https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/104 Sat, 08 Oct 2016 10:21:48 +0000 Abstract Background and objectives: Cervical cancer is one of the leading causes of morbidity and mortality. Human papillomavirus (HPV) is known to be associated with cervical intraepithelial neoplasia (CIN) and cancer. The objective of the present study was to determine the rate of HPV infection among the Bangladeshi women with different grades of CIN and cancer. Methods: Women aged 20 to 55 years, diagnosed as a case of chronic cervicits, cervical intraepithelial neoplasia (CIN) or invasive cancer by Papanicolaou (Pap) smear and colposcopy directed biopsy were enrolled in the study. High and intermediate risk oncogenic HPV were detected in cervical samples by real time PCR (rt-PCR).  Results: Seventy two women with chronic cervicitis and different grades of CIN were included in the study. Out of 72 cases, 28 (38.9%) and 44 (61.1%) had chronic cervicitis and CIN respectively. Overall, the HPV infection  rate was 43.1% (95% CI= 32%-54%) among the study population. CIN cases had significantly high (p<0.01) HPV infection (78.6%; 95% CI=60%-89%) compared to cases with chronic cervicitis (18.2%; 95% CI=11.1%-34.5%). Women between the age of 20-30 years had the highest positive rate (50.0%) followed by 31-40 years age group (43.6%). All CIN grade 2 and 3 had HPV infection. Conclusion:  The study showed that HPV was strongly associated with different grades of CIN. Specific HPV types should be determined to find out  the most prevalent HPV types among the Bangladeshi women with CIN and cervical cancers.        A total of 72 women with chronic cervicitis and different grades of CIN were included in the study. Out of 72 cases, 28 (38.9%) and 44 (61.1%) had chronic cervicitis and CIN respectively. The distribution of HPV positive cases in different age groups is shown in Table-1. Overall, the HPV positive rate was 43.1% among the study population.  Women between the age of 20-30 years had the highest positive rate (50.0%) followed by 31-40 years age group (43.6%).  Age group 20-30 and 31-40 years had significantly higher (p<0.05) HPV positive rate compared to women above 40 years of age. Table 2 shows that cases with CIN had significantly high (p<0.01) HPV infection (78.6%) compared to those with chronic cervicitis (18.2%). All cases of CIN 2 and CIN 3 were positive for HPV compared to 57.1% cases of CIN 1.      Total Case Total positive N (%) 26 31 – 40 14 (43.6) 14 Total 31 (43.1)*              *95% CI for total HPV positivity rate= 32%-54%                           grade of CIN  and chronic cervicitis Category HPV positive case 1. Chronic cervicitis         CIN 1       CIN 3 28 11 9 (20.5) 09 (57.1)    3 (100.0)  Note: p < 0.01, compared between the CIN and chronic cervicitis group.             95% CI for CIN= 60%-89%; Chronic cervicitis= 11.1%-34.5%               Discussion The present study has demonstrated that high and intermediate risk oncogenic HPV types are prevalent in different grades of CIN and chronic cervicitis cases. All CIN grade 2 and 3 cases were positive for HPV while >50% was positive in CIN1. The rate of HPV infection was significantly low in chronic cervicitis (18.2%) but it was comparatively higher than in Bangladeshi women with normal cervical cytology [12]. Studies in different countries of Africa reported similar high rate of HPV infection in different grade of CIN [6]. But a previous study from Bangladesh in 2009 reported only 7-10% HPV positivity rate among CIN 2, CIN 3 and invasive carcinoma of the cervix [14]. In the present study, we could not determine the prevalence of particular HPV types as the commercial kit we used detected both high and intermediate risk HPV types as whole. A previous study in Bangladesh reported presence of high risk HPV type (16, 18, 31 and 45) in about 56% of women with high risk behavior [13]. Similarly, a population based study in Bangladesh also found the prevalence of high risk HPV types among women with normal cytology [12].   1. GLOBOCAN 2012: Population Fact Sheets World. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. 3. Stanley M. Immune responses to human papillomavirus. Vaccine. 2006; 24:S16–S22 5. Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, de Sanjosé S. Cervical human papillomavirus prevalence in 5 continents: Meta‑analysis of 1 million women with normal cytological findings. J Infect Dis 2010; 202:1789‑99. 7. Ebrahim S, Mndende XK, Kharsany ABM, Mbulawa ZZA, Naranbhai V, Frohlich J, et al. High burden of human papillomavirus (HPV) infection among young women in KwaZulu-Natal, South Africa. PLoS ONE  2016; 11(1): e0146603.doi:10.1371/journal.pone.0146603  papillomavirus infection in Beijing, People’s Republic of China: a population based study. British Journal of Cancer 2009; 101: 1635–1640. 10. Sukvirach S, Smith JS, Tunsakul S, Munoz N, Kesararat V, et al. Population-based human papillomavirus prevalence in Lampang and Songkla, Thailand. The Journal of Infectious Diseases 2003; 187: 1246–1256. 12. Nahar Q, Sultana F, Alam A, Islam JY, Rahman M, et al. Genital human papillomavirus infection among women in Bangladesh: findings from a population-based survey. PLoS ONE  2014; 9(10): e107675. doi:10.1371/journal.pone.0107675 14. Khatun S,  Hussain SMA, Hossain F, Chowdhry A. Human papillomavirus and other risk factors of carcinoma cervix. Bangladesh Medical Journal 2009; 38 (1): 22-27. 2026 Ibrahim Medical College. All rights reserved.