title: Type-specific HPV prevalence in cervical cancer and high-grade lesions in Latin America and the Caribbean: systematic review and meta-analysis.
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.
  
  
  RESULTS
  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.
authors: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina. aciapponi@iecs.org.ar
authors: Agustín
authors: A
authors: Ciapponi
authors: Ariel
authors: A
authors: Bardach
authors: Demián
authors: D
authors: Glujovsky
authors: Luz
authors: L
authors: Gibbons
authors: María Alejandra
authors: MA
authors: Picconi
mesh_terms: D000328:Adult; D017691:Caribbean Region / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D060005:Genotyping Techniques; D005843:Geography; D052162:Human papillomavirus 16 / Q000502:physiology*; D052161:Human papillomavirus 18 / Q000502:physiology*; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D060787:Neoplasm Grading; D015995:Prevalence; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology / Q000821:virology*