Herpes Simplex Virus type 2, Epstein Barr Virus and Human Papilloma Virus Co-infection in Cervical Squamous Cell Carcinoma among Sudanese Females

Abstract

Introduction: Squamous cell carcinoma (SCC) of the uterine cervix is the second cancer among Sudanese females, peculiar tendency to present late due to lack of education and efficient screening programs. High risk HPV 16, 18 have been detected, also existence of HPV 35 was documented.There are postulations to incriminate other viruses in the etiology of cervical carcinoma like Epstein - Barr virus and herpes simplex virus the exact role of these viruses in the etiology of cervical cancer is not clear. The aim of this study was to clarify the existence and prevalence of these viruses among Sudanese women with cervical cancer, and verify the existence of new players in cervical cancer. Method: This was observational case control study conducted in Khartoum state-Sudan during period from October 2013 to June 2016. One hundred and eighty paraffin-embedded tissue blocks were included in this study; 98 blocks from patients with cervical squamous cell carcinoma (case group) versus 82 cervix tissue blocks malignancy-free (control group), were subjected to detection of HSV-2, EBV and HPV infections using Polymerase Chain Reaction (PCR) and Immunohistochemistry (IHC) techniques.Results: HPV infection was detected in 41.8% among cases, while the healthy individuals reported2.4% with high statistically significant different, the P value was 0.000 with 28.8 odds ratio (Ors 28.8; 95% CIs=6.686-123.86; P=0.000),ladies with HPV infection have 28.8 chance to develop cervicalcancer. HSV-2 revealed positivity in 6.1% of the cases biopsies, and in 1.2% of the controls biopsies,with no statistically significant correlation, the P value was 0.128. EBV was positive in 2% of the cancer samples, while the non cancer samples reported in 0.00%, with no statistically significant correlation, the P value was 0.501. Conclusion: HPV, HSV-2 and EBV infections were present in cervix SCC samples, but with different positive rates. HPV remains the major virus associated with cervix SCC tumorigenesis. Both HSV-2 and EBV their roles in the development of cervical SCC appear as bystanders rather than oncoviruses or cofactors. Further studies are needed to determine its precise role.