HPV profiles in Botswana: An analysis of healthy women, cervical intraepithelial neoplasia, and invasive cervical cancer

Caroline Kernell; Emily MacDuffie; Xiang Lin; Le Gao; Doreen Ramogola-Masire; Surbhi Grover; Erle Robertson

doi:10.1016/j.gore.2025.101971

HPV profiles in Botswana: An analysis of healthy women, cervical intraepithelial neoplasia, and invasive cervical cancer

Gynecol Oncol Rep. 2025 Oct 17:62:101971. doi: 10.1016/j.gore.2025.101971. eCollection 2025 Dec.

Authors

Caroline Kernell¹, Emily MacDuffie², Xiang Lin³, Le Gao³, Doreen Ramogola-Masire⁴, Surbhi Grover², Erle Robertson⁵

Affiliations

¹ University of Texas at Southwestern Medical Center, Dallas, TX, United States.
² Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
³ New Jersey Institute of Technology, Newark, NJ, United States.
⁴ University of Botswana, Gaborone, Botswana.
⁵ Departments of Otorhinolaryngology-Head and Neck Surgery, and Microbiology, and the Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.

Abstract

Purpose/objectives: High prevalence of HPV and HIV contribute to the high rate of cervical cancer (CaCx) in Botswana. HPV subtypes in healthy, unvaccinated students (Cohort 1), women with CIN II/III (Cohort 2), and women with invasive CaCx (Cohort 3) were compared.

Materials/methods: The Ipabalele study in Gaborone, Botswana enrolled patients between 2016-2020. Demographics, clinical characteristics, and HPV cervical swabs were collected. PathoChip quantified prevalence of HPV subtypes.

Results: Overall 414 patients enrolled. Cohort 1: 43; Cohort 2; 212; Cohort 3: 159. Median age was 19, 39, and 46 years. Women living with HIV (WLWH) accounted for 0 %, 76 %, and 72 %. High-risk (HR) HPV prevalence in Cohort 1 increased 34 % to 57 % over 20 months. HPV profiles did not differ by HIV status. The prevalence of all HR HPV subtypes in Cohorts 2 and 3 is increased compared to Cohort 1. The prevalence of HPV HR subtypes except for HPV 53 is increased in Cohort 3 compared to Cohort 2. Among WLWH, Cohort 3 had a higher prevalence of HPV 16, 18, and 34 compared to Cohort 2. Among women without HIV, Cohort 3 had a higher prevalence of HPV 16 and 18 compared to Cohort 2.

Conclusions: Compared to healthy women, HPV subtype representation is higher among women with CIN and CaCx. This suggests the presence of multiple HR HPV strains may impact transformation from pre-cancerous lesions to CaCx, highlighting the importance of CIN detection and primary prevention of HR HPV to decrease the incidence of CaCx in Botswana.

Keywords: Botswana; Cervical cancer; Cervical intraepithelial neoplasia; HIV; Human papilloma virus; PathoChip microarray.