Prevalence of High-Risk Human Papillomavirus and Associated Risk Factors Among Individuals With Head and Neck Cancer in a National Referral Center in Tanzania.

Abstract

While the prevalence of human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC), specifically in the oropharynx subsite, is increasing in western populations, limited data exist on prevalence in sub-Saharan Africa. This study describes the prevalence and associated risk factors of HPV association among individuals with HNSCC presenting to Muhimbili National Hospital, the largest public tertiary referral center in Tanzania, a country in East Africa. Participants with HNSCC presenting between July 2020 and June 2022 were prospectively recruited in this cross-sectional study. Tumor samples were tested for HPV DNA polymerase chain reaction (PCR) and p16 immunohistochemistry (IHC). Multivariate logistic regression models assessed potential risk factors for HPV. Among 121 individuals diagnosed with HNSCC, the median age was 55 years (IQR, 47-68 years), 76.0% (92/121) were male, and 10.9% (13/119 tested) were HIV positive. Among all cases of HNSCC, the prevalence of HPV was 14.6% (95% CI, 7.5 to 21.6) using PCR testing and 23.6% (95% CI, 15.5 to 31.7) using p16 IHC as a surrogate marker. For the oropharynx subsite, 23.1% (95% CI, 0.2 to 46.0) of specimens using PCR testing and 28.6% (95% CI, 4.9 to 52.2) using p16 IHC tested positive (Kappa 3.0 [95% CI, -51.1 to 57.1]; McNemar <i>P</i> value = .66). Factors independently associated with HPV positivity were oropharynx subsite (odds ratio [OR], 6.4 [95% CI, 1.0 to 40.6], <i>P</i> = .048), nonsmokers (OR, 6.4 [95% CI, 1.1 to 35.4], <i>P</i> = .035), and unmarried individuals (OR, 10.6 [95% CI, 2.4 to 47.3], <i>P</i> = .002). HPV association in HNSCC did not significantly differ by HIV status or sexual activity. HPV association in HNSCC, specifically of the oropharyngeal subsite, is lower in this cohort from Tanzania compared with western populations. Additional regional data are needed to inform clinical care guidelines and vaccination policies.