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Meta-Analysis
. 2011;6(10):e25493.
doi: 10.1371/journal.pone.0025493. Epub 2011 Oct 4.

Type-specific HPV prevalence in cervical cancer and high-grade lesions in Latin America and the Caribbean: systematic review and meta-analysis

Agustín Ciapponi  1 , Ariel Bardach, Demián Glujovsky, Luz Gibbons, María Alejandra Picconi
Affiliations
Meta-Analysis

Type-specific HPV prevalence in cervical cancer and high-grade lesions in Latin America and the Caribbean: systematic review and meta-analysis

Agustín Ciapponi et al. PLoS One. 2011.

Abstract

Background: Cervical cancer is a major public health problem in Latin America and the Caribbean (LA&C), showing some of the highest incidence and mortality rates worldwide. Information on HPV type distribution in high-grade cervical lesions (HSIL) and invasive cervical cancer (ICC) is crucial to predict the future impact of HPV16/18 vaccines and screening programmes, and to establish an appropriate post-vaccinal virologic surveillance. The aim was to assess the prevalence of HPV types in HSIL and ICC in studies in LA&C.

Methods and findings: We performed a systematic review, following the MOOSE guidelines for systematic reviews of observational studies, and the PRISMA statement for reporting systematic reviews and meta-analyses. Inclusion criteria were at least ten cases of HSIL/ICC, and HPV-type elicitation. The search, without language restrictions, was performed in MEDLINE, Cochrane Library, EMBASE, LILACS from inception date to December 2009, proceedings, reference lists and consulting experts. A meta-analysis was performed using arc-sine transformations to stabilize the variance of simple proportions. Seventy-nine studies from 18 countries were identified, including 2446 cases of HSIL and 5540 of ICC. Overall, 46.5% of HSIL cases harbored HPV 16 and 8.9% HPV18; in ICC, 53.2% of cases harbored HPV 16 and 13.2% HPV 18. The next five most common types, in decreasing frequency, were HPV 31, 58, 33, 45, and 52. Study's limitations comprise the cross-sectional design of most included studies and their inherent risk of bias, the lack of representativeness, and variations in the HPV type-specific sensitivity of different PCR protocols.

Conclusions: This study is the broadest summary of HPV type distribution in HSIL and ICC in LA&C to date. These data are essential for local decision makers regarding HPV screening and vaccination policies. Continued HPV surveillance would be useful, to assess the potential for changing type-specific HPV prevalence in the post-vaccination era in Latin America.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: The study was supported by an independent grant from GlaxoSmithKline and the Institute for Clinical Effectiveness and Health Policy - IECS. The authors have declared that no other competing interests exist. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Study flow diagram.
Figure 2
Figure 2. HPV type-specific prevalence in Cancer and HSIL, with 95% CIs.
Figure 3
Figure 3. Prevalence of HPV16 in HSIL.
Figure 4
Figure 4. Prevalence of HPV18 in HSIL.
Figure 5
Figure 5. Prevalence of HPV16 in ICC.
Figure 6
Figure 6. Prevalence of HPV18 in ICC.
Figure 7
Figure 7. Distribution HPV 16/18 in HSIL in LA&C.
Figure 8
Figure 8. Distribution HPV 16/18 in ICC in LA&C.
See this image and copyright information in PMC

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