Browsing by Subject "Human papillomavirus"
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Item Open Access Association between PEG3 DNA methylation and high-grade cervical intraepithelial neoplasia.(Infectious agents and cancer, 2021-06) Bosire, Claire; Vidal, Adriana C; Smith, Jennifer S; Jima, Dereje; Huang, Zhiqing; Skaar, David; Valea, Fidel; Bentley, Rex; Gradison, Margaret; Yarnall, Kimberly SH; Ford, Anne; Overcash, Francine; Murphy, Susan K; Hoyo, CathrineBackground
Epigenetic mechanisms are hypothesized to contribute substantially to the progression of cervical intraepithelial neoplasia (CIN) to cervical cancer, although empirical data are limited.Methods
Women (n = 419) were enrolled at colposcopic evaluation at Duke Medical Center in Durham, North Carolina. Human papillomavirus (HPV) was genotyped by HPV linear array and CIN grade was ascertained by biopsy pathologic review. DNA methylation was measured at differentially methylated regions (DMRs) regulating genomic imprinting of the IGF2/H19, IGF2AS, MESTIT1/MEST, MEG3, PLAGL1/HYMAI, KvDMR and PEG10, PEG3 imprinted domains, using Sequenom-EpiTYPER assays. Logistic regression models were used to evaluate the associations between HPV infection, DMR methylation and CIN risk overall and by race.Results
Of the 419 participants, 20 had CIN3+, 52 had CIN2, and 347 had ≤ CIN1 (CIN1 and negative histology). The median participant age was 28.6 (IQR:11.6) and 40% were African American. Overall, we found no statistically significant association between altered methylation in selected DMRs and CIN2+ compared to ≤CIN1. Similarly, there was no significant association between DMR methylation and CIN3+ compared to ≤CIN2. Restricting the outcome to CIN2+ cases that were HR-HPV positive and p16 staining positive, we found a significant association with PEG3 DMR methylation (OR: 1.56 95% CI: 1.03-2.36).Conclusions
While the small number of high-grade CIN cases limit inferences, our findings suggest an association between altered DNA methylation at regulatory regions of PEG3 and high grade CIN in high-risk HPV positive cases.Item Embargo Developing a stigma responsive educational program to promote uptake of HPV-based cervical cancer screening and treatment in Kisumu, Kenya(2022) Herfel, EmilyBackground: Despite increasing availability of preventative HPV vaccines and screening strategies, uptake of these effective measures in Kisumu, Kenya is limited by cultural and logistical barriers. Limited understanding and societal perceptions of HPV and cervical cancer are potential sources of stigma that could negatively impact screening behavior. By designing and implementing a stigma-responsive educational intervention, we sought to improve understanding and risk perception and increase the likelihood cervical cancer screening.
Methods: We carried out a study of a stigma responsive strategy to deliver HPV-based cervical cancer prevention services in Kisumu, Kenya. Focus group discussions (FGDs) explored experiences of HPV and cervical cancer screening, health messaging and potential stigma sources. Qualitative analysis of the FGDs informed the development of a stigma-responsive educational video. Four Kisumu County healthcare facilities were randomized to either watch the video or receive standard HPV and cervical cancer education, after which participants at both sites completed a survey to measure HPV- and cervical cancer stigma. Stigma scores were compared between control and intervention groups using linear regression.
Results: Thirty women participated in the focus group discussions. Drivers of stigma included concerns about confidentiality and disclosure of HPV results, fears of cancer or implications of a sexually transmitted infection diagnosis. Anticipated outcomes included illness or death, financial hardship or family abandonment. The FGDs findings informed development of the educational video. A total of 288 women, 109 in the intervention group, completed the stigma survey. Mean HPV and cervical cancer scores were found to be statistically lower in the intervention arm, with Dholuo language associated with higher stigma levels in both arms.
Conclusions: This multi-step study explored knowledge, attitudes and beliefs specific to HPV and cervical cancer health messaging in western Kenya in order to develop and test a stigma-responsive education strategy. The stigma-responsive video demonstrated a quantitative decrease in stigma survey response means for those who watched the video. The pre-pilot design will drive a larger pilot study to examine the effect of the educational video on HPV self-sampling.
Item Open Access Human Papillomavirus Awareness in Haiti: Preparing for a National HPV Vaccination Program.(J Pediatr Adolesc Gynecol, 2017-02) Boggan, J; Gichane, MW; Calo, WM; McCarthy, SH; Walmer, KA; Brewer, NTSTUDY OBJECTIVE: Cervical cancer morbidity and mortality are pressing public health issues that affect women in Haiti. To inform efforts to develop a human papillomavirus (HPV) vaccination program in Haiti, we sought to understand HPV awareness and willingness to get HPV vaccination in Haiti. DESIGN, SETTING, AND PARTICIPANTS: We interviewed a convenience sample of 475 women and men in 2 clinical settings in Port-au-Prince and Léogâne, Haiti between April and July 2014. INTERVENTIONS AND MAIN OUTCOME MEASURES: HPV awareness and willingness to get HPV vaccine for daughters. RESULTS: Few participants (27%, 130/475) had heard of HPV. Awareness of HPV was higher among respondents with a previous sexually transmitted infection compared with those without a previous sexually transmitted infection (odds ratio, 2.38; 95% confidence interval, 1.10-5.13). Adults who had heard of genital warts were also more likely to be aware of HPV compared with those who had not (odds ratio, 4.37; 95% confidence interval, 2.59-7.38). Only 10% (24/250) of parents had previously heard of HPV vaccine; however, after researchers explained the purpose of the vaccine, nearly all (96%, 240/250) said they would be willing to get HPV vaccine for their daughters if it were available. CONCLUSION: Despite low awareness of HPV in Haiti, interest in HPV vaccination was nearly universal in our study of health care-seeking adults. This high acceptability suggests that HPV vaccination programs instituted in Haiti would be well received.Item Open Access Prevalence and Genotype Distribution of Human Papillomavirus in Women with Cervical Histopathology in Haiti(2010) Ndirangu, Jacqueline WanjikuThe 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.
Item Open Access Screening for Cervical Cancer in HIV Positive Kenyan Women: the Role of HPV Genotyping(2013) Dainty, Erin E.Problem: Among HIV positive women in Kenya, cervical cancer has the highest incidence of any malignancy. In order to create effective screening strategies for both the primary and secondary prevention of cervical cancer in HIV-infected women, an understanding of the natural history of human papillomavirus (HPV) and HIV co infection is critical.
Objectives: To describe the prevalence of HPV genotypes in HIV infected women with mild dysplasia and those with biopsy-confirmed severe dysplasia and invasive cervical cancer in Eldoret, Kenya. To determine how CD4 count, as a marker of immunocompetence, relates to HPV genotype distribution in patients with compared to those with severe dysplasia and invasive cervical cancer.
Methodology: This was a cross-sectional study recruiting from two groups: women who have invasive cervical cancer and women who have mild dysplasia. Cervical swabs were collected for genotyping, along with a recent CD4 count and relevant sociodemographic and medical data. HPV genotyping for types 6, 11, 16, 18, 26, 31, 33, 35, 39, 43, 44, 45, 51, 52, 53, 54, 56, 58, 66, 68, 69, 70, 71, 73, 74, and 82 was performing using the INNO-LiPA HPV genotyping assay, SPF10 system version 1 (Innogenetics, Ghent, Belgium). Crude and covariate-adjusted prevalence odds ratios were calculated using logistic regression analysis, and were performed separately for each HPV-type. In addition, modification of HPV-type prevalence ratios by CD4 count was analyzed. All data analysis was performed using Stata 12.1 (College Station, TX).
Results: HPV 52 had a significantly higher prevalence in this population than HPV 16 or 18. Neither HPV genotype nor CD4 count had changed the prevalence odds of severe dysplasia and invasive cervical cancer. Participant age, history of syphilis, anemia, vaginal bleeding, and greater than five pregnancies increased the prevalence odds of severe dysplasia and invasive cervical cancer, compared to mild dysplasia.
Conclusions: These findings suggest that duration of HPV infection and host response to infection, rather than HPV genotype or CD4 count, are primarily responsible in the oncogenic transformation of infected cervical tissue. The overwhelming predominance of HPV 52 has implications regarding the efficacy of vaccination against HPV 16 and 18 in the primary prevention of cervical cancer in HIV infected women in Western Kenya.