Age-specific prevalence of Human Papillomavirus type 16/18 infections, abnormal cytology and cervical intraepithelial neoplasia among screened women in Tbilisi

Eter Kiguradze, Tamar Skhirtladze, Nikoloz Chkhartishvili, Tamuna Gogoladze, Nino Chikhladze, Tamar Alibegashvili


Objective: The objective of this study was to estimate the age-specific prevalence of Human
Papillomavirus (HPV) type 16/18 infections, abnormal Pap results, and cervical intraepithelial
neoplasia CIN2+ in women screened in Tbilisi, Georgia. Additionally, the study aimed to
evaluate the association between HPV genotyping, Pap test results, and the presence of CIN2+
disease, providing valuable information for clinical decision-making and treatment strategies.
Methods: This cross-sectional study recruited women at the locations of National Screening
Centre in Tbilisi. Participants underwent HPV testing using polymerase chain reaction (PCR) to
detect HPV types 16 and 18. PAP tests were conducted to evaluate cervical abnormalities.
Colposcopy was performed in women with atypical PAP results and/or HPV-positive tests and in
case of abnormal colposcopy findings biopsy samples were collected for histological analysis to
determine the presence of CIN2+ disease. Statistical analyses were performed to estimate
prevalence of HPV infection, abnormal PAP results, and CIN2+ disease. Multivariate analysis
was conducted to assess associations between HPV types 16/18 and abnormal PAP result with
CIN2+ disease.
Results: Among 998 participants enrolled, 1.3% had invalid HPV genotyping test results, and
0.4% had invalid PAP test results, leading to their exclusion from further analysis. Among the
981 women with complete data, the prevalence of high-risk HPV (Hr-HPV) was 11.3%, with
HPV genotypes 16/18 accounting for 3.4% (95% CI: 2.3%-4.7%). The prevalence of any
abnormal PAP result was 11.0% (95% CI: 9.1%-13.1%), and the prevalence of CIN2+ diseases
was 1.3% (95% CI: 0.7%-2.2%). Stratification by age categories showed a higher prevalence of
Hr-HPV and abnormal PAP results among women aged 30-39, which decreased in older age
groups. Statistically significant differences were observed for HPV genotypes 16/18 and
abnormal Pap results, but not for ≥CIN2 disease. The Poisson regression model indicated a
strong association between HPV genotypes 16/18 and CIN2+ disease (PR 49.90, 95% CI:
18.45-134.92, p<0.0001). Abnormal PAP test results showed a significant association in
univariate analysis but not in the multivariate model. No association was found between age
and CIN2+ disease.
Conclusion: The prevalence of HPV 16/18 types and abnormal PAP results varied with age,
with higher rates observed in women aged 30-39, which decreased in older age groups. No
significant differences were found in the prevalence of CIN2+ across age groups. HPV
genotyping may serve as a more reliable predictor of ≥CIN2 disease compared to PAP testing,
highlighting the importance of implementing HPV screening in Georgia.


HPV; PAP; CIN2+ disease; Cervical Cancer; Georgia;

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