High risk Human Papillomavirus Infection among normal women from various Indian population: A comparative profile

C Duttagupta PhD^a, S Sengupta PhD^a, M Roy MSc^a, P Bhattacharya MSc^a, P Laikangbam MSc^a, D Sengupta PhD^b, S Roy MD, DRC Path^c, S Ghosh, FRCOG ^d, TD Singh MD, S Path MBBS^e,f, Y Verma MD, S Path MD PhD^g,h

^aBiochemistry Unit, ^bStatistics & Mathematics Unit; Indian Statistical Institute, Calcutta, W. Bengal, ^cDirector, Quadra Diagnostic Centre, Calcutta, W. Bengal, ^dFormer Director, Gynecological Service, Cancer Centre & Welfare Home, Thakurpukur, W. Bengal, ^eBabina Diagnostiic Centre, Manipur, Chhattish Garh, ^fLeirik Memorial Hospital, Manipur, Chhattish Garh, ^gDepartment of Pathology, STNM Hospital, Sikkim, Chhattish Garh, ^hVivekananda Tribal Hospital, Jagdalpur, Chhattish Garh, India

Aim: Socioculturally India is highly heterogeneous and a high level of reproductive morbidity continues to exist especially among the rural and tribal women. Our aim is to determine whether sociocultural differences influence human papillomavirus (HPV)-infection among different populations of India. Methods: Married women from low socioeconomic strata from four States, a northeastern (Manipur, MN), a northern (Sikkim, SI), an eastern (West Bengal, WB) and a Tribal State (Chhattish Garh, CG) attending the clinics of each region for receiving reproductive health care counseling were enrolled. A Pap smear and a lavage were taken under assigned code number and these were screened for the presence and types of HPV DNA by PCR amplification and RFLP. None of these women had HPV testing and majority also did not have Pap smear done prior to this study. HPV infection and abnormal cytology (ASCUS and LSIL) were determined in each of the 3 demographic factors, viz age at reporting (Age), age at the consummation of marriage (ACM) and parity. Contingency tables were constructed and tests of independence were performed to examine any association of HPV infection or abnormal cytology with the demographic factors and also with different variables (performing 2 test or Fisher’s exact test as appropriate). Results: Baseline data on subjects from MN [n = 470, ages: 40.8 (SD:  10.6,) yr; ACM: 21.6 ( 5.2) yr; parity: 3.7 ( 3.5)]; SI [n = 353, ages: 36.2 ( 9.6) yr; ACM: 20.1 ( 4.1) yr; parity: 2.7 ( 1.7)]; WB [n = 1114; ages: 30.5 ( 10.6) yr; ACM: 16.2 ( 2.6) yr; parity: 3.0 ( 2.5)]; CG [n =195; ages: 36.7 ( 11.02) yr; ACM: 16.7 ( 3.01) yr; parity: 3.0 ( 1.8)] enrolled in the first 2-year showed that oncogenic HPV infection was present as 57.1% in MN, 51.9% in SI, 78.3% in WB and 40% in CG. Of these, women from MN showed more of HPV 18 (50%) than HPV 16 (25%). Women from SI and CG did not have any HPV 18. WB had 67.2% HPV 16 followed by 7.8% HPV 18. Age wise distribution of HPV 16/18 showed a significant trend for WB (p_trend =0.046) but not for MN (p_Trend = 0.531) or SI (p_Trend = 0.477). The abnormal cytology profile was within the range of 2-6%, except for CG (13%). Age wise distribution showed significant association (p = 0.025, 0.001 and 0.000 respectively for MN, SI and WB/CG). HPV infection was independent of ACM and parity. Abnormal cytology showed a significant association with parity for SI and WB (p = 0.002 & 0.000) but none with ACM. High inflammation was present in a large number of subjects from all states. Conclusions: The findings show that oncogenic HPV infection in Indian women vary in different locations. It brings out certain demographic (age. parity etc) and other life style factors on the development of abnormal cytology in rural/tribal Indian women and emphasizes the paucity of epidemiological data. This justify the need for screening women for cervical cancer (including oncogenic HPV testing). For, it is extremely difficult to carry out retrospective studies in India and no organized screening program yet exist.

Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Nice, France; February 7 - 10, 2004; in poster session 992 (Screening & detection).