Health Science Reviews

By: Siphamandla Mdingi

Cervical cancer is the deadliest type of cancer that ranks as the second most common
cancer in South Africa, claiming more than 300,000 women’s lives a year globally. This
cancer continues to have high prevalence despite the free cervical cancer screening
and vaccine services in the health facilities. The development of cervical cancer is
mostly caused by the human papillomavirus (HPV). HPV can be divided into high-risk
(HR) and low-risk (LR) HPV genotypes; the HR-HPV types are associated with the
development of cancer. Some women can clear out an HPV infection, but some suffer
fatal consequences.

But who is at high risk?
Researchers in the Eastern Cape conducted a study to determine the prevalence and
types of HPV in women, and how factors like age and HIV status influence the
infection. Additionally, current vaccines were investigated to determine if they protect
women against high-risk HPV genotypes. They collected cervical specimens from 325 women, aged 18 – 60 years, for cervical cancer screening and HPV testing using lab-
based techniques like multiplexed real-time PCR to detect 28 different types of HPV.

To explore HPV prevalence and genotype distribution, participants were grouped
according to their age group and HIV status.
The overall HPV prevalence was found to be 65.2%, while HR-HPV was dominant
with 53.8%. Furthermore, the highest prevalence of 80.9% was observed in women
aged 18-25 years. As a result, HPV prevalence and genotype distribution were found
to decrease significantly with increasing age in all women. HIV-positive women had
the highest HPV prevalence and genotype distribution compared to HIV-negative
women. This could be due to factors like sexual activity patterns, multiple and
persistent exposure to HR – HPV.

Interestingly, the overall most common HR-HPV types were HPV-58, 35, 68, and 16.
Commercially available vaccines only cover a limited number of the HPV types
detected amongst this population, with the highest coverage being Gardasil-9, with
42.2% coverage. The second most common type of HPV-35 is not covered by any
currently available vaccines in South Africa. This raises concerns about vaccine strategies that are developed using global vaccine formulations, and that they should
be developed using local genotype data to ensure maximum coverage.

While the study was limited to only one health centre in the Eastern Cape among 9
provinces, the findings are clear that better vaccines are needed to protect against
HR-HPV types, especially in younger women and HIV-positive women. The study also
highlights the urgent need for the distribution of knowledge about cervical cancer
screening and the vaccine, as many women in that region did not have this information.

References:
Mbulawa, Z.Z.A., Kondlo, S., Toni, S., Faye, L.M. & Businge, C.B. 2024. Prevalence,
Characteristics, and Distribution of Human Papillomavirus According to Age and HIV
Status in Women of Eastern Cape Province, South Africa. Viruses. 16(11):1751–1751.
DOI: https://doi.org/10.3390/v16111751.