Exploring the Prevalence of HPV Genotypes in Women of Northeast India using the Dry Filter Paper Method and Correlation with Pap Test Findings in Low Resource Setting

Summary: Introduction: Persistent high-risk Human Papillomavirus (HR HPV) infection is the primary cause of 99.75% of cervical cancer. In India, cervical cancer is associated with lower socioeconomic status and is attributed to HPV types 16 and 18. However, in Northeast India, HPV epidemiology remains largely unexplored due to lack of diagnostic facilities particularly in rural areas. To address these gaps, this study aims to evaluate the prevalence of HR HPV genotypes in Northeast India using dry filter paper method and correlating with Pap test Materials and Methods: The study was a hospital-based prospective cross-sectional study wherein around 609 subjects from 2020 to 2023 were enrolled. Cervical samples underwent Pap test and HR HPV DNA testing using multiplex PCR on Whatman 903 filter paper. Data were analyzed with IBM SPSS∨26. Results: Among 609 subjects, 80.13% and 19.87% were reported as normal (NILM) and abnormal Pap test respectively. HR HPV was detected in 94 (15.44%) of samples, with HPV16 (53.19%, 50/94) as the predominant strain, followed by HPV18 (12.77%, 12/94). Co-infection of HPV16 and 18 was found in 4.25% (4/94) of cases, and 29.79% (28/94) were other HR HPV (Figure 1). Comparing HR HPV-positive samples to Pap tests: 37.23 %( 35/94) were NILM (5 HPV 16, 2 co-infection, and 28 other HR HPV), while 62.77% (59/94) showed abnormalities-10 ASCUS (8 HPV 16, 2 HPV 18), 13 LSIL (8 HPV 16, 3 HPV 18, 2 co-infection), 19 HSIL (12 HPV 16, 7 HPV 18), and 17 SCC (all HPV 16) (Table 1). Statistical analysis showed a significant correlation between HPV status and Pap test findings. Conclusions: The HR HPV 16 was the most prevalent genotype and HPV other than 16 and 18 were prevalent in cases where diagnosis was NILM. The dry filter paper method for HPV testing is simple, inexpensive and safe, allowing long-term sample storage. It is ideal for resource-limited settings, offering convenience in sample collection.