title: Identification of human papillomaviruses from formalin-fixed, paraffin-embedded pre-cancer and invasive cervical cancer specimens in Zambia: a cross-sectional study.
abstract: BACKGROUND
  The most common human papillomavirus (HPV) genotypes isolated from cervical cancer in select African countries are HPV-16, HPV-18, HPV-35, and HPV-45, but the most common genotypes in Zambia are unknown. The overall objective of this study was to assess the potential impact of current HPV vaccines in preventing cervical cancer in Zambia, by determining the combined prevalence of HPV-16 and/or HPV-18 in invasive cervical cancer (ICC) and high-grade pre-cancer [cervical intraepithelial neoplasia 2 or 3 (CIN2/3)] cases.
  
  
  RESULTS
  We compared DNA extraction techniques to determine which assay performs well in the Zambian context, where unbuffered formalin is used to fix specimens. We then tested specimens with the Abbott RealTime High-Risk HPV test to estimate the prevalence of HPV-16/18 in formalin-fixed, paraffin-embedded ICC and CIN2/3 specimens. DNA extraction using heat (without xylene) was more successful than xylene-based extraction. Over 80% of specimens tested using heat extraction and the Abbott RealTime HPV test were positive for HPV. HPV-16 and/or HPV-18 were identified in 65/93 (69.9%) ICC specimens positive for HPV and in 38/65 (58.5%) CIN2/3 specimens positive for HPV.
  
  
  CONCLUSIONS
  To our knowledge this is the first report to identify HPV genotypes in cervical cancers in Zambia. A combined HPV-16/18 prevalence of 69.9% in ICC specimens suggests that current vaccines will be highly protective against cervical cancer in Zambia.
authors.affiliation: Centre for Infectious Disease Research in Zambia, Plot 5032 Great North Road, Lusaka, Zambia. bateman.allen@gmail.com.|Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. bateman.allen@gmail.com.
authors.forename: Allen C
authors.initials: AC
authors.lastname: Bateman
authors.affiliation: Centre for Infectious Disease Research in Zambia, Plot 5032 Great North Road, Lusaka, Zambia. Katundu.Katundu@cidrz.org.
authors.forename: Katundu
authors.initials: K
authors.lastname: Katundu
authors.affiliation: University of Zambia Teaching Hospital, Lusaka, Zambia. poleman1981@gmail.com.
authors.forename: Pascal
authors.initials: P
authors.lastname: Polepole
authors.affiliation: University of Zambia Teaching Hospital, Lusaka, Zambia. shibemba@yahoo.com.
authors.forename: Aaron
authors.initials: A
authors.lastname: Shibemba
authors.affiliation: Centre for Infectious Disease Research in Zambia, Plot 5032 Great North Road, Lusaka, Zambia. mulindim@gmail.com.|University of Zambia Teaching Hospital, Lusaka, Zambia. mulindim@gmail.com.
authors.forename: Mulindi
authors.initials: M
authors.lastname: Mwanahamuntu
authors.affiliation: Program in Global Oncology, UNC Lineberger Comprehensive Cancer Center and School of Medicine, UNC, Chapel Hill, North Carolina, USA. dirk_dittmer@med.unc.edu.
authors.forename: Dirk P
authors.initials: DP
authors.lastname: Dittmer
authors.affiliation: Centre for Infectious Disease Research in Zambia, Plot 5032 Great North Road, Lusaka, Zambia. professorparham@gmail.com.|University of Zambia Teaching Hospital, Lusaka, Zambia. professorparham@gmail.com.|Department of Obstetrics and Gynecology, UNC School of Medicine, UNC, Chapel Hill, North Carolina, USA. professorparham@gmail.com.
authors.forename: Groesbeck P
authors.initials: GP
authors.lastname: Parham
authors.affiliation: Centre for Infectious Disease Research in Zambia, Plot 5032 Great North Road, Lusaka, Zambia. Carla.Chibwesha@cidrz.org.|Department of Obstetrics and Gynecology, UNC School of Medicine, UNC, Chapel Hill, North Carolina, USA. Carla.Chibwesha@cidrz.org.
authors.forename: Carla J
authors.initials: CJ
authors.lastname: Chibwesha
mesh_terms: D002584:Cervix Uteri / Q000821:virology*; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D060005:Genotyping Techniques; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification*; D052161:Human papillomavirus 18 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D053918:Papillomavirus Vaccines / Q000276:immunology; D015995:Prevalence; D002583:Uterine Cervical Neoplasms / Q000821:virology*; D015024:Zambia
chemical_list: D004279:DNA, Viral; D053918:Papillomavirus Vaccines