Prevalence of Cutaneous Human Papillomavirus infections at Parirenyatwa hospital's Kaposi Sarcoma Clinic and the Opportunistic Infections Clinic: Association with Non- Melanoma Skin Cancers

Abstract

Human papillomavirus (HPV) types from the Betapapillomaviruses (ß-HPVs) genus are ubiquitous in non-melanoma skin cancers (NMSC), hyperkeratotic skin warts and in cancer free skin biopsies among fair skinned races. There is paucity of information regarding the prevalence and distribution of ß-HPVs among black Africans. To determine the prevalence of ß-HPV genotypes in cutaneous infections among black Zimbabweans and their association with NMSC, a cross-sectional study was carried out in which skin biopsies were collected from patients attending a referral hospital. HPV typing was done by Primer mix polymerase chain reaction (PM-PCR) and the subsequent reverse hybridization assay (RHA) which is known to identify 25 cutaneous ß-HPV types implicated in skin lesions. We included 144 Black participants with clinically apparent cutaneous warts (n=28), suspected NMSC (n=98) and Kaposi sarcoma (KS) (n=18). The skin biopsies were analyzed for HPV DNA presence and type. The frequency of ß-HPV DNA was 70.1% (101/144). HPV DNA positivity was significantly higher in the HIV infected group 79.2% (57/72) compared to the HIV uninfected 61.1% (44/72), [OR=2.42, 95%CI (1.09-5.47), P=0.018]. All warts patients were HPV DNA positive and 89% (16/18) of those with KS and 58% (57/98) of those with NMSC. Single HPV infections were observed in 33.7% (34/101) of the participants that were HPV DNA positive, 66.3% (67/101) had multiple HPV types and 20.8% (21/101) had greater than five HPV types. The frequency and distribution of different HPV types did not show associations with neither age, sex, biopsy type but showed association with immune status. ß-HPVs are not uncommon in the Zimbabwean black population with skin lesions. There is a difference in the types of HPV genotypes detected in the skin lesions in this population (ß species 1 predominance) when compared to European populations, where there is a ß species 2 predominance. The study provides baseline molecular-epidemiological information for cutaneous HPV infections in Zimbabwe. However, wider national surveys using less invasive techniques are warranted to establish the exact extent of HPV cutaneous infections for more effective public health interventions.