High-risk human papillomavirus genotypes in cervical squamous cell carcinomas diagnosed in Rwanda

Cervical cancer is driven by long persisting high-risk HPV infections(hrHPV). HIV+ women with hrHPV co-infections are sixfold more likely to develop cervical cancer compared with HIV- women. To inform Rwandan policy on HPV vaccines and screening strategies, we assessed the distribution of hrHPV types in cervical cancer tissue overall and by HIV status. We retrieved all cervical squamous cell carcinomas (SCCs) diagnosed between 2018 and 2021 from three referral health facilities in Kigali, Rwanda (n = 415); tissues for 107 cases could not be retrieved. Of the remaining 308 cases, the H&E-stained slides from formalin-fixed, paraffin-embedded tissue for every case underwent a histological review, medical records were extracted, and tissue blocks were selected for HPV genotyping. AmpFire HPV genotyping test (Atila BioSystems, Sunnyvale, CA, USA) was used to test for HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, and 68. We compared HPV type distribution by HIV status. STATA 17 (StataCorp LLC, College Station, Texas, USA) was used for data analysis. Two hundred-five cases (60%) had valid HPV genotyping results; 71 (34.6%) were HIV-, 32 (15.6%) were HIV+, and 102 (49.8%) had an unknown HIV status. The mean age was 57.7 (± 11.8) years, ~ 60% were married, and 54% were FIGO stage 3 or 4. Most cervical SCCs (90.2%, n = 185) tested positive for hrHPV. There was no significant difference for overall and type-specific hrHPV positivity between positive, negative, and unknown HIV status except for HPV31 (p = 0.002), HPV35 (p < 0.001), and HPV68 (p = 0.005); HPV31-positive SCCs were more common in women living with HIV than in HIV-negative women (p = 0.008). There were few differences in the HPV type distribution between known HIV + and HIV- women. Importantly, currently available HPV vaccines in Rwanda do not target HPV31 and no commercially available HPV vaccine targets HPV35. This highlights the need to advocate for access to vaccines targeting those HPV types for optimized cervical cancer prevention.