Prevalence of Human Papillomavirus (HPV) Genotypes in Women from North Macedonia

Abstract

Cervical cancer remains one of the most prevalent malignancies among women both globally and within North Macedonia. Persistent infection with high-risk oncogenic genotypes of Human Papillomavirus (HPV) is a critical etiological factor in its development. This study aimed to determine the genotype distribution and prevalence of HPV among women in North Macedonia and to explore associated infection risk factors. Between June 2023 and July 2024, a total of 300 cervical samples were collected from women for HPV analysis. Molecular detection was performed using conventional PCR and real-time qPCR methods. Two commercial kits were utilized: the AmpliSens® HPV HCR Screen-FEP kit was applied to 50 samples for the detection of high-risk HPV (HR- HPV) genotypes only, while the remaining 250 samples were tested using the NeoPlex™ HPV29 Detection kit, which identifies a broader spectrum of genotypes, including HR- HPV, probable high-risk (pHR-HPV), and low-risk (LR-HPV) types. DNA extraction and purification were carried out using the AmpliSens® DNA-sorb-AM kit, following the manufacturer’s protocols. Statistical analysis was conducted using binary logistic regression, with a 95% confidence level, to assess associations between HPV positivity and the independent variables: age group, infection complexity (single vs. multiple genotypes), and genotype risk classification. The overall HPV prevalence was 18.33%. The 36–66 age group exhibited a higher infection rate (67.27%) compared to the 26–36 age group (32.73%). Genotypes HPV 16 and HPV 31 emerged as the most frequently detected and are known for their strong oncogenic potential. HR-HPV types constituted 94.5% of the positive cases, while LR- HPV types were present in 21.8% of infections. The predominance of high-risk HPV types and the age-related increase in infection rates underscore the need for targeted vaccination strategies, routine cervical screening, and long-term monitoring to reduce the burden of cervical pre-cancerous conditions.

Keywords: Cervical cancer, Human Papillomavirus (HPV), Genotyping, Age groups, Oncogenic risk.