title: Cervical human papillomavirus infection and squamous intraepithelial lesions in rural Gambia, West Africa: viral sequence analysis and epidemiology.
abstract: The development of effective strategies against cervical cancer in Africa requires accurate type specific data on human papillomavirus (HPV) prevalence, including determination of DNA sequences in order to maximise local vaccine efficacy. We have investigated cervical HPV infection and squamous intraepithelial lesions (SIL) in an unselected cohort of 1061 women in a rural Gambian community. Squamous intraepithelial lesions was diagnosed using cytology and histology, HPV was typed by PCR-ELISA of DNA extracts, which were also DNA sequenced. The prevalence of cervical HPV infection was 13% and SIL were observed in 7% of subjects. Human papillomavirus-16 was most prevalent and most strongly associated with SIL. Also common were HPV-18, -33, -58 and, notably, -35. Human papillomavirus DNA sequencing revealed HPV-16 samples to be exclusively African type 1 (Af1). Subjects of the Wolof ethnic group had a lower prevalence of HPV infection while subjects aged 25-44 years had a higher prevalence of cervical precancer than older or younger subjects. This first report of HPV prevalence in an unselected, unscreened rural population confirms high rates of SIL and HPV infection in West Africa. This study has implications for the vaccination of Gambian and other African populations in the prevention of cervical cancer.
authors.affiliation: Infection and Immunity, Henry Wellcome Research Institute, Wales College of Medicine, Cardiff University, Cardiff CF14 4XX, Wales, UK. wallsr@cf.ac.uk
authors.forename: S R
authors.initials: SR
authors.lastname: Wall
authors.forename: C F
authors.initials: CF
authors.lastname: Scherf
authors.forename: L
authors.initials: L
authors.lastname: Morison
authors.forename: K W
authors.initials: KW
authors.lastname: Hart
authors.forename: B
authors.initials: B
authors.lastname: West
authors.forename: G
authors.initials: G
authors.lastname: Ekpo
authors.forename: A N
authors.initials: AN
authors.lastname: Fiander
authors.forename: S
authors.initials: S
authors.lastname: Man
authors.forename: C M
authors.initials: CM
authors.lastname: Gelder
authors.forename: G
authors.initials: G
authors.lastname: Walraven
authors.forename: L K
authors.initials: LK
authors.lastname: Borysiewicz
mesh_terms: D000293:Adolescent; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000235:genetics / Q000821:virology; D004279:DNA, Viral / Q000032:analysis*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000235:genetics / Q000821:virology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D017422:Sequence Analysis, DNA; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000235:genetics / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000235:genetics / Q000821:virology
chemical_list: D004279:DNA, Viral