Analysis of Human Papillomavirus-HPV-18 and HPV-45 Type-specific variants in a contemporary cohort of individuals with cervical disease in Ghana

Objectives: E6 and E7 DNA sequence profile of HPV-18 and HPV-45 lineage/sublineage variants in Ghana. Design: A cross-sectional study. Setting: Obstetrics/Gynaecology Directorate, Komfo Anokye Teaching Hospital, Kumasi and Department of Radiotherapy/Nuclear Medicine and the Family Planning Unit, Korle-Bu Teaching Hospital, Accra. Participants: 207 individuals referred with clinical suspicion of cervical cancer (CxCa) or confirmed CxCa/precancer cases. Methods: Cervical swabs were collected (from October 2018 to November 2020) from individuals, with L1 DNA positivity for HPV-18(40 samples) and/or HPV-45(28 samples), out of 207 samples tested for 24-HPV-genotypes. DNA was extracted from a convenience sample and HPV-E6/E7-PCR (33/40-HPV-18-+ve- or 20/28-HPV-45-+ve samples), sequencing, and BLAST analysis was carried out. Results: After PCR amplification, the E6/E7 gene regions of 26 out of 33(HPV-18+ve) samples and ten (10) out of 20 (HPV-45+ve) samples were eligible for sequencing. For HPV-18 variants, 24 out of 26 samples (92.31%) were of lineage-B/C, including samples of lineage-C and 22 samples of lineage-B (out of which ten (10) samples were with E7-SNP-C665T). Nine out of ten HPV-45 variants were sublineage-A1, of which two (2) samples harboured both E6-SNPs-C134T and C4I7T including one sample with E6-SNPs-C134T, G415C, C4I7T detected together. Conclusions: Our study confirms a dominance of HPV-45-sublineage-A1 and HPV-18-lineage-B (with rare occurrence of Africa-specific HPV-18-lineage-C) variants in Ghana. Our study provides preliminary data on E6/E7 SNPs of HPV-18 and HPV-45 lineages and sublineages among CxCa cases in Ghana. We hope our data will inform future studies on pattern and distribution of HPV type-specific nucleotide changes that can be useful for therapeutic intervention.