In the Journals

High-risk HPV prevalent in American Indian women

Naomi Lee, PhD
Naomi R. Lee

A study conducted on one of the largest American Indian reservations in the United States found that women from the tribal community had a high prevalence of high-risk HPV, with older women experiencing a prevalence approximately triple that of other races.

“Cervical cancer disproportionately affects American Indian and Alaska Native (AIAN) women,” Naomi R. Lee, PhD, assistant professor in the department of chemistry and biochemistry at Northern Arizona University, told Infectious Disease News.

“The cancer disparity is primarily attributed to a lack of screening and unequal access to health care. However, recent studies in certain tribes indicate that a higher prevalence of HPV among AIAN women, especially among older AIAN women, is also a likely contributor. Therefore, efforts to reduce the cervical cancer disparity should focus on increased cancer screening, continued promotion of HPV vaccination, and further research on contributing factors to HPV persistence and cancer progression such as the vaginal microbiota.”

Lee and colleagues estimated the prevalence of high-risk HPV (HrHPV) using self-collected vaginal swabs from 698 American Indian women aged 21 to 65 years from a tribal community in the Great Plains region, which includes 17 tribes located in North Dakota, South Dakota, Nebraska and Iowa. (The community where the study took place elected not to be identified, Lee and colleagues said.) Study participants could not be pregnant or have given birth within 6 weeks of starting the study, which was part of a grant program through the NIH-funded Center for Native Population Health Disparities.

According to the findings, 34.8% (n = 243) participants tested positive for at least one HrHPV genotype, with the most prevalent HrHPV genotypes being HPV-51 (7.6%), HPV-58 (5.3%), HPV-52 (4.3%), HPV-18 (4.3%) and HPV-16 (3.9%). Lee and colleagues noted a decline in HrHPV prevalence with age, with women aged 21 to 24 years having the highest overall prevalence (42.2%) of the 14 genotypes included in the study; however, only 2% of the women in that age group had tested positive for either HPV-16 or HPV-18. Women aged 25 to 29 years had the second-highest overall prevalence of the HrHPV genotypes (39.1%) and the highest prevalence of HPV-16 and HPV-18 (13%).

Older women had lower overall prevalence of HrHPV genotypes (women aged 30-39 years, 32.85%; aged 40-49 years, 36.1%; aged 50-65 years, 27.9%).

“The overall prevalence of the 14 HrHPV genotypes assessed in our sample was higher than in the general U.S. population, especially among women aged 50-65 years,” Lee and colleagues concluded. “A key finding was that HPV-51, which is not covered by any available vaccines, was the most prevalent HrHPV genotype in our sample, at 7.6%. This genotype has a lower prevalence in the general population but is the most prevalent in at least two tribal communities.

“Next-generation vaccines that offer broad protection against additional HPV genotypes may provide expanded coverage against HrHPV types that are prevalent in American Indian communities. We also highlight the need for evaluating the impact of the 9vHPV vaccine in tribal health systems.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

Naomi Lee, PhD
Naomi R. Lee

A study conducted on one of the largest American Indian reservations in the United States found that women from the tribal community had a high prevalence of high-risk HPV, with older women experiencing a prevalence approximately triple that of other races.

“Cervical cancer disproportionately affects American Indian and Alaska Native (AIAN) women,” Naomi R. Lee, PhD, assistant professor in the department of chemistry and biochemistry at Northern Arizona University, told Infectious Disease News.

“The cancer disparity is primarily attributed to a lack of screening and unequal access to health care. However, recent studies in certain tribes indicate that a higher prevalence of HPV among AIAN women, especially among older AIAN women, is also a likely contributor. Therefore, efforts to reduce the cervical cancer disparity should focus on increased cancer screening, continued promotion of HPV vaccination, and further research on contributing factors to HPV persistence and cancer progression such as the vaginal microbiota.”

Lee and colleagues estimated the prevalence of high-risk HPV (HrHPV) using self-collected vaginal swabs from 698 American Indian women aged 21 to 65 years from a tribal community in the Great Plains region, which includes 17 tribes located in North Dakota, South Dakota, Nebraska and Iowa. (The community where the study took place elected not to be identified, Lee and colleagues said.) Study participants could not be pregnant or have given birth within 6 weeks of starting the study, which was part of a grant program through the NIH-funded Center for Native Population Health Disparities.

According to the findings, 34.8% (n = 243) participants tested positive for at least one HrHPV genotype, with the most prevalent HrHPV genotypes being HPV-51 (7.6%), HPV-58 (5.3%), HPV-52 (4.3%), HPV-18 (4.3%) and HPV-16 (3.9%). Lee and colleagues noted a decline in HrHPV prevalence with age, with women aged 21 to 24 years having the highest overall prevalence (42.2%) of the 14 genotypes included in the study; however, only 2% of the women in that age group had tested positive for either HPV-16 or HPV-18. Women aged 25 to 29 years had the second-highest overall prevalence of the HrHPV genotypes (39.1%) and the highest prevalence of HPV-16 and HPV-18 (13%).

Older women had lower overall prevalence of HrHPV genotypes (women aged 30-39 years, 32.85%; aged 40-49 years, 36.1%; aged 50-65 years, 27.9%).

“The overall prevalence of the 14 HrHPV genotypes assessed in our sample was higher than in the general U.S. population, especially among women aged 50-65 years,” Lee and colleagues concluded. “A key finding was that HPV-51, which is not covered by any available vaccines, was the most prevalent HrHPV genotype in our sample, at 7.6%. This genotype has a lower prevalence in the general population but is the most prevalent in at least two tribal communities.

“Next-generation vaccines that offer broad protection against additional HPV genotypes may provide expanded coverage against HrHPV types that are prevalent in American Indian communities. We also highlight the need for evaluating the impact of the 9vHPV vaccine in tribal health systems.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.