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Oncogenic Viral Prevalence in Invasive Vulvar Cancer Specimens From Human Immunodeficiency Virus–Positive and -Negative Women in Botswana
  1. Martha Tesfalul, BA*,,
  2. Kenneth Simbiri, PhD,
  3. Chikoti M. Wheat, BA,§,
  4. Didintle Motsepe, MMed,
  5. Hayley Goldbach, BS*,
  6. Kathleen Armstrong, MD,
  7. Kathryn Hudson, MD*,
  8. Mukendi K. Kayembe, MD#,
  9. Erle Robertson, PhD and
  10. Carrie Kovarik, MD,**
  1. *University of Pennsylvania Perelman School of Medicine, Philadelphia, PA;
  2. Botswana–University of Pennsylvania Partnership, Gaborone, Botswana;
  3. Department of Microbiology, University of Pennsylvania, Philadelphia, PA;
  4. §Duke University School of Medicine, Durham, NC;
  5. Princess Marina Hospital, Gaborone, Botswana;
  6. Division of Plastic & Reconstructive Surgery, University of Toronto School of Medicine, Toronto, Ontario, Canada;
  7. #Botswana National Health Laboratory, Gaborone, Botswana; and
  8. **Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  1. Address correspondence and reprint requests to Carrie Kovarik, MD, University of Pennsylvania, 2 Maloney Bldg, 3600 Spruce St, Philadelphia, PA 19104. E-mail: carrie.kovarik{at}


Objective The primary aim of this study was to describe the prevalence of select oncogenic viruses within vulvar squamous cell carcinoma (VSCC) and their association with human immunodeficiency virus (HIV) status in women in Botswana, where the national HIV prevalence is the third highest in the world.

Methods A cross-sectional study of biopsy-confirmed VSCC specimens and corresponding clinical data was conducted in Gaborone, Botswana. Polymerase chain reaction (PCR) and immunohistochemistry (IHC) viral testing were done for Epstein-Barr virus, human papillomavirus (HPV) strains, and Kaposi sarcoma herpesvirus, and PCR viral testing alone was done for John Cunningham virus.

Results Human papillomavirus prevalence by PCR was 100% (35/35) among tested samples. Human papillomavirus type 16 was the most prevalent HPV strain (82.9% by PCR, 94.7% by either PCR or IHC). Kaposi sarcoma herpesvirus prevalence by PCR had a significant association with HIV status (P = 0.013), but not by IHC (P = 0.650).

Conclusions The high burden of HPV, specifically HPV16, in vulvar squamous cell cancer in Botswana suggests a distinct HPV profile that differs from other studied populations, which provides increased motivation for HPV vaccination efforts. Oncogenic viruses Kaposi sarcoma herpesvirus and Epstein-Barr virus were also more prevalent in our study population, although their potential role in vulvar squamous cell cancer pathology is unclear.

  • Human immunodeficiency virus
  • Human papillomavirus
  • Molecular viral testing
  • Oncogenic viruses
  • Vulvar squamous cell carcinoma

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  • Supported by a pilot grant from the Penn Center for AIDS Research of University of Pennsylvania (to C.K.), an International Clinical Research Fellowship grant from the Doris Duke Charitable Foundation to the University of Pennsylvania (to M.T.), and student support from the Eugene A. Stead Scholarship Committee of Duke University (to C.M.W.).

  • The authors declare no conflicts of interest.