Comparing human papillomavirus prevalences in women with normal cytology or invasive cervical cancer to rank genotypes according to their oncogenic potential: a meta-analysis of observational studies.
BACKGROUND
Mucosal human papillomavirus (HPV) infection is a necessary cause of cervical cancer. Vaccine and non-vaccine genotype prevalences may change after vaccine introduction. Therefore, it appears essential to rank HPV genotypes according to their oncogenic potential for invasive cervical cancer, independently of their respective prevalences.


METHODS
We performed meta-analyses of published observational studies and estimated pooled odds ratios with random-effects models for 32 HPV genotypes, using HPV-16 as the reference.


RESULTS
Twenty-seven studies yielded 9,252 HPV-infected women: 2,902 diagnosed with invasive cervical cancer and 6,350 with normal cytology. Expressed as (odds ratio [95% confidence interval]), HPV-18 (0.63 [0.51, 0.78]) ranked closest to HPV-16, while other genotypes showed continuously decreasing relative oncogenic potentials: HPV-45 (0.35 [0.22, 0.55]), HPV-69 (0.28 [0.09, 0.92]), HPV-58 (0.24 [0.15, 0.38]), HPV-31 (0.22 [0.14, 0.35]), HPV-33 (0.22 [0.12, 0.38]), HPV-34 (0.21 [0.06, 0.80]), HPV-67 (0.21 [0.06, 0.67]), HPV-39 (0.17 [0.09, 0.30]), HPV-59 (0.17 [0.09, 0.31]), HPV-73 (0.16 [0.06, 0.41]), and HPV-52 (0.16 [0.11, 0.23]).


CONCLUSIONS
Our results support the markedly higher oncogenic potentials of HPV-16 and -18, followed by HPV-31, -33, -39, -45, -52, -58 and -59, and highlight the need for further investigation of HPV-34, -67, -69 and -73. Overall, these findings could have important implications for the prevention of cervical cancer.
Institut Pasteur, Unité de Pharmaco-Épidémiologie et Maladies Infectieuses, 25-28 rue du Dr Roux, 75724 Paris Cedex 15 France.
Erik
E
Bernard
Margarita
M
Pons-Salort
Michel
M
Favre
Isabelle
I
Heard
Elisabeth
E
Delarocque-Astagneau
Didier
D
Guillemot
Anne C M
AC
Thiébaut
D000328:Adult; D052685:Alphapapillomavirus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D030361:Papillomavirus Infections / Q000150:complications / Q000235:genetics; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology*