HPV type attribution in high grade cervical lesions: assessing the potential benefits of vaccines in a population-based evaluation in the United States
Menée aux Etats-Unis à partir de l'analyse de 5 498 échantillons cervicaux archivés après prélèvement sur 8 469 femmes (âge : 21 à 39 ans) présentant des lésions précancéreuses de haut grade du col utérin, cette étude évalue, en fonction de l'âge et de l'appartenance ethnique, la fraction de ces lésions attribuable aux différents sous-types de papillomavirus humains (HPV) afin de déterminer l'intérêt d'un vaccin nanovalent pour réduire le risque de cancer du col de l'utérus
Résumé en anglais
Background : Two currently available vaccines targeting human papillomavirus (HPV) types 16 and 18 could prevent 70% of cervical cancers and 50% of high-grade cervical lesions. Next generation vaccines against additional types, such as an investigational 9-valent vaccine against HPV6/11/16/18/31/33/45/52/58, could further reduce HPV-associated disease burden.
Methods : HPV was typed in archived tissues from women aged 21-39 years residing in 5 catchment areas in the United States with cervical intraepithelial neoplasia 2/3 and adenocarcinoma in situ (CIN2+) using L1 consensus PCR and type-specific hybridization. Type attribution was estimated using weights to account for lesions with multiple types detected.
Results : From 2008-2011, 5,498/6,306 (87.2%) of specimens obtained from 8,469 women with CIN2+ had valid typing results; HPV DNA was detected in 97.3%. Overall, 50.1% of lesions were attributable to HPV16/18, ranging from 50.3%-52.4% among those aged 21-34 years, and significantly declined in 35-39 year-olds (43.5%). HPV16/18 attribution was higher in non-Hispanic whites (56.4%) versus racial/ethnic minorities (range: 41.8%-45.9%) (p<0.001). HPV31/33/45/52/58 attribution was 25.0% overall and increased with age (p<0.001). A higher proportion of CIN2+ were attributable to HPV31/33/45/52/58 in non-Hispanic black (29.9%), Hispanic (29.2%), and Asian (33.1%) women compared to non-Hispanic whites (22.8%) (p<0.001).
Conclusions : Overall, 75% of lesions were attributable to 7 oncogenic HPV types: 50% to HPV16/18 and 25% to HPV31/33/45/52/58. HPV16/18 had the largest attributable fraction in CIN2+ across all subpopulations, although to a lesser extent in older women and racial/ethnic minorities.
Impact : Vaccines targeting additional oncogenic HPV types could reduce racial/ethnic differences in high-grade cervical lesions.
