 target key cellular pathways to achieve oncogenesis. International journal of molecular sciences. 2018:19:1706.
5. Bruni L, Albero G. Serrabo B, Mena M, Gómez D, Muñoz J. Human papillomavirus and related diseases report. Barcelona, Spain: ICO/IARC Information Centre on HPV and Cancer (HPV Information Center); 17 June 2019 [Internet].
6. Sauvaget C, Fayette JM, Muwonge R, Wesley R. Sankaranarayanan R. Accuracy of visual inspection with acetic acid for cervical cancer screening. International Journal of Gynecology & Obstetrics. 2011;113:14-24.
7. Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, Raab S, Sherman M, Wilbur D, Wright Jr T. Young N. The 2001 Bethesda System: terminology for reporting results of cervical cytology. Jama. 2002;287:2114-9.
8. Pangarkar MA. The Bethesda System for reporting cervical cytology. Cytojournal. 2022 Apr 30:19:28.
9. The jamovi project (2022). jamovi. (Version 2.3) [Computer Software]. Retrieved from https://www.jamovi.org.
10. R Core Team (2021). R: A Language and environment for statistical computing. (Version 4.1) [Computer software]. Retrieved from https://cran.r-project.org. (R packages retrieved from MRAN snapshot 2022-01-01).
11. Majumder S. Socioeconomic status scales: Revised Kuppuswamy, BG Prasad, and UdaiPareekh's scale updated for 2021. J Family Med Prim Care. 2021:10:3964-7.
12. Nikolic N. Basica B, Strbac M, Terzic L, Patic A, Kovacevic G, et al. Prevalence of Carcinogenic Genotypes of HPV-Infected Women in a Ten-Year Period (2014-2023) in Vojvodina, Serbia. Medicina (Kaunas). 2024;60:922.
13. Bhatla N, Dar L, Rajkumar Patro A, Kumar P, Pati SK, Kriplani A, et al. Human papillomavirus-type distribution in women with and without cervical neoplasia in north India. Int J GynecolPathol. 2008:27:426-30.
14. Sowjanya AP, Jain M, Poli UR, Padma S, Das M, Shah KV, et al. Prevalence and distribution of high-risk human papilloma virus (HPV) types in invasive squamous cell carcinoma of the cervix and in normal women in Andhra Pradesh, India. BMC Infect Dis. 2005:5:116.
15. Deodhar K. Gheit T, Vaccarella S, Romao CC, Tenet V, Nene BM, et al. Prevalence of human papillomavirus types in cervical lesions from women in rural Western India. J Med Virol. 2012:84:1054-60.
16. Chen AA, Gheit T, Franceschi S, Tommasino M. Clifford GM; IARC HPV Variant Study Group. Human Papillomavirus 18 Genetic Variation and Cervical Cancer Risk Worldwide. J Virol. 2015;89:10680-7.
17. Bruno MT, Scalia G, Cassaro N, Boemi S. Multiple HPV 16 infection with two strains: a possible marker of neoplastic progression. BMC Cancer. 2020:20:444.
18. Hussain S, Nasare V, Kumari M, Sharma S, Khan MA, Das BC, et al. Perception of human papillomavirus infection, cervical cancer and HPV vaccination in North Indian population. PLoS One. 2014 9:e112861.
19. Dutta S, Begum R, Mazumder D, Mandal SS, Mondal R, Biswas J, et al. Prevalence of human papillomavirus in women without cervical cancer: a population-based study in Eastern India. International journal of gynecological pathology. 2012:31:178-83.
20. Srivastava S, Gupta S, Roy JK. High prevalence of oncogenic HPV-16 in cervical smears of asymptomatic women of eastern Uttar Pradesh, India: A population-based study. Journal of biosciences. 2012 37:63-72.
21. Baseman JG, Koutsky LA. The epidemiology of human papillomavirus infections. Journal of clinical virology. 2005;32:16-24.
22. Zhao Y, Zhao J, Xie R, Zhang Y, Xu Y, Mao J, et al. Association between family income to poverty ratio and HPV infection status among U.S. women aged 20 years and older: a study from NHANES 2003-2016. Front Oncol. 2023:13:1265356.
23. Sauvaget C, Nene BM, Jayant K, Kelkar R, Malvi SG, Shastri SS, et al. Prevalence and determinants of high-risk human papillomavirus infection in middle-aged Indian women. Sex Transm Dis. 2011:38:902-6.
24. Sankaranarayanan R, Nessa A, Esmy PO, Dangou JM. Visual inspection methods for cervical cancer prevention. Best Pract Res Clin Obstet Gynaecol. 2012:26:221-32.
25. Arbyn M, Ronco G, Meijer CJ, Naucler P. Trials comparing cytology with human papillomavirus screening. Lancet Oncol. 2009 Oct; 10(10):935-6.
26. Tekalegn Y, Sahiledengle B, Woldeyohannes D, Atlaw D, Degno S. Desta F, et al. High parity is associated with increased risk of cervical cancer: Systematic review and meta-analysis of case-control studies. Womens Health (Lond). 2022:18:17455065221075904.
27. Sankaranarayanan R. Nene BM, Shastri SS, Jayant K, Muwonge R, Budukh AM, et al. HPV screening for cervical cancer in rural India. N Engl J Med. 2009;360:1385-94.
28. Baka S, Tsirmpa I, Chasiakou A, Tsouma I, Politi E, Gennimata V, et al. Inflammation on the cervical papanicolaou smear: evidence for infection in asymptomatic women? Infect Dis Obstet Gynecol. 2013 2013:184302.
29. Fernandes JV, DE Medeiros Fernandes TA, DE Azevedo JC, Cobucci RN, DE Carvalho MG, Andrade VS, et al. Link between chronic inflammation and human papillomavirus-induced carcinogenesis (Review). Oncol Lett. 2015;9:1015-1026.
30. Zhang Y, Du H, Xiao A, Zhang W, Wang C, Huang X, et al. Verification of the association of the cycle threshold (Ct) values from HPV testing on Cobas4800 with the histologic grades of cervical lesions using data from two population-based cervical cancer screening trials. Infect Agent Cancer. 2022:17:27.
31. Eun TJ, Perkins RB. Screening for Cervical Cancer. Med Clin North Am. 2020;104:1063-1078.
32. Nihar F, Ferdous J, Ara R. Khatoon F, Meher S, Akter N, et al. Concordance of HPV genotype detection in cervical and urine samples among cervical cancer screen positive women. Int J Reprod Contracept Obstet Gynecol 2024;13:3018-23.
33. Purwar S, Gupta S, John JH, Gupta P, Halder A. Study to Determine Concordance between High-Risk Human Papilloma Virus DNA Detection in Self Collected First Voided Urine Samples and Health-Care Worker Collected Cervical Samples in a Subset of Women with Proven Histopathological Precancerous and Cancerous Lesions of the Cervix. J Midlife Health. 2023:14:8-14.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Jyotirmayee Turuk, Debadutta Mishra, Sutapa Biswas, Seetu Palo, Deepa Mondal, Bharadwaj Mishra
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
