In Italy, organized cervical screening programmes were started since 2001. In 2012, the target population amounted to 87.3% of women aged 25-64 years. Compliance to invitation was 40.8%, with a strong decreasing North-South trend. Currently, data on HPV types prevalence are available regarding healthy women undergoing spontaneous or organised screening. Little is known about the prevalence of type-specific HPV among women with LSIL, more severe dysplasia, or invasive cancer. A national HPV immunization programme in Italy was introduced in 2008 for females aged 11-12 years; in addition, some regions have extended the offer of vaccination to one or more older birth cohorts through 26 years.
We conducted a cross-sectional survey among a large number of women with LSIL, HSIL, ASC-H, ACG, squamous cell carcinoma, AIS, or adenocarcinoma recruited into the organized screening programme across Apulia region (1,130,000 women aged 25-64 years) between 2010-2012. We collected demographics characteristics, information on possible risk factors for HPV infection, and type-specific HPV-DNA testing. In order to assess the association between the HPV status of participants and other variables of interest a logistic regression model was performed.
The overall prevalence of HPV infection was 86% (1,182/1,370 women with abnormal citology tested for HPV, 95%CI=84%-88%); 78% (1,063/1,370, 95%CI=75%-80%) of these infections were identified as HR-HPV (83%, 95%CI=80%-86% among the youngest group 25-34 years) and 34% (460/1,370, 95%CI=31%-36%) were LR-HPV. The prevalence of coinfections with HR and LR types was 25% (349/1,370, 95%CI=23%-28%).
A total of 526 HPV genotypes, including 352 genotypes belonging to the “12 HR-HPV IARC group 1”, were found in 294 women. The overall prevalence of HR-HPV was 81% (238/294, 95%CI=76%-85%), 87% (95%CI=80%-92%) among 25-34 year olds. The proportion of the HR vaccine genotypes targeted by both the bivalent and quadrivalent vaccines was 53% (187/352); the proportion of HR-HPV genotypes covered by the nonavalent vaccine was 78% (275/352). Cross-protection against non-vaccine HR-HPV closely related to HPV16/18 was 67% (237/352) for the bivalent and 63% (222/352) for the quadrivalent vaccine.
HPV infection was more common among women single (OR=2.9, 95%CI=1.4-6.1, p<0,05), divorced (OR=2.7, 95%CI=1.2-6.2, p<0,05), holding a bachelor's degree (OR=2.8, 95%CI=1-7.9, p<0,05), and living in metropolitan areas (OR=5.3, 95%CI=1.4-6.1, p<0,05).
Our findings contribute to anticipate the full impact of HPV vaccines on the burden of cervical disease including cancer and its current and future effects on population based cervical screening programmes.