Keris Krennhrubec

Human Papillomavirus-16 Variants and Cervical Cancer among Tunisian Women


HPV Types and Variants Among Cervical Cancer Tumors in Three Regions of Tunisia (pdf)

Summer internship experience abstract

ABSTRACT: Cervical cancer is the second most common cancer among women worldwide, with about 80% of cervical cancer disease burden occurring in developing countries. Prolonged infection with one of several types of sexually-transmitted human papillomavirus (HPV) is causally associated with the development of cervical dysplasia. Tunisia presents an interesting environment in which to study HPV infection and cervical cancer due to the relatively low incidence rate of disease, at 6.8 per 100,000 (ASR). Morocco and Algeria, to which Tunisia is culturally similar and most often compared on health indicators, have incidence rates of 13.2 and 15.6, respectively.  None of these three countries have a national screening program for cervical cancer, and all three have similar social characteristics controlling sexual behavioral practices. Tunisia also has intra-country variation in incidence rates, with the three cancer registry centers reporting rates of 6.1 in Tunis, 7.1 in Sousse, and 2.7 in Sfax.

HPV 16 DNA can be found in about 50% of cervical cancer cases. This HPV type has been shown to have genetic dissimilarity of up to 5%, and phylogenetic analysis has revealed five geographic branches of HPV 16; European, African-1, African-2, Asian, and Asian-American. Slight variation in carcinogenicity has been shown among these genetic variants, with African variants being found in more frequently in cancer than European or Asian variants. Research to investigate this association has been performed in a number of countries, however, none has been performed in North Africa or Tunisia.

Thus, we would like to sequence the DNA of HPV 16 infections among women with cervical cancer in Tunisia in order to achieve the following:

  • to provide a genetic profile of HPV 16 variants in Tunisia that can be compared with other countries,
  • to increase knowledge of the etiology of HPV infection and its progression to cancer,
  • to explore the difference in cervical cancer incidence between the three geographic regions in Tunisia,
  • to add to the greater body of knowledge of HPV types and variants among cervical cancer cases.