Human papillomavirus infection in non-cervical sites in India

Human papillomaviruses are sexually transmitted viruses that have cutaneous and mucosal tropism. While usually cleared by the immune system, persistent infection can lead to cancer. HPV-related tumours account for 5 % of all cancers and over 30 % of cancers of infectious aetiology. One out of every 13 cancers in India are from HPV-related sites. The role of HPV in cervical cancer is well established, but has also been implicated in non-cervical malignancies including penile, anal, vulvar, vaginal, and head and neck cancers. The prevalence and distribution of HPV-related non-cervical cancers, however, varies globally and remains underreported in countries like India with a paucity of large-scale, population-based studies.

A literature search of the PubMed database was conducted using relevant MeSH terms and keywords. The findings aimed to summarize the existing literature on HPV-associated non-cervical cancers in India, the implicated HPV genotypes across anatomical sites, and identify possible research gaps in surveillance, screening, and possible prevention strategies.

In this article, we have reviewed Indian studies against the backdrop of the global scenario, reporting the presence of HPV in non-cervical cancers and high-risk populations. Findings revealed considerable HPV prevalence in non-cervical malignancies in India: 42.5 % in penile cancers, 52.2 % in anal cancers, 22.8-44.8 % in oropharyngeal cancers, and 7.5-34.1 % in laryngeal cancers. HPV-16 was the predominant genotype identified across most tumours. Additionally, high-risk groups particularly HIV-positive MSMs, exhibited elevated HPV DNA positivity from anal, penile and scrotal sites. Overall, in India, there was a lack of robust, population-based data and standardized diagnostic protocols. The absence of routine HPV testing and screening and the limited implementation of HPV vaccination further compound this public health challenge. Enhanced epidemiological surveillance, screening and vaccination are needed to address the rising burden of HPV-related non-cervical cancers.