Type-specific HPV prevalence in high grade lesions or cervical cancer in Latin America and the Caribbean: a systematic review of epidemiological studies

CIAPPONI, AGUSTÍN; BARDACH, ARIEL; GLUJOVSKY, D; GIBBONS, LUZ; PICCONI MA

Conferencia; 24th International Papillomavirus Conference and Clinical Workshop; 2007

BACKGROUNDCervical cancer remains as a major public health problem in Latin America and theCaribbean, showing some of the highest incidence and mortality rates worldwide.Information on human papillomavirus (HPV) type distribution in high?grade cervicallesions (HSIL) and invasive cervical cancer (ICC) is crucial to predict the future impactof HPV16/18 vaccines and screening programmes, and to establish an appropriatepost-vaccinal virologic surveillance.AIMTo assess the prevalence of all HPV types in HSIL and ICC in Latin Americaand the Caribbean by an exhaustive systematic review.RESULTSMATERIAL and METHODSObservational studies were assessed by a checklist of essential items listed in theSTROBE statement. A meta-analysis was performed using arc-sine transformations inorder to stabilize the variance of simple proportions.A fixed effects model (inverse variance) was used when there were no heterogeneitybetween the studies and a random effects model (DerSimonian-Laird) was appliedwhen there was heterogeneity between the studies.We applied a Meta regression analysis in order to get the adjusted prevalence.StatDirect and STATA software were used. (www.statdirect.com; www.stata.com)CONCLUSIONSThis is the broadest summary of HPV type distribution in HSIL and ICC in Latin America and the Caribbean. It added new data on HPV types in HSIL to previous reports (Clifford etal. 2003, and Smith et al, 2007); and duplicated the number of Latin American cases from 833 considered by the last published meta-analysis (Smith et al., 2007) to 1,976 in ourstudy. The proportions of HSIL cases attributable to HPV16/18 of this study (55.15%).Data on ICC have greatly enriched previous reports; we triplicate the number of Latin American included cases from 1,427 considered by the last published meta-analysis (Smith etal, 2007) to 4,513 in our study. Overall, 65% of ICC cases harboured HPV 16/18, which confirms previous data.This information may be of huge importance for local decision makers to consider the relevance of the HPV vaccination.