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Background: India has the highest number of estimated deaths from cervical cancer globally, with most cases attributed to Human papillomavirus (HPV). The World Health Organization recommends primary HPV vaccination for girls ages 9–14, with catch-up vaccination for young women ≥ 15 if feasible. India authorized a new, inexpensive HPV vaccine in 2022; given anticipated vaccine expansion, we conducted a mixed-methods study exploring acceptability of HPV catch-up vaccination for young emerging adult women in rural Mysore, India. Methods: Between September 2022-April 2023, participants were recruited with assistance from community health workers. In the qualitative phase, gender-stratified, audio-recorded focus group discussions (FGDs) were conducted in Kannada with emerging adults ages 18–26. FGDs were transcribed, translated, and analyzed using rapid approach to identify key HPV vaccination attributes. In the quantitative phase, a conjoint analysis was conducted to assess the impact of seven vaccination attributes on likelihood to vaccinate (LTV). Women ages 18–26 ranked LTV in eight hypothetical vaccination scenarios, and the relative impact of each attribute on LTV was calculated. All participants received education about cervical cancer, HPV, and HPV vaccination. Results: Fifty-two young adults (female = 31, male = 21) participated in seven FGDs, and 101 women participated in the conjoint analysis. Average age of the 153 participants was 22.5 years, 66.7% had married, and all had completed high school. Only 17.9% had heard of cervical cancer, and 2.7% knew of the HPV vaccine. FGDs identified seven HPV vaccination attributes: cost, vaccination location, family support, peer influence, dose number, side effects, and risk of acquiring HPV. In the conjoint analysis, all attributes except dose number significantly impacted LTV. Family support (impact score = 19.37, p < 0.0001) and peer influence (impact score = 18.01, p < 0.0001) had the greatest influence, followed by cost (impact score = 16.64, p < 0.0001) and HPV risk (impact score = 12.31, p < 0.0001). Vaccination location (government centers preferred) and side effects were also significant. Conclusion: Participants had poor knowledge of cervical cancer and HPV. Social attributes (family support, peer influence) had greatest impacts on LTV, and future studies should explore family-based interventions and peer education. Providing free vaccines at government centers through India's national immunization program would maximize catch-up HPV vaccination for rural young women. [ABSTRACT FROM AUTHOR]

Introduction: Human papilloma virus is a dominant factor for cervical carcinogenesis. First coitus at a younger age, having a high number of pregnancies, and marrying at an early age are identified as significant risk factors for HPV infection. Objective: The current study was initiated to evaluate the overall prevalence of HPV in women from the northern state of India. Materials and method: This cross-sectional study was conducted on 120 married women within the age group of 21 to 65 years, who reported specific complaints such as vaginal discharge or bleeding per vaginum. Already diagnosed with cervical cancer, received HPV vaccination, and confirmed cases of tuberculosis or any other carcinoma were excluded from the study. Cervical smears were taken by trained technician using modified AYRE'S SPATULA. Ethical approval for the study was obtained from the Institutional Ethical Committee. Result: Prevalence of HPV among women patients, who reported specific complaints, such as vaginal discharge or bleeding per vaginum, 82.50% were tested positive, while 17.50% were tested negative. The study also contributes valuable insights into age-specific trends of HPV infection, indicating an increased risk among women aged 25 to 34 years. Conclusion: The Study reveals a higher prevalence of HPV among women with normal cytology, but minor gynecological complaints and the complex relationship between HPV and biomarkers, suggests the need for further research. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the second most common cancer in Indian women. In India, cervical cancer contributes to 6-29% of all cancers in women.[1] Late diagnosis results in poor outcomes in the majority of instances of cervical cancer. Cervical carcinoma is the leading cause of mortality (17%) in 30-69 years old women.[1] The aim of this study is to assess the knowledge in Indian women attending oncology Outpatient Department (OPD) at Kurnool medical college and Government General hospital, Kurnool regarding cervical cancer screening and Human Papilloma Virus (HPV) vaccination. The secondary goal of the study was to create awareness among patients attending OPD regarding carcinoma cervix. Materials and Methods: This is a cross sectional study, conducted in 423 women who attended OPD, Department of Oncology, Kurnool Medical college, Kurnool after taking prior permission from hospital ethics committee. After taking informed consent, the questionnaire was provided to the subjects who met inclusion criteria, in the language understandable to them. In case if subject was illiterate, the questionnaire was read aloud by doctor and the responses were recorded. After completion of questionnaire, the doctor shared knowledge regarding etiological factors, screening tests, awareness on vaccination and treatment options available for carcinoma cervix with the patients. Results: Majority of the women have poor knowledge about cervical cancer (75.82% [321/423]) and it's screening (77.7% [329/423]). Conclusion: Many women lacked knowledge regarding cervical cancer and its screening, which is the reason behind late diagnosis and high mortality. It is the high time to create awareness of cancer cervix, its screening and adoption of prevention measures like vaccination to decrease the burden of disease in India. [ABSTRACT FROM AUTHOR]

Smokeless tobacco (SLT) is consumed by more than 300 million people worldwide. Studies show high use among Indian indigenous women who are also at high risk for oral cancers. Both human papillomavirus infection (HPV) and SLT have been associated with oral cancer, this study examined the presence of high-risk HPV in oral samples collected from tribal smokeless tobacco users in Mysuru, India. Between June and August 2019, 100 tribal females (50 SLT-users and 50 non-users) from rural Mysuru District, Karnataka, were enrolled in a cross-sectional study. Following informed consent, demographic data and oral samples were collected and processed using a digene HC2 High-Risk HPV DNA test (Qiagen, USA). On average participants were 45.5 (SD: ±6.6) years. Chronic SLT users were mostly married (73%), Hindu (100%), illiterate (62%), and employed (90%). One woman was positive for high-risk HPV infection. Oral HPV infection was low in this sample and this is consistent with the literature from other low and middle-income countries. SLT use is high in this group so interventions to reduce tobacco use are warranted. [ABSTRACT FROM AUTHOR]

Background: Human Papillomavirus (HPV) causes various types of cancer in both men and women. Woman with HPV infection has a risk of developing invasive cervical cancer. Globally, HPV 16 and 18 were predominant. This study aims to find the distribution of various HPV types in South Andaman. Methods: A cross-sectional study was conducted among women in South Andaman, where cervical scrapes were collected after collecting written informed consent. Detection of HPV genotypes was carried out by using a PCR assay. Further, sequencing analysis was performed using MEGA11 to identify various genotypes in this territory. Result: Of these 1000 samples, 32 were positive for HR-HPV 16, and four were positive for HR-HPV 18. Fifteen HPV genotypes were detected using molecular evolutionary analysis. Six cases were identified with multiple genotypes. The most prevalent genotype is HPV 16 which belongs to Lineage-A and sub-lineage A2. HPV 18 identified in South Andaman belonged to the lineage A1 to A5. Discussion: Various HPV types were identified among women in South Andaman. Global burden of cervical cancer associated with various HPV sub-lineages. HPV-16 A1 sub-lineage was globally widespread, whereas sub-lineages A1, A2 and D1 prevailed in South Andaman. Conclusions: HR-HPV identified in this study enlightens the importance of HPV vaccination among women in remote places. These findings will help to strengthen public health awareness programs and prevention strategies for women in remote areas. [ABSTRACT FROM AUTHOR]

Background: Urothelial carcinomas (UC) account for 6 and 2% of all cancers in men and women, respectively. Human papillomavirus (HPV) is one of the causative agents in cancers of the uterine cervix and head and neck. The role of HPV is also being studied in cancers of the urinary bladder, penis, and prostate. As p16-INK4a is a surrogate marker for high-risk HPVE7 oncoprotein, this study aims to highlight the utility of p16 immunohistochemistry (IHC) in the evaluation of HPV-associated UC. Materials and Methods: A retrospective study was conducted on UC of the bladder received in the Pathology department between January 2013 and December 2018. Bladder biopsies from non-neoplastic lesions served as controls. IHC was done for the detection of the p16 antigen. The p16 staining was recorded as positive, when there was strong staining in >50% of tumor nuclei. The p16 positive and negative tumors were compared based on age, gender, tumor size, grade, and muscle invasion. P value <0.05 was considered statistically significant. Results: The expression of p16 was analyzed in 72 UC and compared with 20 non-neoplastic cases, of which 26.4% of the cases showed p16 expression. The p16 expression was absent in the non-neoplastic lesions. While the majority (87.5%) of the low-grade tumors were negative for p16 expression, 43.8% high-grade tumors were positive. Similarly, a larger proportion of invasive carcinomas (38.8%) expressed p16 as compared to non-invasive carcinomas (13.8%). Thus, p16 expression showed a significant association with grade and stage in these malignancies (P < 0.05). Conclusion: The p16 expression was associated with high-grade and muscle-invasive UC. The p16 was absent in all non-neoplastic and precursor lesions. Thus, it can provide essential information not only about HPV association but also on the prognostic implications for the patients. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (PLHIV) are at higher risk for human papillomavirus (HPV)-related oropharyngeal cancers compared to the general population. Xpert HPV test is a polymerase chain reaction (PCR) assay capable of rapid HPV detection. Performing the assay requires minimal intervention by laboratory personnel. Its use could improve oropharyngeal cancer screening among PLHIV living in low-and middle-income countries (LMICs) with limited diagnostic capacities. However, Xpert HPV performance for oral samples has not been evaluated. Here, we describe our experience with Xpert HPV and compare its results with traditional PCR, for oral samples. Methods: Oral samples from 429 PLHIV receiving care at a tertiary care hospital affiliated antiretroviral therapy center in Pune, India were used. Samples were collected either after a 30s oral rinse and gargle (n = 335) or in combination with cytobrush scraping of the oral mucosa (n = 91). Unsuccessful tests were those that generated an invalid or error result on Xpert HPV. Successful tests were those that generated a positive or negative result. Kappa statistic was used to compare concordance between Xpert HPV and traditional real-time PCR results. Results: There were 29.8% (n = 127) unsuccessful tests, of which 78.7% (n = 100) were invalid and 21.3% (n = 27) were error results. Adding cytobrush scraping to oral rinse as a collection procedure did not significantly reduce the proportion of unsuccessful tests (p = 0.9). For successful tests, HPV positivity on Xpert was 0.3% (n = 1/299). Kappa statistic was 0.11, indicating poor agreement between Xpert HPV and traditional PCR results. Conclusions: Presently, Xpert HPV appears to have limited use for oral HPV detection among PLHIV using oral samples. More research to improve the diagnostic capabilities of Xpert HPV for oral samples among PLHIV is needed. [ABSTRACT FROM AUTHOR]

Cervical cancer can be eradicated by 2030 by the implementation of a global strategy involving the vaccination of young girls against human papillomavirus (HPV), screening 70% of women in 30–69 years of age and treating 90% of the women with precancerous lesions. For a country with a large population like India, all the three strategies can be a challenge. There is a need for implementation of a high throughput technology that can be scalable. Cobas 4800, a multiplexed assay based on quantitative polymerase chain reaction technology, identifies HPV 16 and HPV 18 along with the concurrent detection of 12 pooled other high‐risk HPV infections. This technology was used to test 10 375 women from the South Indian community for the first time as a feasibility program. Upon testing, high‐risk HPV was found in 595 (5.73%) women. A total of 127 women (1.2%) were found to be infected with HPV 16, 36 women (0.34%) with HPV 18 and 382 women (3.68%) with the 12 pooled high‐risk HPV and multiple mixed infections were found in 50 women (0.48%). It was observed that there was a high prevalence of high‐risk HPV in younger women, 30–40 years of age and a second peak was observed at 46–50 years of age. The second peak had higher mixed infections in the 46–50 years of age and this association was statistically significant. We found that 24/50 (48%) of the multiple mixed high‐risk HPV infections were in the age group 46–50 years. The current study is the first attempt from India, on a completely automated platform using Cobas 4800 HPV test in a community screening program. This study shows HPV 16 and HPV 18 infections, when differentiated, can be valuable for risk stratification in community screening program. Women in the perimenopausal age (46‐50yrs) showed a higher prevalence of multiple mixed infections, signifying a higher risk. [ABSTRACT FROM AUTHOR]

We are reporting (a) updated incidence of cervical intraepithelial neoplasia (CIN) among women who did not have colposcopic or histopathological disease at baseline and (b) disease outcomes among women treated for CIN and their follow‐up HPV status; in a cohort of women living with HIV (WHIV). The median overall follow‐up was 3.5 years (IQR 2.8‐4.3). The incidence of any CIN and that of CIN 2 or worse disease was 16.7 and 7.0 per 1000 person‐years of observation (PYO), respectively. Compared with women who were HPV negative at baseline, women who cleared HPV infection had 23.95 times increased risk of incident CIN 2 or worse lesions (95% CI 2.40‐661.07). Women with persistent HPV infection had 138.18 times increased risk of CIN 2 or worse lesions (95% CI 20.30‐3300.22). Complete disease regression was observed in 65.6% of the HPV positive women with high‐grade CIN and were treated with thermal ablation but HPV persistence was seen in 44.8% of those with high‐grade disease. Among those who did not have any disease at baseline and were also HPV negative, about 87% (95% CI 83.79‐89.48) women remained HPV negative during consecutive HPV test/s with the median interval of 3.5 years. Long‐term surveillance of WHIV treated for any CIN is necessary for the prevention of cervical cancer among them. Our study provides an early indication that the currently recommended screening interval of 3 to 5 years among WHIV may be extended to at least 5 years among HPV negative women. Increasing the screening interval can be cost saving and improve scalability among WHIV to support WHO's cervical cancer elimination initiative. [ABSTRACT FROM AUTHOR]

• PI3K pathway mutations were found in 54.8% of South Indian cervical cancers. • PIK3CA was the most commonly mutated gene with frequent helical domain mutations. • E542K and E545K may activate PI3K pathway through altered p110α-p85α interaction. Cervical cancer is the second most common cancer in India. The phosphatidylinositol-3 kinase (PI3K) signaling is one of the most commonly activated pathways in cancer and comprises key molecules commonly targeted in cancer therapy. This study analyzed six PI3K pathway gene mutations. We carried out targeted next-generation sequencing of six PI3K pathway genes (PIK3CA, PIK3R1, PTEN, AKT1, TSC2, and mTOR) in a total of 93 South Indian cervical cancer samples and confirmed them by sanger sequencing. The PI3K pathway gene mutations were observed in 54.8% (51/93) of the tumors and PIK3CA was the most mutated (34.4%, 32/93), followed by TSC2 (18.3%, 17/93), and PIK3R1 (14%, 13/93). The PIK3CA hotspot mutations E542K and E545K observed in this study were likely to disrupt the p110α-p85α interaction that could result in the PI3K pathway activation. We also found a few novel mutations in PIK3R1, PTEN, AKT1, TSC2, and mTOR genes while some of the tumors harbored multiple mutations in the genes of the PI3K pathway. The majority of the tumors were positive for high-risk HPV16/18 (60.7%). The high incidence of the PI3K pathway gene mutations observed in this study could be exploited for the therapeutic management of cervical cancers. [ABSTRACT FROM AUTHOR]

Persistent infection of human Papillomavirus is the main etiological factor for cervical cancer. Austro‐Asiatic tribes are early settlers in India and they have unique genetic variations compared to other people. The immunological response is crucial for the prevention of viral associated diseases. Interleukin‐1 receptor antagonist (IL‐1RN) is considered being an important regulator of host immune surveillance. A total of 45 Santali tribal women and 10 Kora tribal women were enrolled in the present study and demographic variables were recorded during collection. Genomic DNA was extracted from cervical/vaginal swab samples. IL1RN variable number of tandem repeats (VNTR) polymorphisms and HPV types were determined by PCR‐based assay. Association between IL1RN VNTR polymorphisms with the HPV infections among the tribal communities was determined by logistic regression analysis. HPV18 prevalence was significantly higher among tribal women. We observed that the polymorphism A2*A2 (p = 0.022; odds ratio [OR] (95% confidence interval [CI]) = 0.16 (0.03–0.86)] were more resistant to oncogenic HPV infection. Use of oral contraceptives was associated with higher relative risk (p = 0.008; OR [95% CI] = 5.39 [1.47–19.8]) for oncogenic HPV18 positivity among the tribal women. The A2 allele homozygosity of IL1RN VNTR was identified to be associated with the protection from oncogenic HPV infection among various tribal communities of West Bengal and therefore may be a useful marker of host immune response among them. [ABSTRACT FROM AUTHOR]

Background & objectives: Human papillomavirus (HPV) and oropharyngeal squamous cell carcinoma (OPSCC) are found to be strongly associated with each other with an increase in incidence has been noted globally over the years. A literature search for data depicting the role of HPV in oropharyngeal carcinoma in South India, however, has resulted in little information, thus, the present study was aimed to assess a possible association between the two among OPSCC patients from a tertiary care cancer centre in South India. Methods: One hundred and forty three OPSCC cases were included in the study and analyzed for age, gender, marital status, habits, clinical TNM staging, site, laterality, symptoms, histological type (keratinizing and non-keratinizing), primary treatment and follow up period. All the cases were subjected to p16INK4a immunostaining. Statistical analysis was done using SPSS software. Results: Of the 143 cases 12 were found to be p16 positive with no significant difference between the study variables among p16 positive and negative cases. Base of the tongue was the most commonly involved site for the p16 positive cases. The p16 positive cases presented at an elderly age, early stage and were mainly the keratinizing type. Interpretation & conclusions: The p16 positive OPSCC cases constituted a small proportion in the present study and behaved similar to p16 negative cases. Usage of tobacco and alcohol appear to be the susceptible factors even in p16 positive cases. More studies from other States would be helpful to determine if HPV-related SCC in the Indian subcontinent behave differently or similarly to cases from Western countries. [ABSTRACT FROM AUTHOR]

Background: Oral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. However, there is little information available on the prevalence of oral HPV in this population.Methods: We tested 302 HIV-positive Indian MSM for oral HPV infection using L1 HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load (VL) were measured. Participants completed an interviewer-administered questionnaire including a sexual history.Results: The prevalence of oral HPV was 23.7% (95% CI: 19-29%) and 2.4% of participants had oncogenic HPV types. No participants had oral HPV type 16 (HPV-16) and the prevalence of other anogenital HPV types was low. Participants with higher CD4+ levels had reduced odds of having any oral HPV infection (OR: 3.1 [1.4-6.9]) in multivariable analyses.Conclusions: This is the first report of oral HPV among Indian HIV-positive MSM. Our results show a high prevalence of oral HPV infection consistent with studies from Western populations. However, oncogenic anogenital HPV types were relatively uncommon in our study population. It is unknown what the impact of this distribution of oral HPV will be on oropharyngeal cancers. HIV-positive MSM in India should be monitored closely for oral and oropharyngeal pre-cancer and cancer. [ABSTRACT FROM AUTHOR]

Background: Extra-genital warts (EGWs) affect 7-10% of population. Even though a plethora of studies have been conducted to assess the impact of genital warts (GWs) showing a significant impact on the quality of life but surprisingly, barely any data has been collected on the impact of EGWs on quality of life. Aims and Objective: This cross-sectional study aimed at comparing the magnitude of EGWs on health-related quality of life and various variables with that of GWs. Patients and Methods: The study consisted of two groups of immunocompetent adults, each with 100 patients aged 18 years or above, attending the skin outpatient department at our tertiary center between April 2018 and March 2019 and consented to participate. Group A consisted of patients with EGWs and group B comprised of patients with GWs. All patients were asked to fulfill the validated Hindi hard copy of the Dermatology Life Quality Index (DLQI) questionnaire. Results: The mean DLQI score of patients with EGWs was 8.73 ± 0.84 and that of patients with GWs was 5.83 ± 0.83 (P = 0.026). In group A, those affected the most were patients with warts on multiple exposed sites (mean DLQI score of 14), followed by warts on feet (mean DLQI score of 10.69), followed by warts on hands (DLQI score of 9.12), and facial warts (DLQI score of 6.80). Patients with a prior history of failed treatment and/or a longer duration of illness had a higher level of dissatisfaction. To the best of our knowledge, no such study has been conducted in the past in our country. Conclusions: EGWs inflict a severe negative impact on the quality of life. Owing to its notorious persistence and recurrence, healthcare professionals must educate patients on how to prevent the spread and recurrence, discuss details of available treatment modalities while keeping in view the psychological and sociological impact. [ABSTRACT FROM AUTHOR]

Background: Every year, globally 570,000 women are diagnosed with cervical cancer, out of which around 311,000 die. India contributes to about 132,000 new cases and 74,000 deaths yearly. One of the major risk factors for cervical cancer is infection with some types of human papillomavirus (HPV). This is both preventable (by vaccination) and detectable early (routine screening programs). Objective: The objective of this study is to assess the knowledge and attitude in medical and paramedical students about cervical cancer and HPV vaccination. Material and Methods: A cross-sectional survey was conducted, using predesigned and validated questionnaire. It was segregated into three parts: Q1—demographic details, Q2a—questions assessing knowledge, Q2b—questions assessing attitude. Our target population was female students (18–25 years) studying in medical, nursing, and physiotherapy colleges. Descriptive statistics of data was analyzed using SPSS 16.0. Results: We had 73% response rate. Most participants belonged to upper middle and upper socioeconomic class, were pursuing MBBS, resided in villages, had educated parents, and had good health-care-seeking behavior. School education, television, and printed advertisements appeared to be underutilized. Around 50% of the participant had received chickenpox and typhoid vaccine, but only 8% had received HPV vaccine. The mean knowledge score was 5.19 ± 2.24, with 0.00 minimum and 11.0 maximum, out of a maximum possible score of 17. Only, place of residence appeared to effect the knowledge score. Conclusion: The study shows the dismal knowledge levels about HPV amongst students. Participants were interested in seeking knowledge; consider HPV vaccination provided they were provided with sufficient knowledge. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) is increasingly recognized as a significant risk factor in the development of head and neck cancers (HNCs), with varying prevalence and impact. This study aims to systematically review and analyze the prevalence of HPV in HNCs in India, providing insights into regional variations., Methods: A comprehensive literature search was carried out using PubMed, Embase, and Web of Science up to November 10, 2023. Inclusion criteria focused on original research reporting HPV-positive cases among HNC patients in India. We used Nested-Knowledge software, for screening, and data extraction. The modified Newcastle-Ottawa Scale was used for quality assessment of included studies. We pooled the prevalence of HPV among HNC patients and performed a random-effects model meta-analysis using R software (version 4.3)., Results: The search yielded 33 studies, encompassing 4654 HNC patients. The pooled prevalence of HPV infection was found to be 33% (95% CI: 25.8-42.6), with notable heterogeneity (I² = 95%). Analysis of subgroups according to geographical location indicated varying prevalence rates. Specifically, the prevalence was 47% (95% CI: 32.2-62.4) in the eastern regions and 19.8% (95% CI: 10.8-33.4) in the western regions. No evidence of publication bias was detected., Conclusion: The observed considerable regional disparities on the prevalence of HPV in HNC patients in India emphasizes the need for integrated HPV vaccination and screening programs in public health strategies. The findings underline the necessity for further research to explore regional variations and treatment responses in HPV-associated HNCs, considering the impact of factors such as tobacco use and the potential benefits of HPV vaccination., (© 2024. The Author(s).)

One major advantage of molecular assays for human papillomavirus (HPV) DNA detection is that these assays can be performed on self‐collected samples unlike cytology or visual inspection with acetic acid (VIA). This cross‐sectional study was carried out between March 2017 and April 2019 to compare the diagnostic performance in self‐collected urine and vaginal samples for HPV DNA detection. Viral DNA was extracted from processed samples using a Qiagen viral DNA extraction Kit (QIAamp DNA Mini Kit). To detect four common high‐risk HPV types (16, 18, 31, 45), multiplex real‐time polymerase chain reaction (PCR) targeting the LCR/E6/E7 region of the HPV genome was performed in ABI 7500 cycler (Applied Biosystems). The negative samples were screened by conventional PCR targeting the L1 capsid region to exclude other HPV types. The overall agreement between the two self‐collecting sampling methods was 64.04% with a κ value of 0.29 pointing towards a fair agreement (P <.01). The sensitivity of HPV DNA detection in urine samples was 57.95% (47.52%, 67.72), and specificity was 84.6% (66.47%, 93.85%) when compared with vaginal samples. The study concludes that self‐collected vaginal HPV DNA testing is more sensitive than unpreserved‐urine samples for HPV DNA detection in a hospital‐based setting. Highlights: 1.HPV DNA based uterine cervical cancer screening assays can be performed in samples collected by participants at their convenience.2.This is the first study from India comparing the molecular test performance in self‐collected urine and vaginal samples3.In order to optimize the urine based HPV testing, further research using preservative fixed urine sample in special collection device is to be undertaken. [ABSTRACT FROM AUTHOR]

Objectives: To assess the efficacy of self-collected vaginal samples compared with physician-collected cervical samples for the detection of HPVDNA.Methods: A hospital-based cross-sectional study was carried out among patients with newly diagnosed cervical cancer attending the Gynecologic Oncology Division, Department of Obstetrics and Gynecology and Radiation Oncology Department at Government Medical College, Kozhikode, Kerala between March 2017 and April 2019. Consenting patients collected their vaginal samples, followed by cervical sample collection by the clinician. The paired samples were transported at 4-8 °C to the laboratory. Amplification of LCR/E6/E7 regions of the HPV genome was done by polymerase chain reaction (PCR). The agreement level between paired samples was assessed by the Kappa index.Results: Among the 114 cervical cancer patients enrolled in the present cross-sectional study, the prevalence of HPV DNA was 78.1% (95% confidence interval [CI] 69.2%-85%) in cervical samples and 77.2% in vaginal samples (95% CI 68.7%-83.9%). The overall agreement between the two sampling methods was 93.9% and the kappa value was 0.82 (P<0.001). The sensitivity of HPV detection using vaginal samples was 98.9% (95% CI 93.9%-99.8%) and the specificity was 100% (95% CI 86.7%-100%) with cervical sampling as the gold standard. By Kappa index, an almost perfect agreement for HPV DNA detection between self-collected and physician-collected samples was observed.Conclusion: Self-collection of vaginal samples ensures equity of cervical cancer screening in low-income countries such as India. [ABSTRACT FROM AUTHOR]

Cervical cancer accounts for a high number of deaths worldwide. Risk factors are extensive for cervix cancer but Human papillomavirus (HPV) plays a prime role in its development. Different strains of HPV are prevalent globally, which show different grades of mortality and morbidity among women. This study is planned to evaluate the molecular mechanism of different strains of HPV infection and progression leading to cervix cancer. This review includes different research articles on cervix cancer progression reported from India and all over the world. HPV 16 and 18 are prevalent strains using heparan sulfate-independent and dependent pathways for viral replication inside the cell. It also uses transcription mechanisms through NF-kappa B, FOXA-1, and AP-1 genes while strains like HPV-35, 45, and 52 are also predominant in India, which showed a very slow mechanism of progression due to which mortality rate is low after their infection with these strains. HPV uses E6 and E7 proteins which activate NF-kappa B and AP-1 pathway which suppresses the tumor suppressor gene and activates cytokine production, causing inflammation and leading to a decrease in apoptosis due to Caspase-3 activation. In contrast, the E7 protein involves HOXA genes and decreases apoptotic factors due to which mortality and incidence rates are low in viruses that use E7 motifs. Some HPV strains employ the cap-dependent pathway, which is also associated with lower mortality and infection rates. • The specific strain variant of HPV is a deciding factor for the diagnosis and prognosis of cervical cancer. • Inhibited NF-KB and AP-1 pathways contribute to cervix cancer by enhancing hyperimmune response and dysregulating transcription factors. • HPV utilizes host mechanisms driven by E6 and E7 transcription factors, to replicate its genome, repress tumor suppressors, promote cell division, and inhibit apoptosis. [ABSTRACT FROM AUTHOR]

Cervical cancer is the second-most prevalent gynecologic cancer in India. It is typically detected in women between the ages of 35 and 44. Cervical cancer is mainly associated with the human papillomavirus (HPV). The report shows that 70 % of cervical cancer is caused by HPV 16 and 18. There are few therapeutic options and vaccines available for cervical cancer treatment and γδ T cell therapy is one of them. This therapy can kill various types of cancers, including cervical cancer. The major γδ T cell subset is the Vγ9Vδ2 T cell, mainly distributed in peripheral blood which recognize non-MHC peptide antigens and can eliminate MHC-downregulated cancer. Moreover, γδ T cells can express different types of receptors that bind to the molecules of stressed cells, often produced on cancerous cells but absent from healthy tissue. γδ T cells possess both direct and indirect cytotoxic capabilities against malignancies and show potential antitumoral responses. However, γδ T cells also encourage the progression of cancer. Cancer immunotherapy using γδ T cells will be a potential cancer treatment, as well as cervical cancer. This review focused on the γδ T cell and its function in cancer, with special emphasis on cervical cancer. It also focused on the ligand recognition site of γδ T cells, galectin-mediated therapy and pamidronate-treated therapy for cervical cancer. Instead of the great potential of γδ T cell for the eradication of cervical cancer, no comprehensive in-depth review is available to date, so there is a need to jot down the various roles and modes of action and different applications of γδ T cells for cancer research, which we believe will be a handy tool for the researchers and the readers. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) affects approximately 80% of individuals, irrespective of gender, and is implicated in various cancers. Existing HPV vaccines, while safe and effective, do not sufficiently protect males when administered solely to females. This review, triggered by the urgent need to address this gap and reduce the associated stigma, aims to evaluate the introduction of a gender-neutral HPV vaccine, GARDASIL-9, in India. The primary objective is to assess the necessity and feasibility of incorporating the gender-neutral HPV vaccine into India's national immunization program. This integration is crucial to ensure equitable access for all children and to mitigate the substantial burden of HPV. A literature search was conducted using databases such as Google Scholar, PubMed, government websites, and relevant publications. Keywords included "gender-neutral vaccine", "HPV vaccine", and "Indian population". The central research question guiding this review is: How necessary and feasible is the inclusion of a gender-neutral HPV vaccine in India's national immunization schedule to ensure equitable access for all children and reduce the HPV burden? The review inclusion criteria comprised studies addressing the prevalence of HPV infections, HPV vaccination awareness among both genders, the cost-effectiveness of gender-neutral vaccines, current HPV vaccination status, and future perspectives specific to India. Studies not meeting these criteria were excluded. The review highlights that introducing a gender-neutral HPV vaccine in India is imperative. Including males in vaccination efforts significantly reduces the overall disease burden and helps in reducing the stigma associated with HPV. A comprehensive vaccination program, bolstered by education and awareness campaigns, and its inclusion in the national immunization schedule is essential. This approach ensures equitable access to the vaccine for all children, fostering a healthier community, preventing HPV-related cancers, and enhancing public health outcomes in India., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: The 70% screening coverage target proposed in the global cervical cancer elimination strategy is not achieved even at tertiary centres in India. A situational analysis was done to assess the currently existing facilities and barriers in tertiary care institutes., Methods: This cross sectional multicentric study was conducted from August to September 2021 in six tertiary care institutes across India. Women aged 30-49 years attending outpatient services (OPD) were invited for cervical screening. Women and health care professionals (HCPs) were administered structured questionnaires to assess knowledge, attitude and practices regarding cervical cancer screening services., Results: Out of 6709 eligible women who attended OPD, 1666 (24.8%; range:19-57%) received screening. Availability of screening kits was limited to 10-25 Pap/HPV tests per day. Visual inspection with acetic acid (VIA) and HPV testing were offered only at certain centres. Colposcopy and treatment facilities were optimal at all centres. Knowledge, attitude and practices were analysed for 1800 women: 45.7% had heard of cervical cancer, 78.0% did not know that it is preventable, 75.8% never heard about screening. Common symptoms correctly identified included postmenopausal bleeding (4.8%), postcoital bleeding (5.7%), intermenstrual bleeding (5.8%) and vaginal discharge (12.4%). Risk factors were identified by minority: poor menstrual hygiene (6.6%), oral contraceptive pill use (6.4%), multiparity (4.4%), and HPV infection (3.0%). Out of 21, mean total knowledge score (MTKS) was 2.07± 2.67. Out of 317 HCPs, 96.5% knew that cervical cancer is caused by HPV infection, is preceded by premalignant stage, and that it is preventable by screening and treatment (80.1%). Knowledge about screening modalities was present in 87.4% for cytology, 75.1% for VIA, 68.8% for HPV test. MTKS of HCPs was 20.88±6.61 out of 32., Conclusion: Even at tertiary centres, limited availability of HPV tests, reluctance to implement VIA and lack of awareness among women remain the major barriers.

Head and neck cancer is one of the most common cancers in the world, accounting for up to 30–40% malignancies in India. Research is always on the lookout for parameters that help in early diagnosis of such disease and to explore the possibility of discovering such parameters that would assist in management of the disease by its potential to predict and prognosticate the disease. To estimate serum ADA levels and to correlate with response to therapy and also to correlate between different clinical stages and serum ADA levels and to correlate HPV status to response to therapy. A prospective cohort study. 30 patients who were diagnosed with squamous cell carcinoma of the oropharynx, hypopharynx and larynx were considered in this study. The pre and post treatment values of serum ADA was estimated in these patients and the tumour was assessed for HPV status. The difference in the in the serum ADA levels before and after treatment was 9.982 which was statistically significant with a p value of < 0.001. HPV positive status and response to therapy in the form of recurrence shows a p value of 0.485 which is not statistically significant. Serum ADA level can be used as a parameter to assess the severity of the disease and the response to treatment in cases of carcinoma of the oropharynx, hypopharynx and larynx. HPV status of the disease has its limitation in prediction and prognosis of the disease. [ABSTRACT FROM AUTHOR]

Purpose: In India, cervical cancer is the second leading cause of cancer-related death in women. We piloted a cervical cancer prevention intervention in a rural town in southeastern Punjab, India to test the feasibility of a peer-driven intervention (PDI) model. Methods: Sixty-eight women (18-50 years) attended workshops with pre-post evaluation. Women learned skills of community health workers (CHWs), including strategies to engage women from the community for subsequent workshops. Results: Workshop 1 attendees (n=35) referred 33 women for Workshop 2, confirming the feasibility of PDI. Mean age was 29.48 (SD=8.2). Paired T-tests showed increased knowledge (19.41 vs 29.25, p<.001), and confidence (2.67 vs 3.70, p<.001) in imparting information to others. Conclusions: This PDI is a feasible, culturally specific approach in which community women took on the role of CHWs to reach others. They successfully acquired knowledge and confidence in discussing cervical cancer prevention at low cost and minimal resources. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) infection at the cervix, anus and oropharynx has been rarely concurrently estimated among HIV-infected women. Using multiplex polymerase chain reaction testing, we prospectively evaluated HPV genotype distribution across three anatomic sites among 50 eligible HIV-infected women from Chennai, India, who provided biological specimens and answered a sexual behaviour questionnaire. We also assessed clinical and behavioural factors related to HPV prevalence. Oncogenic HPV prevalence was comparable between the anus and cervix at 52.2% and 52.0% and lower at the oropharynx at 13.2%; 78% of women with a cervical HPV infection had the same type in the anus. Newly acquired oncogenic HPV infections were lower at cervix (24%) than anus (35%) at three months. 'Any type' cervical HPV prevalence was higher among women with low education and less than five years since HIV diagnosis. CD4+ count and antiretroviral therapy status were not associated with HPV prevalence at the three anatomic sites; however, enrolment cervical HPV16 prevalence was elevated among women with nadir CD4+ <200 cells/µL and enrolment CD4+ <350 cells/µL. Regular cervical screening is essential in HIV-infected Indian women irrespective of CD4+ count and antiretroviral therapy status. Additional research clarifying the natural history of anal HPV infection is also needed in this population. [ABSTRACT FROM AUTHOR]

Objective To evaluate the prevalence of HPV infection among women from three districts of Tamil Nadu (Erode, Salem, and Namakkal). Methods Between January 27, 2007, and December 15, 2009, 1800 women aged 20–70 years who had normal cervical cytology were enrolled into a cross-sectional study. Participants completed interviews and provided first void urine samples for assessment of HPV infection. Results Among 1699 eligible samples, 179 (10.5%) were HPV positive. HPV16 was the most common type (affecting 68 [4.0%] women), followed by HPV6 (58 [3.4%]). Among the 179 HPV-positive women, 71 (39.7%) were aged 36–45 years. An annual income of less than 25 000 INR was significantly associated with HPV infection in all three districts ( P < 0.05). Regular intercourse was also associated with HPV in Erode and Salem ( P < 0.05). Conclusion Screening and prophylactic vaccines containing HPV16 and HPV6 should be promoted in western Tamil Nadu. [ABSTRACT FROM AUTHOR]

Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. This paper attempts to review the available knowledge regarding the epidemiology and pattern of cervical cancer; types of HPV (human papilloma virus) prevalent among cervical cancer patients and among women in general, high-risk groups such as commercial sex workers, and HIV (human immunodeficiency virus)-positive women; and the role of the national program on cancer in control efforts. The peak age of incidence of cervical cancer is 55-59 years, and a considerable proportion of women report in the late stages of disease. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behavior change communication exercises and routine early screening with VIA. Sensitizing the people of the area, including menfolk, is necessary to increase uptake levels. Vaccination against types 16 and 18 can also be undertaken after taking into confidence all stakeholders, including the parents of adolescent girls. Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence. [ABSTRACT FROM AUTHOR]

Brief Background India has the highest number of cases of oral cancer in the world and this is increasing. This burden is not fully appreciated even within India, despite the high incidence and poor survival associated with this disease. Because the aetiology of oral cancer is predominantly tobacco-related, the immense public health challenge can be ameliorated through habit intervention. Methods We reviewed current rates of incidence, mortality and survival, and investigated the determinants of disease and current prevention strategies. Results In addition to tobacco smoking and the myriad other forms of tobacco use prevalent in India, risk factors include areca nut consumption, alcohol consumption, human papilloma virus, increasing age, male gender and socioeconomic factors. Although India has world-leading cancer treatment centres, access to these is limited. Further, the focus of healthcare services remains clinical and is either curative or palliative. Summary and Conclusions: Although the efforts of agencies such as the Ministry of Health and Family Welfare and the Indian Dental Association are laudable, enhanced strategies should be based on common risk factors, focusing on primary prevention, health education, early detection and the earliest possible therapeutic intervention. A multi-agency approach is required. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to identify the status of HPV infection among young sexually unexposed girls from Tiruchriapalli district, Tamilnadu, India. Methods: The distribution of HPV genotypes was evaluated by PCR DNA genotyping after self sampling from 246 study subjects. Results: Positivity for HPV DNA was reported among 9.2 % of the study subjects. The most frequently detected HPV type was HPV 16 (0.8 %) followed by HPV 11 (0.4 %). Conclusion: Our results suggest that the age did not seem to be a cofactor for HPV infection and nevertheless, sexual intercourse is an important factor for HPV infection. Moreover, these results demonstrate that HPV detection performed in self collected samples may be important to appraise better preventive strategies and monitor the influence of vaccination programmes within the population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the prevalence of HPV infection among women with cervical cancer in Tiruchirapalli, Tamil Nadu, India. Methods: A case–control study was conducted with 246 women with cervical cancer and 257 control participants aged between 20 and 70years. The presence of HPV DNA was determined using the MY09/11 PCR protocol, the GP5+/6+ PCR protocol, and type-specific PCR-based assays. Results: The overall HPV prevalence was 54.9% and HPV 16 was the most prevalent type. The women the most vulnerable for HPV infection were those aged 41 to 60years. The major contributing risk factors for cervical cancer were having had 3 or more pregnancies (OR 19.2; 95% CI, 10.78–10.16); harboring high-risk HPV DNA (OR 15.3; 95% CI, 9.81–23.8); being a manual worker (OR 14.9; 95% CI, 9.62–23.08); being illiterate (OR 8.28; 95% CI, 5.51–12.43); and having never been screened for cervical dysplasia (OR 6.70; 95% CI, 10.78–34.44). Conclusion: The present report on the overall and type-specific prevalence rates and risk burden of HPV infection in Tamil Nadu confirms that screening and vaccination programs are urgently needed in this state to overcome the burden of HPV-associated cervical cancer. [Copyright &y& Elsevier]

In developing countries like India, occurrence of Human papillomavirus (HPV) in cervical cancer as well as in the asymptomatic population was observed to be very high. Studies on HPV prevalence have been conducted in different parts of the country but no data were available from the eastern region of Uttar Pradesh (UP). The present study aimed to determine the status of HPV prevalence and its association with different socio-demographic factors in this population. Prevalence of HPV was investigated in a total of 2424 cervical scrape samples of asymptomatic women. Primer sets from L1 consensus region of viral genome were used to detect the presence of HPV, and the positive samples were genotyped by sequencing. Univariate binary logistic regression analysis was used to evaluate association of socio-demographic factors with HPV. 9.9% of the clinically asymptomatic women were found to be infected with HPV comprising 26 different genotypes. Among HPV-positive women, 80.8% showed single infection, while 15.4% harboured multiple infections. HPV-16 (63.7%) was the most prevalent, followed by HPV-31 (6.7%), HPV-6 (5.4%), HPV-81 (4.6%) and HPV-33 (4.2%). Significant association of HPV with non-vegetarian diet ( P < 0.05) and rural residential areas ( P < 0.01) were observed. High prevalence of HPV-16 in asymptomatic women of this population, a frequency comparable to invasive cervical cancers, highlights an urgent need for a therapeutic HPV vaccine covering HPV-16 and other high-risk types to provide protection against the disease. [ABSTRACT FROM AUTHOR]

Oral Squamous Cell Carcinoma (OSCC) constitutes one of the most common cancers with a wide geographic distribution. Its incidence in India is rated as one among the highest in the world. Though the use of tobacco in various forms is widely accepted to be the major etiologic factor in OSCC, Human Papilloma Viruses (HPVs) are now being increasingly associated with the cause of OSCC. Incidence of tongue carcinomas in patients below forty years, without any history of tobacco habits is also being attributed to HPV. Histological detection of HPV altered epithelial cells - Koilocytes - is considered pathognomonic of HPV infection. Here a brief review is done to highlight the association of HPV with OSCC and the methods for timely detection of HPV in such cases. [ABSTRACT FROM AUTHOR]

Abstract: Objective. : HPV infection is a necessary but insufficient cause of cervical cancer. The significance of HPV DNA in blood however is debatable because of variable detection rates due to the differences in the methodology used. The aim of this study was to detect and quantitate HPV 16 and 18 plasma viremia in women with cervical neoplasia. Methods. : HPV DNA was detected in cervical tissue using consensus PGMY primers and genotyped using reverse line blot hybridization. HPV 16 and 18 quantitation in tissue and detection and quantitation in plasma was performed using sensitive real time PCRs targeting E6/E7 region of HPV 16/18 genome respectively. Results were correlated with viral loads in corresponding tissue and with clinical disease stage. Results. : Viremia was detected in 56.4% of HPV 16 positive women and 20% of HPV 18 positive women. The prevalence of HPV 16 DNA in plasma increased with advancing disease stage (p =0.001), although HPV 16 absolute plasma viral load was not significantly associated with advancing disease stage (p =0.281). There was no correlation between absolute plasma viral load and viral load in corresponding cervical tissue (Spearman''s rho=0.184, p =0.187). The prevalence of HPV 18 viremia and absolute HPV 18 plasma viral load were not associated with advancing disease stage (p =0.620, p =0.508). Conclusion. : The presence of HPV 16 in plasma is a marker of advancing cervical disease. [Copyright &y& Elsevier]

Highly effective HPV vaccines are likely to become available for use in India shortly. The availability and validation of the vaccines to prevent oncogenic HPV infection associated lesions from progressing to cancer has clearly offered a cost effective long-term strategy to reduce the cervical cancer burden, particularly for developing countries where effective screening programmes are not available. The enthusiasm for these new vaccines duly justified, are we in reality targeting the actual delinquent by prompting these vaccines in India? The answer would be no as we may not be essentially implementing a rational fool-proof vaccine program which will aid in preventing HPV-related diseases, for the simple reason that there is a lack of understanding about the underlying HPV types responsible for cervical cancer in India. Field trials involving large populations form a major part of continued analysis in understanding any disease and India is still short of such a trial as far as cervical cancer is concerned. Conducting such studies, might also act as prevention programs that will save lives and improve public health in a substantive manner. [ABSTRACT FROM AUTHOR]

India with its highest share of global burden of cervical cancer has to implement a population based cervical cancer control program to reduce the number of deaths. There are new screening options available like visual inspection after acetic acid application (VIA) test, single visit approach to screening and treatment etc. Emergence of the two effective vaccines against human papillomavirus (HPV), the necessary cause of cervical cancer, has introduced a fresh lease of life to the cervical cancer control strategies. The current high cost of the vaccines is a major impediment to implement a vaccine-based primary prevention approach. [ABSTRACT FROM AUTHOR]

Abstract: This study investigates attitudes toward human papillomavirus (HPV) vaccination among parents of adolescent girls in Mysore, India. Seven focus group discussions were held among parents of adolescent girls stratified by sex, religion and region to explore attitudes about cervical cancer and HPV vaccination. The study found that while parents have limited knowledge about HPV or cervical cancer, most are still highly accepting an HPV vaccine. In addition, high acceptability levels appear to reflect positive attitudes toward the government universal immunization program in general, rather than to the HPV vaccine in particular. The results highlight the need for additional education and health promotion regarding HPV and cervical cancer prevention in India. [Copyright &y& Elsevier]

Abstract: Cervical cancer that is associated with high-risk human papillomaviruses (HPV) is the most common malignancy in Indian women. Therefore, the establishment of a prevention program is urgently required considering both vaccination and screening. However, relatively little is known about the prevalence of the different HPV types in cervical cancers in different regions of India, particularly central India. In this study, we have determined the HPV type distribution in 180 cervical cancers of women from Sevagram, a rural area from central India. In addition, we have analyzed other epithelial cancers that are known to be in part associated with high-risk HPV infection, i.e. oral (n =65), vulva and vagina (n =7) and penis (n =7). Approximately 93% of cervical cancers were positive for one or more of the high-risk HPV types. HPV16 was the predominant type being present in 81.7% of the cases. The remaining most predominant high-risk HPV types were: 18, 31, 35, 45, 56 and 59. Oral and vulva/vagina cancers were exclusively associated with HPV16, 27.7% and 70%, respectively. None of penile cancers was found positive for any of the high-risk HPV types. These data show that HPV16 vaccination in this geographical region will have considerable impact on the prevention of cervical and other epithelial cancers. [Copyright &y& Elsevier]

Abstract Background Infection with human papilloma virus (HPV) is an important etiological factor in the development of cervical cancer and it has been proposed that individuals homozygous for Arg/Arg at codon-72 of p53 are seven times more susceptible to HPV-mediated cancer. In this study, we have analyzed the genetic predisposition of the India population to HPV infection and cervical carcinogenesis. Methods We investigated 71 cases of squamous cell carcinoma of the cervix, 14 cases of low-grade squamous intraepithelial lesions, 25 cases of high-grade squamous intraepithelial lesions and 29 noncancer controls for presence of HPV16/18 infections by L-1-specific PCR assay and Southern hybridization, and its association with polymorphism at p53 codon 72. Results We observed that 69·1% (76/110) of the cervical cancer patients were HPV positive, among which the presence of HPV16, 18 and 16/18 coinfection was 40·9%, 8·2% and 13·6%, respectively. The allele frequencies of the three p53 genotypes Arg/Arg, Arg/Pro and Pro/Pro in the HPV-positive tumour samples were 0·34, 0·57 and 0·09 in comparison with frequencies of 0·18, 0·44 and 0·38 for HPV-negative tumours. Hence, there is a significant difference in the allelic frequency of p53 Arg/Arg in high-risk HPV-infected cervical carcinoma cases (0·34) and HPV-negative carcinomas (0·18). Conclusion Our results indicate a striking over-representation of homozygous arginine at codon 72 of p53 in HPV-associated cervical carcinogenesis. We conclude that women with Arg/Arg homozygous allele are more prone to infection by HPV16/18, which leads to cervical carcinomas having poor prognosis. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is one of the most common cancers among women worldwide, with highest mortality in India. The incidence and mortality of cervical cancer can be reduced by screening women for precancerous lesion and by administration of human papilloma virus vaccine to adolescent girls. Knowledge of the women about cervical cancer and awareness about its prevention are the key factors that determine their utilization of screening services. Methods: A cross sectional survey of women attending Gynaecology Out-Patient Department (OPD) in a tertiary care hospital in Puducherry was conducted. Information about their knowledge of cervical cancer, awareness of its prevention and their socio demographic characters were collected. Results: Mean age of the study population was 40.45 ± 12 years. Less than half of the study population (178, 44.5%) knew about cervical cancer. Less than one-fourth of the population knew about screening services for prevention of cervical cancer, and majority (389, 97.2%) were not aware of vaccination as prevention for cervical cancer. Conclusion: Our study population shows poor knowledge about cervical cancer and is unaware of the concept of prevention. Hence extensive health education to the public is needed regarding cervical cancer and its prevention. [ABSTRACT FROM AUTHOR]

Among the screening tests for cervical cancer, advantages of screening with second generation molecular Hybrid Capture 2 (HC2) test is the high sensitivity and negative predictive value that makes it easy to implement as a cervical cancer screening policy necessitating less screening rounds. High income countries are now implementing HC2 test in their national cervical cancer screening program. Since the acceptance of any screening test depends on the sensitivity of the test, the current study was carried out to evaluate the sensitivity of HC2 test reported from Low- and Middle-income countries (LMIC) which share major burden of cervical cancer globally and to establish if HC2 test could be used as a primary screening test in India., Materials and Methods: The population based cross sectional studies from LMICs which evaluated HC2 test as a primary screening modality to diagnose Cervical intraepithelial neoplasm grade 2 and above (CIN2+) lesions were included., Results: A total of 18 studies from LMIC involving 1,13,086 women were reviewed for sensitivity of HC2 as a primary screening test. The overall average sensitivity and specificity to diagnose CIN2+ lesions were 79.84% (95% CI-71.01,86.73) and 85.63% (95% CI- 84.37,86.92) respectively. India demonstrated an average sensitivity and specificity of 65% (95% CI 57,77) and 93% (95% CI- 92,94) respectively., Conclusion: Results from LMIC demonstrate a comparably low sensitivity of HC2 test to diagnose CIN2+ lesions as compared to that reported from High income countries. Sensitivity of HC2 was substantially low for India. The current study discusses issues of HC2 assay and the role of untreated Reproductive tract infections as probable causes for low sensitivity of the test. This needs further research in an attempt to improve the sensitivity of the test in an era of self-sampling and low-cost HPV test on horizon to improve the coverage for cervical cancer., .

Cancer cervix is an important health problem among adult women in developing countries including India, is a well recognized fact. A cohort of 630 symptomatic women from Rural and Sub Urban area belonging to lower socio - economic status underwent visual inspection and conventional Pap test. A subset of hundred asymptomatic cases screened with liquid based cytology. Early marriage (76.5%) is prevalent in rural population thus youngest case registered was of 20 years. Parity more than five was present in 57.9%. Pap test was repeated in all cases of infections (72.85%) after four to six months of treatment. Cervical erosion (45%) was a frequent finding on examination, in study group. Cases with ASUS (14), AGUS (5), LSIL (67), are being followed & HSIL (6) were treated. Invasive carcinoma was seen in ten cases of study group. The higher detection rate of ASCUS (305.41) & HSIL (215.79) was observed in subset with liquid based cytology. Though conventional Pap test is an excellent test but there is need for opportunistic screening programme with more screening tools in rural population. [ABSTRACT FROM AUTHOR]

Background & Objectives: Human papillomavirus (HPV) and oropharyngeal squamous cell carcinoma (OPSCC) are found to be strongly associated with each other with an increase in incidence has been noted globally over the years. A literature search for data depicting the role of HPV in oropharyngeal carcinoma in South India, however, has resulted in little information, thus, the present study was aimed to assess a possible association between the two among OPSCC patients from a tertiary care cancer centre in South India., Methods: One hundred and fourty three OPSCC cases were included in the study and analyzed for age, gender, marital status, habits, clinical TNM staging, site, laterality, symptoms, histological type (keratinizing and non-keratinizing), primary treatment and follow up period. All the cases were subjected to p16 INK4a immunostaining. Statistical analysis was done using SPSS software., Results: Of the 143 cases 12 were found to be p16 positive with no significant difference between the study variables among p16 positive and negative cases. Base of the tongue was the most commonly involved site for the p16 positive cases. The p16 positive cases presented at an elderly age, early stage and were mainly the keratinizing type., Interpretation & Conclusions: The p16 positive OPSCC cases constituted a small proportion in the present study and behaved similar to p16 negative cases. Usage of tobacco and alcohol appear to be the susceptible factors even in p16 positive cases. More studies from other States would be helpful to determine if HPV-related SCC in the Indian subcontinent behave differently or similarly to cases from Western countries.

Objective: Head and neck squamous cell carcinoma (HNSCC) pose a great danger to society and now we have shreds of evidence for Human Papillomavirus (HPV) being one of the major causative agents for it. Though the prevalence of HPV varies throughout the world, it is gradually on the rise. The present systematic review aims to retrospect all the available studies on the prevalence of HPV in HNSCC in India and its clinicopathological aspect to study how it is different from HPV negative HNSCC., Methods: An objective electronic database search was conducted in PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED published in 25 years period from 1994 till 2019. A total of 33 articles were shortlisted for the present review., Results: Studies conducted across India show the prevalence of HPV in Head and Neck Cancers ranging from 0-86.6%. Some studies reported that HPV positive HNSCC is more common in younger age, presents with advanced stage disease, and more commonly presents with nodal metastasis. As opposed to western literature HPV positive HNSCC in India is associated with a well-differentiated tumor grade. There is no difference in treatment outcome and survival among HPV positive and negative HNSCC., Conclusion: Exact prevalence of HPV in HNSCC is still doubtful but now we have some insight into it. The prevalence of HPV in Indian HNSCC patients has risen gradually but treatment outcome and survival may be poorer compared to other countries. However definite conclusions cannot be drawn without proper prospective study., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Vulvar and vaginal cancers are relatively rare cancers, together responsible for less than 1% of the global cancer incidence among women in 2018. The majority of vaginal cancers and a lesser proportion of vulvar cancers are associated with HPV, with rising incidence rates of vulvar cancer observed in younger women, possibly due to an increased prevalence of high-risk HPV types. This report assesses recent international variations in the incidence rates of vulvar and vaginal cancer derived from high-quality data from population-based cancer registries in 68 countries, and further assesses time trends for selected longer-term series in eight countries (Australia, China, Colombia, India, Norway, Slovakia, the U.S., and the U.K.) over the period 1983 to 2012. We observed a 30-fold variation in the recorded incidence rates of vulvar cancer in contrast with the threefold variation for vaginal cancer. We also observed a rising incidence of vulvar cancer in Australia, Norway and the U.K., and Slovakia, with a more rapid rise in the rates seen in women aged < 60 years at diagnosis. The annual percentage change over the most recent decade varied from 1.7% in Norway to 4.1% in Slovakia. The increases are largely confined to younger women and are likely linked to generational changes in sexual behaviour (earlier age at sexual debut and increasing transmission of HPV among cohorts born 1940 to 1950 and thereafter. Vaginal cancer incidence rates, in contrast, were lower and more stable, despite the higher HPV-attributable fraction relative to vulvar cancer. Irrespective of the trends, an increasing number of women are predicted to be diagnosed worldwide with both cancer types in future decades as population ageing and growth continues. The promise of high-coverage HPV vaccination will likely counter this rising burden, but the impact may take a number of decades., (© 2020 UICC.)

Background: Oncogenic Human papillomavirus (HPV) infections are closely associated with anal cancer which is high among human immunodeficiency virus (HIV) infected males. There are no data regarding anal HPV infection and cytological abnormalities in HIV positive males receiving free therapy in the national program. Thus, this cross-sectional study was performed to assess the prevalence and risk factors of anal HPV infection and cytological abnormalities in HIV positive males.Methods: We screened 126 HIV-positive male patients attending the antiretroviral treatment center (ART) between 2014 and 2015 with anal papanicolaou smear cytology and HPV-DNA testing. HPV-DNA was detected by using polymerase chain reaction (PCR) method with two consensus primer sets E6 and MY09/11 and further analyzed for the presence of various HPV genotype by Sanger sequencing. Risk factors associated with anal cytological abnormalities and HPV infection was analyzed by using univariate and multivariate logistic regression models.Results: Out of 126, 52 were on antiretroviral therapy. 91% were married to female partners but during the study 48 (38%) gave positive history of anal intercourse with other men. Anal cytology was done in 95 patients, out of which 60 (63.15%) had cytological abnormalities. LSIL (low-grade squamous intraepithelial lesions) was present in 27 (45%), ASCUS (atypical squamous cells of undetermined significance) in 31 (52%) and ASC-H (atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion) in 2 (3.33%). In multivariate analysis, the risk factors for cytological abnormality were presence of history of anal intercourse (OR, 6.1; 95% CI, 2.0-18.7) and WHO stage III & IV (OR, 2.7; 95% CI, 1.1-7.5). HPV-DNA was detected in 33/119 (27.73%) patients. The most prevalent HPV type in the study was HPV-16 (10.08%), other HPV types detected were 18,31,35,17,66,72,52,68 and 107 (17.65%).Conclusions: High prevalence of anal cytological abnormalities in our study suggests that regular anal Pap smear screening should be done in HIV positive males in the ART center. [ABSTRACT FROM AUTHOR]

Background: WHO has recommended Visual Inspection with Acetic acid (VIA) or Human Papillomavirus (HPV) DNA testing if feasible, for cervical cancer screening in low income countries. However, the number of women undergoing screening is very low as a result of limited information, inadequate infrastructure and invasive nature of sampling. Methods: A cross sectional study was carried out comparing HPV DNA detection by Polymerase Chain Reaction (PCR) in paired cervical and urine samples procured from histologically confirmed cervical cancer cases. Results: Amongst the samples collected from 114 cervical cancer cases, HPV DNA was tested positive in cervical samples of 89 (78.1%) and urine samples of 55 (48.2%) patients. The agreement between the two sampling methods was 66.7% and the kappa value was 0.35 indicating a fair agreement. The sensitivity of HPV detection using urine samples was 59.6% (95% confidence interval 49.16%-69.15%) and the specificity was 92% (95% confidence interval 75.0%-97.8%). Conclusion: Even though not acceptable as an HPV DNA screening tool due to low sensitivity, the urine sampling method is inexpensive and more socially acceptable for large epidemiological surveys in developing countries to estimate the burden.

We report the incidence of cervical intraepithelial neoplasia (CIN) among HIV-infected women who did not have any colposcopic or histopathological evidence of CIN at baseline. Of the 1,023 women without any CIN at baseline, 855 (83.6%) have been followed up to a maximum of 6.4 years contributing 2,875 person years of observation (PYO). Among these 855 women, 54 cases of any CIN were observed resulting in incidence rate of any CIN of 1.9 per 100 PYO. The median time for follow-up for women with any CIN was 3.0 (IQR 1.6-3.7) years. The cumulative incidence rate per 100 PYO of CIN 2 or worse lesion in women with HPV-18 infection at baseline was 13.3% (95% CI 5.1-26.8); in women with HPV-16 infection was 10.8% (95% CI 4.4-20.9); in women with HPV-31 infection was 4.2% (95% CI 0.9-11.7); and in women with other high-risk HPV infections was 5.4% (95% CI 2.6-9.7). HPV-18 infection at baseline contributed highest frequency of incident CIN 2 or worse lesions followed by HPV-16 infection; however, other high-risk HPV types were also responsible for substantial number of incident CIN. The elevated risk of CIN2+ disease in the study cohort was non-significant in women with CD4 count <200, possibly because of the small number of cases. Our results emphasize the need for regular cervical cancer screening of HIV-infected women and urgent implementation of cervical cancer screening services in HIV programs in India and other low and middle-income countries., (© 2018 UICC.)

Study Objective: The purpose of this study was to examine factors predicting human papillomavirus (HPV) vaccine acceptability among parents of adolescent girls in a rural area in Mysore district, India., Design: Cross-sectional., Setting: Mysore, India., Participants: Parents of school-going adolescent girls., Interventions: Parents completed a validated self-administered questionnaire., Main Outcome Measures: Parental willingness to vaccinate their daughters with HPV vaccine., Results: Of the 831 parents who participated in this study, 664 (79.9%) were willing to vaccinate their daughter with HPV vaccine sometime soon if they were invited to receive it. Higher odds of parental willingness to vaccinate their daughters with HPV vaccine was observed among those who believed that HPV vaccine is safe (adjusted odds ratio [aOR], 2.11; 95% confidence interval [CI], 1.01-4.45); their daughter might become sexually active (aOR, 1.84; 95% CI, 1.08-3.13); they have support of other family members to vaccinate their daughter (aOR, 2.86; 95% CI, 1.47-5.57); and that HPV infection causes severe health problems (aOR, 1.64; 95% CI, 1.04-2.57). In contrast, parents who believed that there is low risk that their daughter will get cervical cancer (aOR, 0.52; 95% CI, 0.29-0.95); that the family will disapprove of getting their daughter vaccinated (aOR, 0.45; 95% CI, 0.22-0.76); that the injection might cause pain (aOR, 0.53; 95% CI, 0.31-0.89), and were older-age parents (aOR, 0.96; 95% CI, 0.93-0.99) had lower odds of willingness to vaccinate daughters with HPV vaccine., Conclusion: Acceptance of HPV vaccination for daughters was high among rural parents in Mysore, India. However, health education to reduce the belief that injection is painful and that daughters are at low risk to get cervical cancer is important to further improve parental HPV vaccine acceptability in Mysore. Public health education should target older-aged parents and extended family members., (Copyright © 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Objective: Association of multiple polymorphic variants with cervical cancer has been elucidated by several candidate gene based as well as genome-wide association studies. However, contradictory outcomes of those studies have failed to estimate the true effect of the polymorphic variants on cervical cancer. Methods: Literature mining of the PubMed database was done to gather all the publications related to genetic association with cervical cancer in India. Out of 98 PubMed hits only 29 genetic association studies were selected for meta-analysis based on specific inclusion criteria. A fixed-effect meta-analysis was performed to evaluate the overall association of the genetic polymorphisms with cervical cancer. Cochran’s Q test was performed to assess between study heterogeneity. Publication bias was also estimated by funnel plots and Egger’s regression test. Further, sub-group analysis was conducted by fixed-effect meta-regression to assess the impact of polymorphisms on cervical cancer in the presence of Human Papilloma Virus (HPV). Result: Following a fixed-effect model, meta-analysis was conducted that revealed 2 polymorphic variants viz. ‘deletion polymorphism (Del2) (OR=1.79, 95% CI= 1.08-2.95, P=0.023) in GSTM1’ and ‘rs1048943 (OR = 2.34, 95% CI=1.37-3.99, P=0.0018) in CYP1A1’ to be associated with cervical cancer. However, multiple testing correction showed only rs1048943 of CYP1A1 to be significantly associated (P-value=0.029) with cervical cancer with significant publication bias (P-value=0.0113) as estimated by Egger’s regression test. The polymorphic variants ‘rs1801131’, ‘rs1801133’, ‘rs2430561’, ‘rs1799782’, ‘rs25486’ and ‘rs25487’ showed significant (p<0.05) evidence of heterogeneity between studies by Cochran’s Q test and also by heterogeneity index (I2) calculation. Conclusion: Therefore, our study revealed significant association of rs1048943 in CYP1A1, but a nominal association of deletion polymorphism (Del2) in GSTM1 with cervical cancer, which provides a comprehensive insight on the true effect of the polymorphisms, reported in various case-control studies, on the risk of the development of cervical cancer in Indian women., (Creative Commons Attribution License)

Introduction: Demographic, behavioural and environmental factors have been associated with increased risk of head and neck cancer (HNC). We will review published reports and explore connections between risk factors and HNC incidence. This protocol aims to provide strategies for a systematic review and meta-analysis of HNC risk factor analysis in India. It also provides guidelines in order to visualise obtained HNC risk factor data in the form of a heat-map highlighting variations across gender, age and geographical location., Methods and Analysis: We will identify well-established HNC risk factors and perform a comprehensive systematic review and meta-analysis to quantify each risk factor's impact on HNC incidence. A systematic search will be performed to identify the studies and published reports of HNC risk factors in India. Meta-analysis will be conducted to estimate the proportional contribution of the most prevalent risk factor in HNC on a city-wide basis in Indian states and territories., Ethics and Dissemination: The review protocol draws on publicly available anonymised data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee. We published an outline of the protocol in the International Prospective Register of Systematic Reviews (PROSPERO) in 2017. The results will provide an updated analysis of HNC risk factor prevalence in India, and we will discuss the applicability of rehabilitation care. We plan to disseminate the findings of this systematic review through publication in a peer-reviewed journal and presentation at relevant conference proceedings., Prospero Registration Number: CRD42017077758., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)