Abstract:
<p>The development of HPV vaccines has generated a great deal of hope that the burden of cervical cancer may be eliminated over the next several decades. However, this enthusiasm may be premature if the genotypes associated with high-grade cervical dysplasia and cancer in other countries does not match the select HPV genotypes that were targeted by current vaccines. The objective of this study was to document the profile of high-risk HPV genotypes that are associated with moderate and high-grade dysplasia in a subset of women living in Port-au-Prince and Leogane, Haiti. Preliminary data collected around the world and by Family Health Ministries in Haiti suggest that the high-grade disease seen in many communities may have a different spectrum than the US and Europe. The cross-sectional study was conducted in two medical clinics situated in the cities of Port-au-Prince and Leogane, Haiti. Genotype-specific distribution from cervical samples collected from 269 women was correlated with corresponding cytopathology results. Genotypes associated with HSIL or invasive cancer were HPV-16 (POR 6.8; 95% CI 2.62-17.86), HPV-18 (POR 4.3; 95% CI 1.46-12.40), HPV-35 (POR 4.3; 95% CI 1.63-11.33), and HPV-58 (POR 7.9; 95% CI 1.95-32.00). HPV-58 appeared to have a higher oncogenic potential than HPV-16 and HPV-18. There was a difference in the HPV genotypic profile found in cervical disease in this Haitian population compared to the United States and Europe. It may be less cost-effective to introduce existing HPV prophylactic vaccines to Haiti; resources may be better spent treating existing disease until more appropriate vaccines are developed.</p>
