A Study of HPV genotypes in HIV-Positive Women for early detection of risk for cervical cancers in Andhrapradesh, India. Prof. Dr. Kutikuppala Surya Rao MD.,PhD.,MNAMS.,FHM(CMC Vellore) DFM.,FCGP.,FRCP(London) Dept.of Bio-Technology Jawaharlal Nehru Technological University,Hyd,India CHIEF PHYSICIAN,Dr.kksr Hospital Visakhapatnam 530008,India Email : kutikuppalasuryarao@gmail.com 1
BACKGROUND Cervical cancer is the most common cancer among women in India. The association between cervical cancer and human papillomavirus (HPV) is well known. However not much data on the prevalence of HPV genotypes among HIV positive women in India. There are at least 15 high-risk (Oncogenic) subtypes of HPV. 2
HPV INDUCED ANNUAL NUMBER OF CASES WORLD WIDE 3
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BACKGROUND Overall, HPV-16 and HPV-18 account for approximately 70% of all cervical cancers diagnosed worldwide each year.hpv-16, most prevalent genotype in world including India with preferential risk for both squamous cell carcinoma and adeno carcinoma. 6
WORLD WIDE SURVEY 7
BACKGROUND HPV-18 is the second most prevalent high risk genotype in world including India with preferential risk for adeno carcinoma. In this back ground we studied the prevalence of HPV genotypes among HIV positive women in Andhra Pradesh,India 8
METHODS We conducted a cross-sectional, observational study on 350 HIV Positive women age ranging from 25 to 54 years after following the ethical guidelines from April 2011 to March 2013 at KKSR Hospital, Visakhapatnam. Cervical swab samples were sent for HPV genotyping to Biognosys technologies India Pvt Ltd and Dr.Lal Path Labs,New Delhi 9
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METHODS In HPV qualitative PCR the DNA is extracted from cervical swab and is subjected to genotype specific PCR using HPV 16 and 18 primers. The amplification product from PCR is checked by Agarose gel electrophoresis. The positive amplification reflects as band on Agarose gel. 11
Results EIGHTY TWO-82 (23.4%) out of 350 samples tested had HPV subtypes detected In the age groups of 25 to 34 24 cases (29.2%) 35 to 44 18 cases (21.95%) 45 to 54 40 cases (32.8%) 12
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Comparing the Relation between HPV Genotypes and Cervical Cancer in Multiethnic Groups Study Overall HPV was detected in 92.5% of cases, in 95.9% of squamous cell carcinomas and 84.3%of adeno carcinomas. The five most prevalent high-risk HPV genotypes were HPV 16 (68.2%), 18 (40%), 58 (10.7%), 33 (10.4%) and 52 (10.4%) in HIV Negative Women Sayyidi Hamzi Abdul Raub et al - Asian Pacific Journal of Cancer Prevention, Vol 15, 2014 14
RESULTS The most common high risk genotypes encountered in our study were HPV-16-18/82 (21.95%) HPV- 18-15/82 (18.29%) 15
LITERATURE REVIEW Reports on HPV prevalence published between January, 1995, and and January, 2005 were retrieved. Overall HPV prevalence in 1,57 879 women with normal cervical cytology was estimated to be 10 4% Corresponding estimates by region were Africa 22 1%, Central America and Mexico 20 4%. northern America 11 3%,Europe 8 1% and Asia 8 0% -the lancet.com Vol 7 July 2007 16
HIGH RISK GENOTYPES in HIV-Positive Women in Visakhapatnam, Andhrapradesh, India 17
RESULTS We found that HIV-positive women were more likely to test positive for any HPV as (P <.05), and to test positive for the high risk subtypes as (P <.05) which is statistically significant. 18
Comparing the Relation between HPV Genotypes and Cervical Cancer in Multiethnic Groups Study The percentage of HPV positive cases in Chinese, Malays and Indians were 95.5%, 91.9% and 80.0%, respectively. HPV 16 and 18 genotypes were the commonest in all ethnic groups. The percentage of HPV 16 infection was significantly higher in Chinese (75.9%) compared to Malays (63.7%) and Indians (52.0%) (p<0.05), The HPV 18 was significantly higher in Malays (52.6%) compared to Chinese (25.0%) and Indians (28%) (p<0.05) in HIV Negative Women - Asian Pacific Journal of Cancer Prevention, Vol 15, 2014 19
CONCLUSIONS As the Oncogenic HPV subtypes 16 and 18 were more prevalent in this study, further studies are needed on more number of samples to design preventive strategy and to administer HPV vaccine as a public health measure. Supplementary routine screening for HPV DNA will assist to reduce the incidence of cervical cancers. 20
ACKNOWLEDGEMENTS We sincerely thank the HIV Positive Women who participated in the study. Further we appreciate the services rendered by the staff of Dr. KKSR Hospital, Visakhapatnam, INDIA. Also we show gratitude to Biognosys technologies India Pvt Ltd, Hyderabad and Dr.Lal Path Labs,New Delhi 21
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