Distribution of high-risk HPV genotypes in women population in Serbia

Background

Human papillomavirus (HPV) is the key etiological factor in cervical cancer development. The Cobas HPV test enables detection and partial genotyping of 14 high-risk (hrHPV) types, the test provides specific identification of HPV16 and HPV18, while simultaneously detecting the remaining high-risk types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68). The introduction of HPV screening has major public health importance, particularly in prevention and early detection of premalignant lesions and cancer.

Methods

Within a national pilot project in Serbia, 9,510 women aged 30–65 were tested using RT PCR (Cobas 6800). Among samples positive for pooled hrHPV (794 samples) 405 were further analyzed by RT-PCR (Vector Best) to determine individual genotypes. Frequencies of hrHPV types were expressed as percentages.

Results

Overall hrHPV prevalence was 13%. The presence of hrHPV genotypes were either single or multiple, with two or more hrHPV types detected in some participants. HPV16 was detected in 245 (2.57%) of women, HPV18 in 69 (0.73%), while other hrHPV types were present in 794 (8.35%). In the subgroup (n = 405), HPV31 was most prevalent (26.17%), followed by HPV52 (17.53%), HPV51 (13.83%) and HPV66 (13.09%). Other types included HPV56 (11.85%), HPV33 (11.36%), HPV45 (11.11%), HPV58 (8.64%), HPV59 (7.65%), HPV68 (7.65%), HPV39 (6.67%) and HPV35 (5.68%).

Conclusions

Although non-16/18 HPV types are less frequently associated with cervical intraepithelial neoplasia and cancer, they still represent a significant cause of the disease. In the context of the Serbian population, these types account for 64% of all hrHPV-positive cases, with a notable prevalence of HPV31 (26.17%) and HPV52 (17.53%). Therefore, further stratification of high-risk non-16/18 HPV types is necessary to optimize screening algorithms and improve prevention and treatment strategies, including the broader implementation of the 9-valent vaccine.

Key messages

• Identification of dominant genotypes of hrHPV enables more targeted screening and potential reduction of cervical cancer incidence.

• These findings may support improved prevention strategies, vaccination optimization and strengthening of public health surveillance systems.