Comparative Distribution of High-Risk Human Papillomavirus (HPV) Genotypes in India vs World Health Organization Regions and Countries: Implications for HPV Vaccination

Background: High-risk human papillomavirus (HPV)-induced cervical cancer is a major cause of mortality worldwide. Published data suggest geographic variations in the prevalence of some of the 12 high-risk HPV genotypes. Although the variations in prevalence of the 2 most common high-risk HPV genotypes-16 and 18-have been relatively well documented, the variations in prevalence of the other 10 high-risk genotypes are not as well documented. Reliable proof of variations in prevalence may warrant different high-risk HPV vaccine compositions/vaccination strategies in specific geographic areas. To explore the adequacy of the HPV vaccines available in India, we focused this study on the following: (1) confirming that high-risk HPV genotype variations exist on the Indian subcontinent, (2) determining how the genotype variations differ from the variations in other WHO regions/countries and among different regions/states in India, (3) determining whether any regional variations are sufficiently different to warrant changes in high-risk HPV vaccine compositions and/or vaccination strategies, and (4) determining whether the collected data could lead to new hypothesis generation and study design. Methods: We used 2 methods to gather information. To examine variations in prevalence, we conducted a secondary analysis (data mining) of publicly available data from the HPV Information Centre. The HPV Information Centre data were obtained from a systematic review of studies published from 1990 to 2015. We also conducted a scoping review of the literature published from 2015 to 2024. Results: As expected, we found variations in the prevalence of high-risk HPV genotypes among different regions on the Indian subcontinent. The predominant genotypes identified on the Indian subcontinent, in World Health Organization (WHO) regions, and in WHO South-East Asia Region countries were HPV 16 and HPV 18; other genotypes had varied prevalences. The scoping review of the literature revealed many inhomogeneities among the studies. None of the studies included testing for all 12 high-risk HPV genotypes, confidence intervals were rarely reported, and the quality assurance details of the studies are unknown. Conclusion: Although high-risk HPV genotype variations in prevalence were detected among different regions on the Indian subcontinent, the strength of the data does not justify different HPV vaccination compositions and strategies at this time. Studies are needed that include all 12 high-risk HPV genotypes, use uniform state-of-the-art high-risk HPV detection technologies, and document stringent quality assurance procedures. While our results must be interpreted with caution, our data can help inform future well-designed, homogenous, high-quality studies.