Prevalence of human papillomavirus (HPV) in Brazil: A systematic review and meta-analysis

Abstract

Objectives: This study aimed to estimate the prevalence of genital, anal and oral HPV infection in Brazil through systematic review and meta-analysis.

Methods: We searched EMBASE, LILACS, MEDLINE, Web of Science and SciELO from inception to December 2018. Original research articles that assessed the prevalence of genital (i.e., cervical, penile), anal and oral HPV infection in Brazil were selected in pairs by independent authors. No sex, age, HPV vaccination, language or date restrictions were applied. HPV prevalence was estimated and stratified according to risk factors population and by geographic area throughout the country. The study prevalence was pooled using a random effects model. Analysis was performed using R (version 3.5.2), packages meta version 4.9-4 and metaphor 2.0-0. This review is registered on PROSPERO under protocol number CRD42016032751.

Results: We identified 3,351 references. After the screening process, 139 of them were eligible for this systematic review (57,513 total participants). Prevalence of cervical HPV was 25.41% (95% CI 22.71-28.32). Additionally, prevalence was 36.21% (95% CI 23.40, 51.33) in the penile region, 25.68% (95%CI 14.64, 41.04) in the anal region, and 11.89% (95%CI 6.26, 21.43) in the oral region. Subgroup analysis showed prevalence in each anatomic site was higher in high-risk populations.

Conclusion: The prevalence of HPV is high in the Brazilian population and varies by population risk and anatomic body site, with lower rates in the oral cavity compared to that in the cervical, penile and anal region. Studies on HPV have primarily been developed to evaluate infection and cancer in the cervical region. There is a profound lack of HPV data in many geographic regions of Brazil and for different anatomic sites.

Fig 1. PRISMA flow diagram for the selection of included studies.

Fig 2. Overall prevalence of cervical infection by high-risk HPV genotypes.

Forest plot of a metanalysis of studies reporting prevalence of infection of the cervix by HR-HPV genotypes in Brazil.

Fig 3. Overall prevalence of cervical infection by HPV-16.

Forest plot of a metanalysis of studies reporting prevalence of cervical infection by HPV-16 in Brazil.

Fig 4. Overall prevalence of cervical infection by HPV-18.

Forest plot of a metanalysis of studies reporting prevalence of cervical infection by HPV-18 in Brazil.

Fig 5. Prevalence of cervical HPV infection in low-risk populations.

Forest plot of a metanalysis of studies reporting prevalence of cervical infection by HPV in low-risk populations in Brazil.

Fig 6. Prevalence of cervical HPV infection in high-risk populations.

Forest plot of a metanalysis of studies reporting prevalence of cervical infection by HPV in high-risk populations in Brazil.

Fig 7. Prevalence of cervical HPV in the South region of Brazil.

Forest plot of a metanalysis of studies reporting prevalence of cervical infection by HPV in the South region of Brazil.

Fig 8. Prevalence of cervical HPV in the Southeast region of Brazil.

Forest plot of a metanalysis of studies reporting prevalence of cervical infection by HPV in the Southeast region of Brazil.

Fig 9. Prevalence of cervical HPV in the North region of Brazil.

Forest plot of a metanalysis of studies reporting prevalence of cervical infection by HPV in the North region of Brazil.

Fig 10. Prevalence of cervical HPV in the Northeast region of Brazil.

Forest plot of a metanalysis of studies reporting prevalence of cervical infection by HPV in the Northeast region of Brazil.

Fig 11. Prevalence of cervical HPV in the Central-West region of Brazil.

Forest plot of a metanlysis of studies reporting prevalence of cervical infection by HPV in the Central-west region of Brazil.

Fig 12. Overall prevalence of penile HPV.

Forest plot of metanalysis of studies reporting prevalence of penile HPV infection in Brazil.

Fig 13. Overall prevalence of penile infection by high-risk HPV genotypes.

Forest plot of a metanalysis of studies reporting prevalence of penile infection by HR-HPV genotypes in Brazil.

Fig 14. Prevalence of penile HPV infection in low-risk populations.

Forest plot of a metanalysis of studies reporting prevalence of penile infection by HPV in low-risk populations in Brazil.

Fig 15. Prevalence of penile HPV infection in high-risk populations.

Forest plot of a metanalysis of studies reporting prevalence of penile infection by HPV in high-risk populations in Brazil.

Fig 16. Overall prevalence of anal HPV infection.

Forest plot of a metanalysis of studies reporting prevalence of anal infection by HPV in Brazil.

Fig 17. Overall prevalence of anal infection by high-risk HPV genotypes.

Forest plot of a metanalysis of studies reporting prevalence of anal infection by HR-HPV in Brazil.

Fig 18. Prevalence of anal HPV infection in low-risk populations.

Forest plot of a metanalysis of studies reporting prevalence of anal infection by HPV in low-risk populations in Brazil.

Fig 19. Prevalence of anal HPV infection in high-risk populations.

Forest plot of a metanalysis of studies reporting prevalence of anal infection by HPV in high-risk populations in Brazil.

Fig 20. Prevalence of anal HPV infection in Brazil, by region.

Forest plot of a metanalysis of studies reporting prevalence of anal infection by HPV, stratified by region in which each of them took place.

Fig 21. Overall prevalence of oral HPV infection.

Forest plot of a metanalysis of studies reporting prevalence of oral infection by HPV in Brazil.

Fig 22. Overall prevalence of oral infection by high-risk HPV genotypes.

Forest plot of a metanalysis of studies reporting prevalence of oral infection by HR-HPV in Brazil.

Fig 23. Prevalence of oral HPV infection in low-risk populations.

Forest plot of a metanalysis of studies reporting prevalence of oral HPV infection in low-risk populations in Brazil.

Fig 24. Prevalence of oral HPV infection in high-risk populations.

Forest plot of a metanalysis of studies reporting prevalence of oral HPV infection in high-risk populations in Brazil.

Fig 25. Prevalence of oral HPV infection in Brazil, by region.

Forest plot of a metanalysis of studies reporting prevalence of oral infection by HPV, stratified by region in which each of them took place.