title: HPV types and variants among cervical cancer tumors in three regions of Tunisia.
abstract: Cervical cancer is the second most common cancer among Tunisian women, and the incidence rates vary by region. Three Tunisian registries report age-standardized rates of 6.3/10(5) in the central region, 5.4/10(5) in the north, and 2.7/10(5) in the south. High-risk human papillomavirus (HPV) types and their variants differ in carcinogenic potential and geographic distribution. The HPV type and variant distribution could be a factor in the differing rates between regions of Tunisia. Tumor tissue was collected from 142 Tunisian cervical cancer patients. Demographic and reproductive characteristics of the patients were abstracted from cancer registry and hospital records. HPV type and variant analyses were performed using PCR-based Luminex and dot-blot hybridization assays. Eighty-three percent of tumors were infected with at least one HPV type. European variants of HPV16/18 were the most prevalent in tumors from all three regions, with all HPV18 infections and 64% of HPV16 infections being of European lineage. A higher frequency of HPV16 was present in Northern Tunisia (80%) than in Central (68%) or Southern Tunisia (50%) (P=0.02). HPV18/45 was significantly more common in adenocarcinomas (50%) than in squamous cell carcinomas (11%) (P=0.004). Frequent infection with European HPV variants most likely reflects the history of European migration to Tunisia. In addition to the importance of understanding the variants of HPV in Tunisia, behavioral and cultural attitudes towards screening and age-specific infection rates should be investigated to aid the development of future vaccination and HPV screening programs and policies.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029, USA. kkrennh@umich.edu
authors.forename: Keris
authors.initials: K
authors.lastname: KrennHrubec
authors.forename: Karima
authors.initials: K
authors.lastname: Mrad
authors.forename: Badreddine
authors.initials: B
authors.lastname: Sriha
authors.forename: Farhat
authors.initials: F
authors.lastname: Ben Ayed
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Bottalico
authors.forename: Janae
authors.initials: J
authors.lastname: Ostolaza
authors.forename: Benjamin
authors.initials: B
authors.lastname: Smith
authors.forename: Tatyana
authors.initials: T
authors.lastname: Tchaikovska
authors.forename: Amr S
authors.initials: AS
authors.lastname: Soliman
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D017720:Molecular Epidemiology; D027383:Papillomaviridae / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D011110:Polymorphism, Genetic; D015995:Prevalence; D014416:Tunisia / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000821:virology*; D055815:Young Adult