title: Rare subtype(s) and frequency of multi-viral subtype high-risk human papilloma virus infection in high-grade squamous intraepithelial lesion and squamous cell carcinoma in a cervical carcinoma prevalent developing country: a multiplex real-time polymerase chain reaction-based pilot study.
abstract: BACKGROUND
  Bangladesh, with a population of 160 million and nearly half being women, has the 4th highest rate of cervical carcinoma deaths in the world. It is projected that ∼500,000 of these women would die of this entirely preventable cancer by 2030. HPV vaccination is not widely offered in Bangladesh. This pilot study is designed to find out the prevalence of rare and multi-viral high-risk HPV (hrHPV) subtype(s) infection which may help strategize a large scale vaccination program in tackling cervical carcinoma in the country.
  
  
  METHODS
  Forty cases of cervical High-Grade squamous intraepithelial lesion (HSIL) and Squamous cell carcinoma (SqCa) were collected. DNA was extracted from tissue representing HSIL and SqCa and multiplex PCR was run to identify all 15 hrHPV subtypes along with known positive controls.
  
  
  RESULTS
  Of the total, 27 cases were biopsies/cones and 13 were hysterectomies including 5 HSIL and 35 SqCa. Infection caused by rare subtypes, hrHPV 45 and 52, were found in only two cases. Multi-subtype infection, detected in 28 % cases, was limited to HPV16/18 in all cases but one; one case showed hrHPV16/52 combination.
  
  
  CONCLUSIONS
  A remarkable homogeneity of hrHPV 16 infection is noted in women with HSIL & SqCa in this country in these limited samples. This finding is in sharp contrast to the reports from western countries of frequent multi-viral and rare subtype hrHPV infection. This pilot study suggests that a vaccination program may be highly effective in controlling cervical cancer there. A larger study, however, is required to ratify the findings.
authors.affiliation: Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Akhter
authors.affiliation: Physicians Reference Laboratory, Overland Park, KS, USA.
authors.forename: Pradip
authors.initials: P
authors.lastname: Manna
authors.affiliation: Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kamal
authors.affiliation: Department of Pathology, Women & Infants Hospital & Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA.
authors.forename: C James
authors.initials: CJ
authors.lastname: Sung
authors.affiliation: Department of Pathology, Women & Infants Hospital & Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA.
authors.forename: W Dwayne
authors.initials: WD
authors.lastname: Lawrence
authors.affiliation: Department of Pathology, Women & Infants Hospital & Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA. mquddus@wihri.org.
authors.forename: M Ruhul
authors.initials: MR
authors.lastname: Quddus
keywords: Cervical carcinoma; Cervical dysplasia; High-risk HPV; Multi-subtype infection; Rare subtypes