# HPV profiles in Botswana: An analysis of healthy women, cervical intraepithelial neoplasia, and invasive cervical cancer

## TL;DR

The study analyzes HPV profiles in Botswana women, showing higher prevalence of high-risk HPV in cervical intraepithelial neoplasia and invasive cervical cancer compared to healthy women.

## Contribution

The study identifies specific high-risk HPV subtypes associated with progression from pre-cancerous lesions to invasive cervical cancer in Botswana.

## Key findings

- High-risk HPV prevalence increases from healthy women to those with cervical intraepithelial neoplasia and invasive cervical cancer.
- HPV subtypes like HPV 16 and 18 are more prevalent in invasive cervical cancer compared to cervical intraepithelial neoplasia.
- Multiple high-risk HPV strains may contribute to the progression from pre-cancerous lesions to cervical cancer.

## Abstract

•Widespread HIV and HPV in Sub-Saharan Africa contributes to the growing burden of cervical cancer.•Compared to healthy students, women with CIN or invasive cervical cancer have a higher prevalence of high-risk (HR) HPV.•Compared to women with CIN, women with invasive cervical cancer have higher prevalence of HR HPV.•Cellular HPV viral burden remains unchanged between healthy students, women with CIN, and women with cervical cancer.•Regardless of viral burden, further acquisition of HR HPV in those with CIN is important in progression to cervical cancer.

Widespread HIV and HPV in Sub-Saharan Africa contributes to the growing burden of cervical cancer.

Compared to healthy students, women with CIN or invasive cervical cancer have a higher prevalence of high-risk (HR) HPV.

Compared to women with CIN, women with invasive cervical cancer have higher prevalence of HR HPV.

Cellular HPV viral burden remains unchanged between healthy students, women with CIN, and women with cervical cancer.

Regardless of viral burden, further acquisition of HR HPV in those with CIN is important in progression to cervical cancer.

High prevalence of HPV and HIV contribute to the high rate of cervical cancer (CaCx) in Botswana. HPV subtypes in healthy, unvaccinated students (Cohort 1), women with CIN II/III (Cohort 2), and women with invasive CaCx (Cohort 3) were compared.

The Ipabalele study in Gaborone, Botswana enrolled patients between 2016–2020. Demographics, clinical characteristics, and HPV cervical swabs were collected. PathoChip quantified prevalence of HPV subtypes.

Overall 414 patients enrolled. Cohort 1: 43; Cohort 2; 212; Cohort 3: 159. Median age was 19, 39, and 46 years. Women living with HIV (WLWH) accounted for 0 %, 76 %, and 72 %. High-risk (HR) HPV prevalence in Cohort 1 increased 34 % to 57 % over 20 months. HPV profiles did not differ by HIV status. The prevalence of all HR HPV subtypes in Cohorts 2 and 3 is increased compared to Cohort 1. The prevalence of HPV HR subtypes except for HPV 53 is increased in Cohort 3 compared to Cohort 2. Among WLWH, Cohort 3 had a higher prevalence of HPV 16, 18, and 34 compared to Cohort 2. Among women without HIV, Cohort 3 had a higher prevalence of HPV 16 and 18 compared to Cohort 2.

Compared to healthy women, HPV subtype representation is higher among women with CIN and CaCx. This suggests the presence of multiple HR HPV strains may impact transformation from pre-cancerous lesions to CaCx, highlighting the importance of CIN detection and primary prevention of HR HPV to decrease the incidence of CaCx in Botswana.