Distribution of HPV 16/18 by Ethnicity and Correlation with HPV Vaccination Status

Summary: Introduction: Cervical cancer is considered the most common human papillomavirus (HPV) associated disease in women. HPV types 16 and 18 are reported to be responsible for 70% of cervical cancers worldwide. According to the 2019 ASCCP guidelines, expedited treatment is preferred for non-pregnant patients 25 years or older with high-grade squamous intraepithelial lesion (HSIL) cytology and concurrent positive testing for HPV genotype 16 (HPV 16) (i.e., HPV 16–positive HSIL cytology). Materials and Methods: We evaluated the distribution of HPV 16/18 in women with a cytology diagnosis of High grade squamous intraepithelial lesion (HSIL) and Atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASCH) from 2022-2023 from the Yale pathology database. The prevalence of HPV 16/18 by ethnicity, by HPV vaccination status in women < 40 years, and in cases with a surgical follow-up of high grade intraepithelial neoplasia 2 or higher (-IN2+) was also reviewed. High risk HPV (hrHPV) testing and genotyping was performed on the Roche Cobas platform. Results: There were 250 cases in total (HSIL, n=70; ASCH n=180) who were hrHPV positive, including 93 (37%) cases with HPV16 or 18 (HSIL, n=36; ASCH, n=57). The prevalence of HPV 16 or 18 by ethnicity is reported in Table 1. Of the 226 cases with surgical follow-up, 132 cases had -IN2+ on surgical follow-up. Of those, 59 patients (45%) were HPV 16 or 18 positive and the majority (55%, n= 73) were not HPV 16 or 18. HPV vaccination information was available in 97 women < 40 years. Of 24 women who had completed HPV vaccination, 4 patients (17%) were HPV 16 or 18 positive. Of 73 women who had not received HPV vaccine, 27 (37%) were HPV 16 or 18 positive (Table 2). Conclusions: In our population, the prevalence of HPV 16/18 in women with hrHPV is overall lower than typically expected. Despite the small number of patients, our study highlights a lower prevalence of HPV 16/18 in the African American population compared to Caucasian women and, as expected, in women who were HPV vaccinated. In addition, the predominant types of hrHPV in -IN2+ were hrHPV non 16/18. A shift in the genotype distribution of hrHPV and its effect on -IN2+ could be the downstream herd immunity effect of HPV vaccination. It may be prudent to expedite biopsy diagnosis and treatment to women who are hrHPV positive and not only those who are HPV 16/18 positive. Table 1: Distribution of Positive HPV 16/18 by Ethnicity Ethnicity................................... HSIL & HPV 16/18+................................ASC-H & HPV 16/18+ Caucasian (n=152)......................25/46 (54%).............................................35/106 (33%) African American (n=61)..............7/16 (44%).............................................. 13/45 (29%) Other (n=33)..................................2/6 (33%)..................................................9/27 (33%) Total=246..................................... 34/68 (50%).............................................57/178 (32%) Table 2: Distribution of Positive HPV 16/18 by HPV Vaccination status Diagnosis...............................Vaccinated & HPV 16/18+...........................Not vaccinated & HPV 16/18+ HSIL (n=31).....................................4/8 (50%).....................................................11/23 (48%) ASC-H (n=66)..................................0/16 (0%).....................................................16/50 (32%) Total=97.........................................4/24 (17%)....................................................27/73 (37%)