3524 - Human Papilloma Virus Profiles in Healthy Women, Women with Cervical Intraepithelial Neoplasia, and Women with Invasive Cervical Cancer in Botswana

C. Kernell¹, E. MacDuffie², X. Lin³, L. Gao⁴, S. Grover², D. Ramogola-Masire⁵, and E. S. Robertson⁶; ¹University of Texas at Southwestern, Dallas, TX, ²Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, ³University of Pennsylvania, Philadelphia, PA, ⁴New Jersey Institute of Technology, Newark, NJ, ⁵University of Botswana, Gaborone, Botswana, ⁶Departments of Otorhinolaryngology-Head and Neck Surgery, and Microbiology, and the Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Purpose/Objective(s): Botswana has a high prevalence of HPV and HIV, contributing to the development of cervical cancer (CaCx). This study serves to characterize the patterns of HPV subtypes between healthy, unvaccinated university-aged women (Cohort 1), women with CIN II/III (Cohort 2), and women with invasive CaCx (Cohort 3) with/without HIV. Materials/

Methods: Patients were enrolled into the Ipabalele study in Gaborone, Botswana between 2016-2020. Upon enrollment, baseline demographic data and clinical treatment characteristics were collected in addition to HPV cervical swabs for all cohorts. Cohort 1 repeated swabs at 3 time points between baseline and 3-20 months after enrollment. Hybridization signal intensity (HSI) and prevalence was determined for each HPV subtype by cohort using PathoChip.
Results: This study enrolled 414 participants total: 43 for Cohort 1, 212 for Cohort 2, and 159 for Cohort 3. The median age was 19, 39, and 46 for Cohorts 1, 2, and 3, respectively. Women living with HIV (WLWH) accounted for 0% in Cohort 1, 76% in Cohort 2, and 72% in Cohort 3. High-risk (HR) HPV prevalence increased across Cohort 1 over time. In Cohorts 2 and 3, at least 1 HR subtype was present in >98% and >88% of samples, respectively. All low-risk (LR) subtypes were represented in at least 88% and 80% of samples, respectively. Cohort 2 had an overall higher prevalence of both HPV for both HR and LR subtypes. There was no difference in HR HPV subtype prevalence or HSI between WLWH and patients without HIV among Cohorts 2 or 3. Cohort 1 did not have significantly lower HSI for all HPV subtypes compared to Cohorts 2 and 3. HSI of HPV 26 was the highest among the HR subtypes for both Cohort 1. HSI of HPV 16 was the highest among the HR subtypes for both Cohorts 2 and 3. Among WLWH, HSI of all HR and all LR subtypes were not significantly different. Among women without HIV, Cohort 2 had significantly higher HSI of HR subtype HPV 34 and 9 LR subtypes when compared to Cohort 3.
Conclusion: Women with CIN/invasive CaCx have increased prevalence of high- and low-risk HPV subtypes compared to younger women. Overall, women with CIN had the highest burden and prevalence of HR and LR HPV subtypes. Differences in HR HPV HSI by HIV status within each cohort were not significant. HSI was either the same or significantly higher in CaCx compared to CIN for WLWH, but HSI was lower for invasive CaCx than in CIN for women without HIV. This study suggests that Botswana should continue and even augment screening efforts for HPV-related cervical malignancies, as the current vaccine does not cover all HR subtypes seen. Efforts may also provide insights into the use of HPV vaccination as a component of treatment for CIN/CaCx in the future.