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RÉSUMÉ
Introduction. Les vaccins contre le HPV ciblent de façon privilégiée les papillomavirus humains 16 et 18. La distribution géographique de ces génotypes reste peu connue au Cameroun, ce qui a justifié notre étude. Méthodologie. Nous avons réalisé une étude transversale descriptive et analytique auprès de 157 femmes à l’hôpital de District de Baham-Ouest Cameroun. La détection et le typage des génotypes ont été obtenus par PCR à temps réel. Les analyses statistiques ont été réalisées à partir du logiciel Epi Info 3.5.1. Le test de Khi2 et de Fisher ont été utilisés pour la comparaison des taux. Une différence était considérée comme statistiquement significative lorsque p < 0.05. Résultats. Parmi les 157 prélèvements que nous avons analysés, nous avons eu 26 (16.6%) cas de positivité au HPV de haut risque, [IC à 95% (11.1-23.3%)]. Les génotypes vaccinaux (HPV 16 et, HPV 18) représentaient 30,8% de l’effectif. Le risque d’être infecté au HPV était doublé en cas d’analphabétisme [OR : 1,84(0,57-5,90) ; p=0,25], de premiers rapports sexuels pendant la jeune adolescence [OR : 2,18(0,79-6,01) ; et de recours à la contraception injectable [OR : 1,84(0,41-7,79), p=0,46].Comparées aux femmes négatives au HPV, les femmes avec infection à HPV avaient souvent une anomalie cytologique (23,5 vs 5,1 ; p=0.01). Conclusion. Dans le district de santé de Baham, les génotypes vaccinaux sont minoritaires. Le risque d’être infecté au HPV est doublé en cas d’analphabétisme, de début de rapports sexuels pendant la jeune adolescence et de recours à la contraception injectable.
ABSTRACT
Introduction. The vaccination against HPV targets HPV 16 and 18. However, the geographical distribution of HPV subtypes is little known in Cameroon. Our study aimed to fill this gap. Population and methods. We conducted an analytical and descriptive cross sectional study of 157 women at Baham district Hospital Cameroon. The HPV DNA detection and genotyping were performed by the use of the real time Polymerase Chain Reaction-based assays. For cytological assays, the liquid based cytology method was used. Data were analyzed using Epi-Info 3.5.1. Percentages were compared using Chi-square and Fisher’s exact test and all P values <0.05 were considered statistically significant. Results. Among the 157 women’s specimens, 26 were positive to HPV; thus, the prevalence of the HPV infection was 16.6% [IC to 95%: 11.1 to 23.3%]. The vaccine genotypes (HPV 16 and, HPV 18) represented 30. 8% of the population and the other high risk non vaccine HPV represented 69.2%. The risk to be HPV positive was doubled in case of illiteracy [OR: 1.84(0.57-5.90); p=0.25], first sexual intercourse during the young adolescence [OR: 2.18(0.79-6.01); and in case of use of injectable contraception [OR: 1.84(0.41-7.79), p=0.46]. Compared to the HPV negative women, the HPV positive women were more prone to have an abnormal cytology (23.5 vs. 5.1; p=0.01). Conclusion. In Baham health district, the HPV vaccine genotypes represent a minority proportion. The risk of infection with HPV is doubled in case of illiteracy, first sexual intercourse during the young adolescence; and use of injectable contraception.
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References
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References
(1) Enow Orack GE, Ndom P, Doh AS. Cancer Incidence in Cameroon. Yaoundé Cancer registry, 2004-2007. 2008.
(2) Walboomers JMM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human paillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999;189:12-9.
(3) Villa LL, Costa RL, Petta CA, Andrade RP, Ault KA, Giuliano AR, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol 2005 May;6(5):271-8.
(4) Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med 2003 Apr 24;348(17):1681-91.
(5) Clifford GM, Gallus S, Herrero R, Munoz N, Snijders PJ, Vaccarella S, et al. Worldwide distribution of human papillomavirus types in cytologically normal women in the International Agency for Research on Cancer HPV prevalence surveys: a pooled analysis. Lancet 2005 Sep 17;366(9490):991-8.
(6) Matos E, Loria D, Amestoy GM, Herrera L, Prince MA, Moreno J, et al. Prevalence of human papillomavirus infection among women in Concordia, Argentina: a population-based study. Sex Transm Dis 2003 Aug;30(8):593-9.
(7) Wen LM, Estcourt CS, Simpson JM, Mindel A. Risk factors for the acquisition of genital warts: are condoms protective? Sex Transm Infect 1999 Oct;75(5):312-6.
(8) de SS, Almirall R, Lloveras B, Font R, Diaz M, Munoz N, et al. Cervical human papillomavirus infection in the female population in Barcelona, Spain. Sex Transm Dis 2003 Oct;30(10):788-93.
(9) Ronco G, Ghisetti V, Segnan N, Snijders PJ, Gillio-Tos A, Meijer CJ, et al. Prevalence of human papillomavirus infection in women in Turin, Italy. Eur J Cancer 2005 Jan;41(2):297-305.
(10) de SS, Almirall R, Lloveras B, Font R, Diaz M, Munoz N, et al. Cervical human papillomavirus infection in the female population in Barcelona, Spain. Sex Transm Dis 2003 Oct;30(10):788-93.
(11) Sellors JW, Pickard L, Gafni A, Goldsmith CH, Krepel J, Mahony JB, et al. Prevalence and predictors of human papillomavirus infection in women in Ontario, Canada. CMAJ 2000;163:503-8.
(12) Thomas JO, Herrero R, Omigbodun AA, Ojemakinde K, Ajayi IO, Fawole A, et al. Prevalence of papillomavirus infection in women in Ibadan, Nigeria: a population-based study. Br J Cancer 2004 Feb 9;90(3):638-45.
(13) Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, et al. Prevalence of HPV infection among females in the United States. JAMA 2007 Feb 28;297(8):813-9.
(14) Peyton CL, Gravitt PE, Hunt WC, Hundley RS, Zhao M, Apple RJ, et al. Determinants of genital human papillomavirus detection in a US population. J Infect Dis 2001 Jun 1;183(11):
-64.
(15) Franco E, Syrjanen K, de WC, Patnick J, Ferenczy A, McGoogan E, et al. New developments in cervical cancer screening and prevention. Geneva, Switzerland, June 17-19 1996. Workshop. Cancer Epidemiol Biomarkers Prev 1996 Oct;5(10):853-6.
(16) Herrero R, Hildesheim A, Bratti C, Sherman ME, Hutchinson M, Morales J, et al. Population-based study of human papillomavirus infection and cervical neoplasia in rural Costa Rica. J Natl Cancer Inst 2000 Mar 15;92(6):464-74.
(17) Didelot-Rousseau MN, Nagot N, Costes-Martineau V, Valles X, Ouedraogo A, Konate I, et al. Human papillomavirus genotype distribution and cervical squamous intraepithelial lesions among high-risk women with and without HIV-1 infection in Burkina Faso. Br J Cancer 2006 Aug 7;95(3):355-62.
(18) Ali-Risasi C, Praet M, Van RL, Zinga-Ilunga B, Sengeyi D, Lokomba V, et al. [Human papillomavirus genotype profile in Kinshasa, Democratic Republic of the Congo: implications for vaccination]. Med Trop (Mars ) 2008 Dec;68(6):617-20.
(19) Munoz N, Bosch FX, Castellsague X, Diaz M, de SS, Hammouda D, et al. Against which human papillomavirus types shall we vaccinate and screen? The international perspective. Int J Cancer 2004 Aug 20;111(2):278-85.
(20) Munoz N, Kato I, Bosch FX, Eluf-Neto J, De SS, Ascunce N, et al. Risk factors for HPV DNA detection in middle-aged women. Sex Transm Dis 1996 Nov;23(6):504-10.
(21) Munoz N, Bosch FX, de SS, Herrero R, Castellsague X, Shah KV, et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003 Feb 6;348(6):518-27.
(22) Palefsky JM, Minkoff H, Kalish LA, Levine A, Sacks HS, Garcia P, et al. Cervicovaginal human papillomavirus infection in human immunodeficiency virus-1 (HIV)-positive and high-risk HIV-negative women. J Natl Cancer Inst 1999 Feb 3;91(3):226-36.
(23) Cooper D, Hoffman M, Carrara H, Rosenberg L, Kelly J, Stander I, et al. Determinants of sexual activity and its relation to cervical cancer risk among South African women. BMC Public Health 2007;7:341.
(24) Derchain SF, Sarian LO, Naud P, Roteli-Martins C, Longatto-Filho A, Tatti S, et al. Safety of screening with Human papillomavirus testing for cervical cancer at three-year intervals in a high-risk population: experience from the LAMS study. J Med Screen 2008;15(2):97-104.
(25) McFarlane-Anderson N, Bazuaye PE, Jackson MD, Smikle M, Fletcher HM. Cervical dysplasia and cancer and the use of hormonal contraceptives in Jamaican women. BMC Womens Health 2008;8:9.
(26) Garland SM, Brotherton JM, Condon JR, McIntyre PB, Stevens MP, Smith DW, et al. Human papillomavirus prevalence among indigenous and non-indigenous Australian women prior to a national HPV vaccination program. BMC Med 2011;9:104.
(27) Tebeu PM, Major AL, Rapiti E, Petignat P, Bouchardy C, Sando Z, et al. The attitude and knowledge of cervical cancer by Cameroonian women; a clinical survey conducted in Maroua, the capital of Far North Province of Cameroon. Int J Gynecol Cancer 2007 Sep 14.