HPV-16 lineages among women in Africa: a systematic review with meta-analysis

Infection with high-risk human papillomavirus type 16 (HPV-16) is associated with cervical oncogenesis. The prevalence of HPV-16 lineages has not been well investigated in Africa. There is a lack of comprehensive epidemiological data on the distribution and oncogenic potential of the different HPV-16 lineages and sub-lineages in these populations. Through systematic review and meta-analysis, we aimed to determine the prevalence of HPV-16 lineages among women in Africa between 1997 and 2023.

Eight databases were searched, and studies that identified HPV-16 positive women with distinct HPV-16 lineages, and those that clearly defined an African population, were included. The eight databases include PubMed, PubMed Central, BVS, Embase, Cochrane Library, Scopus, Web of Science, and EBSCOhost. This protocol is registered in PROSPERO (CRD42023437748) and followed the PRISMA guidelines.

Out of the 2698 studies that were screened, 12 studies met the inclusion criteria and were included in the systematic review and meta-analysis. Analysis of these 12 studies identified yielded 1209 HPV-16-positive samples based on distinct diagnostic tests. These samples were classified as lineage A (n = 556), lineage C (n = 278), lineage B (n = 235), and lineage D (n = 140). Overall, lineage A variants were found in 11 studies (556 samples), establishing an overall prevalence of 58% (95% CI: 0.31-0.80; I² = 96.0%; τ² = 2.924; p < 0.0001). Lineage C variants were identified in 8 studies (278 samples), with an overall prevalence of 39% (95% CI: 0.21-0.60; I² = 84.1%; τ² = 1.362; p < 0.0001). Lineage B variants were identified across 7 studies (235 samples), with a prevalence of 20% (95% CI: 0.09-0.37; I² = 90.4%; τ² = 1.109; p < 0.0001). Lineage D variants were identified across 5 studies (140 samples), and its overall prevalence was 10% (95% CI: 0.05-0.19; I² = 89.1%; τ² = 0.672; p < 0.0001).

Women in Africa exhibit a varied distribution of the four HPV-16 lineages. The high prevalence of HPV-16 lineage A in the entire population calls for developing targeted interventions to maximize impact and effectiveness. Future studies that are standardized and include defined geographic region, cytological details, and individual patient data should be conducted to enhance robust findings.