Determinants of Human Papilloma Virus Infection in the Context of Bangladeshi Population: A Tertiary Hospital-based Study

Abstract

Background & Objective: Cervical cancer is a leading cause of female malignancy in Bangladesh, primarily driven by persistent high-risk Human Papillomavirus (HPV) infection. Understanding the sociodemographic and reproductive risk factors is essential for tailoring effective prevention and screening strategies. This study was undertaken to identify the risk factors associated with HPV infection and determine genotype distribution among women diagnosed with cervical precancerous and cancerous lesions in a tertiary hospital in Bangladesh. Methods: This descriptive cross-sectional study was conducted at the Colposcopy clinic, Department of Gynecological Oncology, Bangladesh Medical University (BMU), Dhaka, between August 2022 and July 2024. A total of 300 women presenting with positive screening results or clinical suspicion of malignancy with histologically confirmed cervical lesions, ranging from Cervical Intraepithelial Neoplasia (CIN) to invasive carcinoma, were purposively recruited from the colposcopy clinic. A comprehensive colposcopic evaluation was done and colposcopy-directed biopsies were obtained from all visualized abnormal areas. In instances where colposcopic findings were unremarkable despite positive screening, random four-quadrant biopsies of the transformation zone were performed to exclude occult disease. In clinically evident cases of cervical cancer, biopsies were collected directly from the primary tumor mass. Simultaneously, cervical specimens were collected for HPV-DNA testing from all screening-positive and suspected cancer cases. Molecular analysis was performed using the GenoFlow™ HPV Array Test Kit, which enabled the concurrent detection and identification of 33 HPV genotypes, including high-risk and low-risk variants, providing a detailed molecular profile of the viral burden in the study population. Results: The mean age of participants was 46.8 ± 11.2 years. HPV DNA was detected in 70.3% (n=211) & 29.7%(n=89) patients. Among HPV DNA positive cases (n=211) HPV-16 was the most prevalent genotype, present in 68.7%(n=145) of positive cases, followed by HPV-18 was 4.3%(n=9) and HPV-39 was 3.3%(n=7). Histopathology revealed that 58.3% (n= 175) of patients had invasive cancer, predominantly Squamous Cell Carcinoma 54.6%(n=164) & adenocarcinoma 3.7%(n=11). Low socioeconomic status was significantly associated with HPV positivity 64.5% (n=136) in the positive group vs. 37.5%(n=33) in the negative group;( p < 0.001) which was statistically significant. Passive smoking also showed a notable trend toward association 44.6%(n=134) where p = 0.072. While the majority of patients were multiparous 95%(n=287) and had early sexual debut 52.3%(n=157) at or below 15 years these factors did not reach statistical significance within this specific lesion-positive cohort. Conclusion: High-risk HPV-16 is the dominant driver of cervical lesions in the study population. Poverty is a significant risk factor for infection, likely due to limited healthcare access and awareness. To reduce the burden of cervical cancer, Bangladesh must prioritize high-coverage vaccination for adolescents while considering targeted vaccination for high-risk adults, alongside the implementation of primary HPV-DNA screening to detect infections before they progress to invasive malignancy.