title: Human papillomavirus genotypes and HPV-16 variants distribution among Tunisian women with normal cytology and squamous intraepithelial lesions.
abstract: BACKGROUND
  Little is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries. Herein, we conducted a molecular epidemiological study to investigate prevalence of HPV type and HPV-16 variants among cervical-screened unvaccinated Tunisian women.
  
  
  METHODS
  Cross-sectional study was performed on 494 Tunisian women visiting Women's Healthcare Centers. HPV-DNA detection was carried out on cervical samples using real-time polymerase chain reaction. HPV genotyping and HPV-16 variants were characterized by direct sequencing ofL1viral capsid gene.
  
  
  RESULTS
  The overall HPV prevalence was 34% (95% CI: 30-38%) with significantly higher prevalence among women with squamous intraepithelial lesions (SIL) than those with no intraepithelial lesions (NIL) 84% (95% CI: 76-92%) and 24.5% (95% CI: 20-29%) respectively. The distribution of HPV prevalence according to women's age shows a U-shaped curve and the highest HPV prevalence rates were observed among the youngest (≤25 years; 51.2%, 95% CI: 37-67%) and the oldest women (>55 years; 41.7%, 95% The HPV-16 prevalence was 32.8% (95% CI: 22-45%) among women with SIL and 9.2% (95% CI: 6-12%) among women with NIL. Whereas, the HPV-18 prevalence was 1.3% (95% CI: 0-5%) among women with SIL and 0.3% (95% CI: 0-1%) among women with NIL. Among HPV-16 positive women, European lineage (E) was identified as the predominant HPV-16 variant (85.7%, 95% CI: 76-95%). The frequency of E variant was lower among SIL than among NIL women (81%, 95% CI: 64-99%, and 88%, 95% CI: 77-100%, respectively). Conversely, the African-2 variant frequency was higher among SIL than among NIL women (18%, 95% CI: 1-36% and 6%, 95% CI: 2-14%, respectively). In multivariate analysis, young age was the only risk factor that is independently associated with HPV infection. Moreover, HPV infection and menopause were both found to be independently associated with SIL and HSIL.
  
  
  CONCLUSIONS
  HPV DNA testing should be proposed to young and menopausal Tunisian women. Considering HPV prevalence, only 13% of the Tunisian women could be protected by the bivalent HPV vaccine. These results may be helpful for designing an adapted HPV testing and vaccination program in Tunisia.
authors.affiliation: Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia ; Faculty of Sciences, Carthage University, Bizerte, Tunisia.
authors.forename: R
authors.initials: R
authors.lastname: Ghedira
authors.affiliation: Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia.
authors.forename: W
authors.initials: W
authors.lastname: Mahfoudh
authors.affiliation: National Office of Family and Population, Monastir, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Hadhri
authors.affiliation: Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Gabbouj
authors.affiliation: Department of Epidemiology and preventive medicine, Faculty of Medicine, Monastir University, Monastir, Tunisia.
authors.forename: I
authors.initials: I
authors.lastname: Bouanene
authors.affiliation: Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia ; Department of Gynecology Obstetrics, Farhat Hached University Hospital, Sousse, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Khairi
authors.affiliation: Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia ; Department of Gynecology Obstetrics, Farhat Hached University Hospital, Sousse, Tunisia.
authors.forename: A
authors.initials: A
authors.lastname: Chaieb
authors.affiliation: Unit of Viral and Molecular Tumor Diagnostics, Habib Thameur Hospital, Tunis, Tunisia.
authors.forename: R
authors.initials: R
authors.lastname: Khelifa
authors.affiliation: Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia ; Department of Cancerology Radiotherapy, Farhat Hached University Hospital, Sousse, Tunisia.
authors.forename: N
authors.initials: N
authors.lastname: Bouaouina
authors.affiliation: Laboratory of Anatomy and Pathologic cytology, Sousse, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Remadi
authors.affiliation: Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
authors.forename: A A
authors.initials: AA
authors.lastname: Elmi
authors.affiliation: Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
authors.forename: D
authors.initials: D
authors.lastname: Bansal
authors.affiliation: Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
authors.forename: A A
authors.initials: AA
authors.lastname: Sultan
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital of Monastir, Monastir, Tunisia.
authors.forename: R
authors.initials: R
authors.lastname: Faleh
authors.affiliation: Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia.
authors.forename: A
authors.initials: A
authors.lastname: Zakhama
authors.affiliation: Laboratory of Genetic Medicine and Immunology, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
authors.forename: L
authors.initials: L
authors.lastname: Chouchane
authors.affiliation: Molecular Immuno-Oncology Laboratory, Monastir University, Monastir, Tunisia ; Higher Institute of Biotechnology of Monastir, Monastir University, Monastir, Tunisia.
authors.forename: E
authors.initials: E
authors.lastname: Hassen
keywords: Cervix; HPV-16 variants; Human Papillomavirus; Prevalence; Tunisian women