Human papillomavirus (HPV) genotype distribution in Malaysia: A systematic review

Abstract

Background: Human papillomavirus (HPV) is a key etiological factor in cervical cancer in both Malaysia and globally. It continues to pose a significant public health challenge. This systematic review aims to delineate the distribution of HPV genotypes across different demographics in Malaysia to inform targeted prevention strategies.

Methods: We conducted a systematic review following PRISMA guidelines, analyzing observational studies published from 2000 onward that reported HPV genotypes in cervicovaginal samples from Malaysian women. The review utilized PubMed, SCOPUS, The Cochrane Library, APA PsycNet, and Google Scholar for literature searches, focusing on studies that employed molecular methods for HPV genotyping. Two reviewers independently screened the articles, extracted data, and assessed study quality using the Newcastle-Ottawa Scale (NOS). A descriptive analysis was performed, and findings were synthesized by genotype, region, and ethnicity.

Results: The review included 22 studies from an initial pool of 2,547 articles, encompassing 44,251 women. These studies reported a HPV prevalence of up to 100% in confirmed cervical cancer cases and in general screenings from 4.5 to 47.7%. A total of 28 different HPV genotypes (high- and low-risk) were identified, with HPV16, HPV18, HPV58, HPV52, and HPV33 being the most prevalent high-risk genotypes. Genotype distributions showed significant variation across different states and ethnic groups within Malaysia, highlighting the diverse nature of HPV-related risks.

Conclusions: This review provides a detailed snapshot of the HPV genotype distribution in Malaysia, underscoring the necessity for tailored public health interventions that address the regional and ethnic diversity in HPV prevalence. The findings support the need for targeted vaccination programs and enhanced screening measures to effectively combat the high rates of HPV-related (99%) cervical cancer in Malaysia.

Keywords: Genotype; Human papillomavirus (HPV); Malaysia; Systematic review.

Fig. 1

PRISMA 2020 flow diagram illustrating the study selection process. Displays the number of records identified, screened, assessed for eligibility, and included in the final review, along with reasons for exclusion at each stage.

Fig. 2

Frequency of HPV types detected in the included studies. Map shows regional HPV findings from included studies. Red indicates regions where high-risk HPV genotypes were identified, white represents low-risk HPV genotypes, and black denotes regions where HPV prevalence was reported but specific genotypes were not stated.

Fig. 3

Overall distribution of HPV genotypes reported in Malaysia. A national summary of genotype prevalence across all included studies, combining high-risk and low-risk types, based on the total number of HPV-positive cases.

Fig. 4

Distribution of HPV genotypes by ethnicity. Grouped bar chart comparing the prevalence of key HPV genotypes among major ethnic groups including Malays, Chinese, Indians, and Indigenous populations.