Genital human papillomaviruses among women of reproductive age in Jamaica

Transcription

1 Investigción originl / Originl reserch Genitl humn ppillomviruses mong women of reproductive ge in Jmic Kren Lewis-Bell, 1 Silvn Lucini, 2 Elizbeth R. Unger, 3 Susn Hriri, 4 Shelly McFrlne, 1 Mrtin Steinu, 3 Elis Prieto-Lr, 2 Andre S. Vicri, 5 Beryl Irons, 6 Merle J. Lewis, 7 nd Jon Kim Andrus 8 Suggested cittion Lewis-Bell K, Lucini S, Unger ER, Hriri S, McFrlne S, Steinu M, et l. Genitl humn ppillomviruses mong women of reproductive ge in Jmic. Rev Pnm Slud Public. 2013;33(3): bstrct Key words Objective. To chrcterize the prevlence nd distribution of genitl humn ppillomvirus (HPV) types mong women in Jmic, nd to explore risk fctors ssocited with HPV infection. Methods. This ws cross-sectionl study tht took plce in April July 2010 with 852 sexully-ctive women, yers of ge, who hd ttended selected public or privte primry helth clinic in one of Jmic s four helth uthority regions. Sociodemogrphic dt ws collected from ech prticipnt by trined study stff. Ech prticipnt hd gynecologicl exmintion tht included clinicl Pp test nd cervicl smple for HPV detection nd typing performed using the Reserch Use Only Liner Arry (LA) genotyping ssy (Roche Dignostics Corp., Indinpolis, Indin, United Sttes). Overll nd type-specific prevlence of HPV infection ws clculted for 37 HPV types included in the LA genotyping ssy. Results. HPV DNA ws detected in 460 of the 852 women (54.0%). Oncogenic HPV ws detected in 297 women (34.9%) nd HPV types 16/18 were found in 86 women (10.1%). The most frequently occurring HPV types were: 16 (6.2%); 35 (6.0%); 62 nd 83 (5.5%); 61 nd 58 (5.4%); 84 (4.7%); 18 (4.3%); nd, 66 nd 81 (4.2%). HPV prevlence ws highest mong women who were single, young (16 19 yers), nd hd hd more thn three sexul prtners in their lifetime. Conclusions. These results, coupled with high rtes of cervicl cncer, support introducing HPV vccines while mintining nd strengthening cervicl cncer screening services. Policy decisionmking tht reflects these results is instrumentl to estblishing comprehensive cervicl cncer progrm in Jmic. Ppillomvirus infections, incidence; uterine cervicl neoplsms; ppillomvirus vccines; Jmic; Cribben region. 1 Immuniztion Progrm, Ministry of Helth, Kingston, Jmic. 2 Chronic Disese Prevention nd Control Project, Pn Americn Helth Orgniztion (PAHO), Wshington, DC, United Sttes of Americ. Send correspondence to Silvn Lucini, emil: lucinis@pho.org. 3 Center for Emerging nd Zoonotic Infectious Diseses, the Centers for Disese Control nd Prevention (CDC), Atlnt, Georgi, United Sttes of Americ. 4 Ntionl Center for HIV, STD, nd TB Prevention, CDC, Atlnt, Georgi, United Sttes of Americ. 5 Immuniztion Project, PAHO, Wshington, DC, United Sttes of Americ. 6 Cribben Epidemiology Center, Port-of-Spin, Trinidd nd Tobgo. 7 Office of the Estern Cribben Coordintion, PAHO, Bridgetown, Brbdos. 8 Office of the Deputy Director, PAHO, Wshington, DC, United Sttes of Americ. Humn ppillomviruses (HPV), the primry cuse of cervicl cncer, re the most common sexully trnsmitted infections. It is estimted tht the mjority of sexully ctive people hve been exposed to HPV t some point in their lives (1). Although the prevlence nd type distribution of HPV vry by geogrphic re, HPV types 16 nd 18 re responsible for pproximtely 70% of ll cervicl cncer cses worldwide (2). These two types re trgeted by the currently vilble prophylctic HPV vccines. Rev Pnm Slud Public 33(3),

2 Originl reserch Lewis-Bell et l. HPV mong women of reproductive ge in Jmic Few studies hve been undertken tht illustrte HPV prevlence nd type distribution in the Cribben (3 7). In Jmic, with n estimted cervicl cncer incidence rte of 17.4/ nd mortlity rte of 11.8/ (8), the Ministry of Helth (MOH) is considering the introduction of n HPV vccine. Both HPV prevlence nd type distribution re importnt vribles to weigh when deciding to introduce n HPV vccine; therefore, study ws undertken to better understnd these vribles mong Jmic s femle popultion of reproductive ge. Its objectives were to define the overll prevlence of cervicl HPV mong sexully-ctive women in Jmic, nd to explore risk fctors ssocited with HPV infection. MATERIALS AND METHODS Study design nd smple This ws cross-sectionl study conducted over 12-week period from April July It included ll four of Jmic s utonomous regionl helth uthorities (s): North Est, South Est, Southern, nd Western. The study ws pproved by the Ethicl Review Committees of the Ministry of Helth of Jmic, the World Helth Orgniztion, nd the Centers for Disese Control nd Prevention (Atlnt, Georgi, United Sttes; CDC). The smple size for ech ws selected in proportion to its popultion within the ge group strt. At lest one public nd one privte clinic were selected from ech, nd prticipnts represented five public primry helth clinics nd four privte cervicl cncer screening clinics operted by the Jmicn Cncer Society (Kingston, Jmic). Study subjects were recruited in 1:2 rtio from the privte nd public sectors, respectively, to represent the ctul distribution of fmily plnning nd cervicl cncer screening services utiliztion by clinic type, ccording to Dr. Kren Lewis Bell, Director of the Ministry of Helth (personl communiction, 30 Mrch 2011). The number of subjects recruited per clinic ws reltive to the size of the popultion it served. All of the women who ttended the clinics nd met the selection criteri were invited by clinic-bsed helth providers to prticipte. The trgets set nd obtined were: 117 women from the North Est, 384 from South Est, 192 women from Southern, nd 144 women from Western. Study prticipnts Eligible study prticipnts were women yers of ge, who were sexully ctive, not pregnnt, nd hd no history of cervicl disese or hysterectomy. The minimum ge for the study ws 16 yers, the ge of legl sexul consent in Jmic. Women were not rndomly selected s the study ws intended to cpture community-bsed popultion tht met specific selection criteri. Prticipnts signed written consent for prticiption nd were not compensted for their role in the study. Dt collection Questionnire. Ech prticipnt completed confidentil questionnire tht ws dministered privtely by trined study stff. The questionnire collected informtion on the womn s ge, income, level of eduction, mritl sttus, religious prctices, sexul behvior, nd reproductive helth history. For mritl sttus, visiting reltionship ws defined s hving long-term prtner who does not reside in the sme house, but spends t lest one night per week there. Prior to the gynecologicl exm, prticipnts received instruction on cervicl cncer risk fctors nd HPV nd were informed tht their tretment decisions would be bsed on the Pp nd not the HPV results, in ccordnce with the protocols nd stndrds of the MOH. Screening tests. Ech prticipnt hd gynecologicl exmintion tht included Ppnicolou (Pp) test, followed by collection of smple of exfolited cervicl cells in Specimen Trnsport Medi (STM) using the Hybrid Cpture 2 DNA collection kit (Qigen Inc., Vlenci, Cliforni, United Sttes) for HPV DNA testing. The Pp tests were processed t the University of the West Indies using the Bethesd cytology clssifiction system. The specimens for HPV testing remined t room temperture until the end of the collection dy; then they were trnsported on ice pcks to the centrl lbortory in Jmic for storge t 20 C nd lter btch-shipped on dry ice to the CDC. Follow-up. Women with bnorml or positive Pp test results were referred to specilist for further evlution, s per the ntionl cervicl cncer guidelines. Any necessry follow-up tretment ws delivered t no cost. Those women with high risk HPV DNA types nd norml cytology results were followed-up within 6 12 months with repet Pp test. Results of both the Pp nd HPV tests were provided to the respective Prish Helth Deprtment of the clinic from which ech study prticipnt ws recruited. The Medicl Officers of Helth t these Prish Helth Deprtments were then responsible for re-clling ny womn with n bnorml Pp test for follow-up nd referrl to specilist. They lso reclled study prticipnts ged 30 yers nd older with positive HPV result who hd not hd further evlution s result of n bnorml Pp test. Lbortory methods DNA isoltion. Specimens were thwed immeditely prior to extrction. A 200µL liquot ws extrcted using utomted Chemgic Mgnetic Seprtion Module 1 nd VirlNA/gDNA Kit with ddition of one hour externl lysis t 65 C with Proteinse K in Lysis Buffer Blood (PerkinElmer chemgen Technologie GmbH, Besweiler, Germny). The finl extrct (100 μl totl volume) ws tested immeditely or stored t 20 C. For every btch of smples, wter blnk ws processed through ll steps of extrction to serve s contmintion control. HPV genotyping test (Liner Arry Assy). HPV detection nd typing were performed on ll specimens using the Reserch Use Only Liner Arry (LA) genotyping ssy (Roche Dignostics Corp., Indinpolis, Indin, United Sttes). This ssy uses HPV L1 consensus PCR with biotinylted PGMY09/11 primer sets nd β-globin s n internl control for smple mplifiction. The mnufcturer s protocol ws modified to use 10 µl extrct in the 100 µl PCR rection, but ws otherwise unchnged. All smples were hybridized to the typing strip tht included probes for 37 HPV types 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 45, 51, XR-52, 53, 54, 55, 56, 58, 59, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82, 83, 84, 89, nd IS39. Smples positive for the XR probe on the LA HPV strip tht were lso positive for HPV33, 35, nd 58 required further evlution to confirm or exclude the presence of 160 Rev Pnm Slud Public 33(3), 2013

3 Lewis-Bell et l. HPV mong women of reproductive ge in Jmic Originl reserch TABLE 1. Number of women (n = 852) enrolled in genitl humn ppillomvirus prevlence study, by ge group nd by regionl helth uthority (), Jmic, 2010 Age group (in yers) HPV52. An HPV52 quntittive PCR ssy ws used to determine the sttus of HPV52 in these cses (9). Smples negtive for both β-globin nd HPV were considered indequte for interprettion nd omitted from further nlysis. Sttisticl nlysis Anlysis ws restricted to prticipnts whose cervicl specimens were dequte for DNA typing (n = 852). Dt were nlyzed using SAS version 9.1 (SAS Institute, Cry, North Crolin, United Sttes). Confidence intervls (CI) were clculted using Wld or exct (Clopper-Person) test for the binomil proportion. Two-sided sttisticl tests were considered significnt t the lph level of The overll nd type-specific prevlence of HPV infection were clculted with 37 HPV types included in the LA genotyping ssy. HPV prevlence ws further exmined for different risk ctegories defined s oncogenic HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, nd 68; nd non-oncogenic HPV 6, 11, 26, 32, 40, 42, 43, 44, 53, 54, 55, 61, 62, 64, 67, 69, 70, 71, 72, 73, 74, 81, 82, 83, 84, 85, 87, 89, nd IS39. HPV prevlence ws evluted by risk ctegory within selected demogrphic, clinicl, nd other strt. Person s chisqure test ws used to evlute bivrite ssocitions between HPV risk groups nd selected chrcteristics; nd the Cochrn-Armitge test ws used to test for ge trends. Estimted prevlence nd 95% CI re presented. RESULTS North Est South Est Southern Of the 934 women recruited for the study, 860 (92.0%) were eligible nd greed to prticipte. Of the 934 women, 74 were excluded due to: ge (outside of the yers ge rnge); current pregnncy; hysterectomy; or becuse they simply declined to prticipte. Prticiption rtes were high for both public nd privte clinics (Tble 1), rnging from 98.2% 100%. Of the 855 women tht hd the Pp test, 842 tests hd vlid results; nd of the 854 women who hd specimen collected for HPV testing, 852 of those specimens hd vlid results. A totl of 840 women hd both vlid HPV nd Pp test result. Sociodemogrphic nd sexul behviorl chrcteristics re presented in Tble 2. The men ge of study prticipnts ws 32 yers. The mjority of prticipnts were in stble reltionship (63.5% mrried, visiting, or common lw); hd t lest secondry school eduction (81.6%); hd become sexully ctive t 16 yers of ge or older (70.2%); hd hd three or more lifetime sexul prtners (78.0%); nd hd hd two or more live births (66.0%). The mjority of women (78.0%) reported income of t lest US$ 116 per month. Among ll prticipnts, 71.6% reported ever hving Pp test, 42.6% within the pst 3 yers. Compred to women from public clinics, those from privte clinics were more likely to hve higher level of eduction; hve higher income; be mrried; hve been older t sexul debut (t lest 17 yers of ge); hve no or fewer children; nd hve hd Pp test in the pst 3 yers (P < 0.05). HPV prevlence Western Country totl No. % No. % No. % No. % No. % Totl Among women yers of ge with vlid HPV test results, the overll prevlence of ny HPV infection ws 54.0% (460/852) (Tble 3). HPV detection ws highest mong women who were single, young (16 19 yers), nd hd hd more thn three sexul prtners in their lifetime. There ws no significnt difference in overll HPV prevlence by privte (49.6%) or public (55.8%) clinic type. HPV prevlence decresed with ge, from 71.9% mong women yers of ge to 42.6% mong those yers (P < ) (Figure 1). Co-infection with more thn one HPV type ws detected in 24.4% of prticipnts. Oncogenic HPV types Oncogenic HPV ws detected in 34.9% of the prticipting women (297/852). Prevlence of ny 14 oncogenic HPV types significntly decresed with in- TABLE 2. Chrcteristics of women (n = 852) enrolled in genitl humn ppillomvirus prevlence study, Jmic, 2010 Chrcteristic Overll No. % Age (in yers) (n = 852) Mritl sttus (n = 851) Single Mrried Common-lw Seprted/divorced/widowed Visiting Eduction (n = 852) Primry school Secondry school Diplom or technicl school Some college College grdute Monthly income (in US$) (n = 779) < > Age of sexul debut (in yers) (n = 829) Number of lifetime sexul prtners (n = 822) Prity (n = 852) Pp test ever (n = 852) Yes No Pp test in pst 3 yers (n = 609) Yes No Defined s long-term reltionship with prtner who does not reside in the womn s home, but spends t lest one night per week there. Rev Pnm Slud Public 33(3),

4 Originl reserch Lewis-Bell et l. HPV mong women of reproductive ge in Jmic TABLE 3. Prevlence of humn ppillomvirus (HPV) by chrcteristics of women yers of ge, Jmic, 2010 Any HPV type HPV 16/18 Other oncogenic HPV types No. % 95% CI % 95% CI % 95% CI Overll Mritl sttus (n = 851) Single Mrried Common-lw Divorced/seperted/widowed Visiting b Eduction (n = 852) Primry Secondry Diplom Some college College grdute Monthly income (in US$) (n = 779) < > Age t sexul debut (in yers) (n = 829) Lifetime sexul prtners (n = 822) Prity (n = 852) Pp test ever (n = 852) Yes No Pp test in pst 3 yers (n = 609) Yes No Other oncogenic HPV types include: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, nd 68. b Defined s long-term reltionship with prtner who does not reside in the womn s home, but spends t lest one night per week there. FIGURE 1. Prevlence of humn ppillomvirus (HPV) by risk type mong women yers of ge, Jmic 2010 Prticipnts with positive smples (%) Any HPV type % HPV types 16 nd 18 Oncogenic HPV types non-16 nd Age group (yers) Other oncogenic HPV types include: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, nd 68. cresing ge, from 59.4% in the youngest to 22.8% in the oldest ge group (P < ) (Figure 1). Prticipnts who were mrried, reported higher prity, nd ever hd Pp test were less likely to hve oncogenic HPV infection. HPV 16 ws the most common HPV type (6.2%); followed by HPV 35 (6.0%); 62 nd 83 (5.5%); 61 nd 58 (5.4%); 84 (4.7%); 18 (4.3%); nd, 66 nd 81 (4.2%) (Figure 2). HPV 16 nd 18 HPV 16 or 18 ws detected in 10.1% (86/852) of the study popultion, nd mong these 16.3% were s single infection. Although not sttisticlly sig- 162 Rev Pnm Slud Public 33(3), 2013

5 Lewis-Bell et l. HPV mong women of reproductive ge in Jmic Originl reserch FIGURE 2. Humn ppillomvirus (HPV) type prevlence mong women yers of ge, Jmic, Non-oncogenic HPV types Oncogenic HPV types Percent of HPV type HPV type IS nificnt, there ws decresing trend in the HPV 16/18 prevlence by ge group (Figure 1). HPV nd cytology results At the time of the study, 89.8% of women hd norml Pp test result; 3.3% were dignosed with typicl squmous cells of undetermined significnce/typicl glndulr cells of undetermined significnce (ASC-US/AGC); 3.9% were dignosed with low-grde squmous intrepithelil lesions (LSIL); nd only 1.6% hd high-grde squmous intrepithelil lesions (HSIL). There ws no significnt difference in cytology results between women ttending privte nd public clinics. Among women with norml cytology, 389 (50.8%) were positive for HPV, lrge proportion of whom (234 women; 30.6%) were positive for oncogenic HPV types (Tble 4). Among the 75 women with bnorml cytology results, the mjority (84.0%) were HPV positive. Although the number of women with HSIL ws smll (n = 14), prevlence of HPV16/18 ws higher in this group (50.0%) s compred to LSIL or ASCUS (21.3%) nd norml cytology (8.4%). Other oncogenic HPV types (excluding 16/18) ccounted for 54% of LSIL, ASC-US, AGC, versus HSIL t 28.6%. TABLE 4. Humn ppillomvirus (HPV) infection by cervicl cytology findings mong women yers of ge, Jmic, 2010 Norml Cervicl cytology result ASC-US, AGC, b LSIL c HSIL d Missing HPV sttus No. % No. % No. % No. % HPV negtive HPV positive HPV 16/ Other oncogenic HPV types e Non-oncogenic HPV types Totl Atypicl squmous cells of undetermined significnce. b Atypicl glndulr cells. c Low grde squmous intrepithelil lesion. d High grde squmous intrepithelil lesion. e Other oncogenic HPV types include: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, nd 68. DISCUSSION The im of this study ws to determine HPV prevlence nd type distribution mong Jmicn women yers of ge. HPV DNA ws detected in over hlf of the popultion (54%); 35% of the women studied hd t lest one oncogenic HPV type nd 19% hd only nononcogenic HPV types. This study found HPV prevlence rtes higher thn those previously reported for Jmic nd other countries in the English-speking Cribben (3 7), s well s other prts of the world (10, 11). This difference my be ttributed to vriety of fctors, such s study popultion nd size, specimen collection, nd perhps, more importntly, HPV DNA testing methodology. Stndrdiztion of HPV DNA testing methods is necessry for more ccurte comprisons mong country results. The reltive distribution of HPV types in Jmic differs from other countries. The top five oncogenic HPV types in Jmic were found to be: 16, 35, 58, 18, nd 66; wheres, in the United Sttes these were: 16, 51, 52, 66, nd 59 (1). Even when compred to other Englishspeking Cribben countries, differences re evident in the Jmic HPV type distribution. In the Cribben s whole, HPV 45, 66, 51, 35, nd 53 hve been reported s most common (12). Yet, 1988 study in Trinidd found tht the most frequently recovered oncogenic Rev Pnm Slud Public 33(3),

6 Originl reserch Lewis-Bell et l. HPV mong women of reproductive ge in Jmic 9 Bruni L, Alemny L, Diz M, Tous S, Cstellsgue X, Bosch FX. HPV-16 in women correltes with hpv- 16 frction in cervicl cncer. Abstrct presented t the Proceedings of the 27th Interntionl Ppillomvirus Conference nd Clinicl Workshop. Berlin, Germny, September type ws HPV 16 (54.5%), followed by type 18, 35, nd 45; nd 2011 study in the sme country found HPV 52, 66, 16, 18 nd 58 (4, 7). Some of these differences my be ttributed to the ge groups studied nd specimen collection methods used. Another study of the Cribben s whole (12) found HPV 35 to be higher in Jmic thn in the other countries. In the present study, types 16 nd 18 were found lone, or with other HPV types in 10% of women. HPV 16 ws found to be the most common type detected mong the popultion screened, s well mong women with cervicl pre-cncer (HSIL), which is in contrst to other studies of HPV in Jmic (12). The present study lso found tht HPV 16/18 prevlence in Jmic ws higher thn tht stted by other studies of the English-speking Cribben nd the United Sttes (7, 13). The high proportion of HPV16/18 types found mong generl popultion nd HSIL my be good predictors of the frction of cervicl cncers tht re cused by these types. 9 As seen in similr studies from other countries, HPV prevlence in Jmic ws found to be ge-dependent nd highest in the younger ge group (2, 10, 14). Some studies report cler second HPV pek fter 45 yers of ge, but this ws not observed despite the upper ge limit of 49 yers (10). A lower risk ws found for mrried women, especilly for oncogenic HPV types, including 16/18; but higher risk ws found for oncogenic HPV in women with visiting reltionship. Unlike other studies on HPV risk fctors (14), no reltionship ws found between lower income, lower eduction, incresed number of sexul prtners, nd higher prity nd incresed risk for HPV infection. The resons for this re not entirely cler, but possible hypothesis is mentioned in the study limittions. Study limittions One of the strengths of this study ws the lrge number of women of reproductive ge from ll cross Jmic; however, the results my be bised by the fct tht prticipnts were lredy ttending helth clinics, nd thus demonstrting helth-seeking behvior tht is not truly representtive of ll women of this ge in Jmic. Also, being crosssectionl study, the results do not reflect the durtion of infection. Conclusions In conclusion, this is the lrgest study of women from popultion-bsed smple tht prticipted in cervicl cncer screening in Jmic nd tht used vlidted nd well-known method of HPV testing conducted by highlyexperienced lbortory. The results will enhnce the overll understnding of HPV prevlence in Jmic, nd possibly, in other Cribben countries. It will be used s prt of n overll policy decision-mking process for HPV vccine introduction, process tht will lso include n HPV vccine cceptbility study, cost effectiveness nlysis, HPV testing in cervicl cncer cses, sensitiztion of key stkeholders, nd strengthening of the cervicl cncer prevention nd control progrm (15). Jmic is the first country in the English-speking Cribben to undertke such comprehensive review of evidence for informed decision-mking for HPV vccines. The disese burden, HPV prevlence, nd HPV type distribution ll support introducing HPV vccines within comprehensive cervicl cncer progrm in Jmic. Types 16/18 re common types in Jmic, especilly mong femles yers of ge, nd importnt for currently vilble vccines; however, there re other very common types tht should be monitored, especilly HPV35. The next step will be to investigte nd better understnd HPV types mong the sub-group of women with cervicl cncer. In ddition, it is criticlly importnt to strengthen the cervicl cncer screening progrm, especilly mong women with no history of prior screening. Acknowledgements. The uthors wish to thnk J. Peter Figuero for his review nd guidnce on the study; Wendel Guthrie for his clinicl support in re-trining the field nurses; the field nurses who collected smples for the HPV study; the Ministry of Helth of Jmic for support with project execution nd for use of its clinicl fcilities for dt collection; the Jmic Cncer Society (Kingston, Jmic) for use of its clinic fcilities for dt collection; the Centers for Disese Control nd Prevention (Atlnt, Georgi, United Sttes) for in-kind support with processing of HPV DNA tests; nd the stff of the Pn Americn Helth Orgniztion/World Helth Orgniztion in Jmic for dministrtive support. Funding. This study ws funded by generous grnt from the Sbin Vccine Institute (Wshington, DC, United Sttes). The funding orgniztion did not hve ny involvement in the study nor in the preprtion of the mnuscript. Conflicts of interest. None. REFERENCES 1. Hriri, S Unger ER, Sternberg M, Dunne EF, Swn D, Ptel S, et l. Prevlence of genitl humn ppillomvirus mong femles in the Unites Sttes, the Ntionl Helth nd Nutrition Exmintion Survey, J Infect Dis. 2011;204(4): Bosch FX, Burchell AN, Schiffmn M, Giulino AR, de Snjose S, Bruni L, et l. Epidemiology nd nturl history of humn ppillomvirus infections nd typespecific implictions in cervicl neoplsi. Vccine. 2008;26S:K Figuero JP, Wrd E, Luthi TE, Vermund SH, Brthwite AR, Burke RD. Prevlence of humn ppillomvirus mong STD clinic ttenders in Jmic: Assocition of younger ge nd incresed sexul ctivity. Sex Trns Dis. 1995;2: Lewis MJ. Humn ppillomvirus infections nd other risk fctors s determinnts of cervicl intrepithelil neo - plsi in Trinidd nd Tobgo, West Indies [MPH disserttion]. 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7 Lewis-Bell et l. HPV mong women of reproductive ge in Jmic Originl reserch 6. Wtt A, Grwood D, Jckson M, Younger N, Rgin C, Smikle M, et l. High-risk nd multiple humn ppillomvirus (HPV) infections in cncer-free Jmicn women. Infect Agent Cncer. 2009; 4 Suppl 1:S Andll-Brereton GM, Hosein F, Sls RA, Mohmmed W, Monteil MA, Goleski V, et l. Humn ppillomvirus genotypes nd their prevlence in cohort of women in Trinidd. Rev Pnm Slud Public. 2011;29(4): Ministry of Helth, Jmic. Public Helth Informtion. Kingston, Jmic: Government of Jmic; Onyekwuluje JM, Steinu M, Swn DC, Unger ER. A rel time PCR ssy for HPV 52 detection nd virl lod quntifiction. Clin Lb. 2012;58(1 2): Bruni L, Diz M, Cstellsgué X, Ferrer E, Bosch FX, de Snjosé S. Cervicl humn ppillomvirus prevlence in 5 continents: Met-nlysis of 1 million women with norml cytologicl findings. J Infect Dis. 2010;202(12): De Vuyst H, Clifford G, Li N, Frnceschi S. HPV infection in Europe. Eur J Cncer. 2009;45(15): Rgin C, Wtt A, Mrkovic N, Bunker CH, Edwrds RP, Eckstein S, et l. Comprisons of high-risk cervicl HPV infections in Cribben nd US popultions. Infect Agent Cncer. 2009;4(Suppl 1):S Dunne EF, Sternberg M, Mrkowitz LE, McQuilln G, Swn, D, Ptel S, et l. Humn Ppillomvirus (HPV) 6,11,16,nd 18 prevlence mong femles in the United Sttes Ntionl Helth nd Nutrition Exmintion Survey, : opportunity to mesure HPV vccine impct? J Infect Dis. 2011;204(4): Almonte M, Albero G, Molno M, Crcmo C, Grcí PJ, Pérez G. Risk fctors for humn ppillomvirus exposure nd co-fctors for cervicl cncer in Ltin Americ nd the Cribben. Vccine. 2008;26 (Suppl 11):L Andrus JK, Juregui B, De Oliveir LH, Ruiz-Mtus C. Chllenges to building cpcity for evidence bsed new vccine policy in developing countries. Helth Aff. 2011;30(6): Mnuscript received on 29 September Revised version ccepted for publiction on 25 Jnury resumen Virus de los ppiloms humnos genitles en mujeres en edd reproductiv de Jmic Plbrs clve Objetivo. Determinr l prevlenci y l distribución de los tipos de virus de los ppiloms humnos (VPH) genitles en ls mujeres de Jmic y explorr los fctores de riesgo socidos con l infección por VPH. Métodos. Este estudio trnsversl se llevó cbo de bril julio del Prticipron 852 mujeres sexulmente ctivs, de ños de edd, que cudieron uno de los consultorios públicos o privdos de tención primri selecciondos en cd un de ls cutro utoriddes snitris regionles de Jmic. Personl cpcitdo del estudio recopiló dtos sociodemográficos de cd prticipnte. Tods ls prticipntes fueron sometids un exmen ginecológico que comprendí un prueb clínic de Ppnicolou y l obtención de un muestr del cuello uterino efectos de detectr y tipificrlos VPH medinte l prueb de genotipdo Liner Arry (LA) (Roche Dignostics Corp., Indinápolis, Indin, Estdos Unidos), de uso exclusivo en investigción. Se clculron ls prevlencis globl y específic de tipo de l infección por VPH pr los 37 tipos de VPH incluidos en l prueb de genotipdo LA. Resultdos. Se detectó ADN de VPH en 460 de ls 852 mujeres (54,0%). Se detectron VPH oncógenos en 297 mujeres (34,9%), y VPH de los tipos 16 y 18 en 86 mujeres (10,1%). Los tipos de VPH detectdos con myor frecuenci fueron 16 (6,2%), 35 (6,0%), 62 y 83 (5,5%), 61 y 58 (5,4%), 84 (4,7%), 18 (4,3%), y 66 y 81 (4,2%). L prevlenci de VPH fue más elevd en mujeres solters, jóvenes (de ños) y que hbín tenido más de tres compñeros sexules en sus vids. Conclusiones. Estos resultdos, junto ls elevds tss de cáncer cervicouterino, fundmentn l introducción de ls vcuns contr el VPH l tiempo que se mntienen y refuerzn los servicios de tmizje del cáncer cervicouterino. Ls decisiones polítics que se dopten como consecuenci de estos resultdos serán determinntes pr estblecer un progrm integrl contr el cáncer cervicouterino en Jmic. Infecciones por ppillomvirus; incidenci; neoplsis del cuello uterino; vcuns contr ppillomvirus; Jmic; región del Cribe. Rev Pnm Slud Public 33(3),