1. Update on HPV analysis in the Aberdeen Area Delf Schmidt-Grimminger Assistant Professor The University of South Dakota

3. Facilities  AA IHS works with 13 service units in ND, SD, IA, NE  9 hospitals  8 health centers  Tribal involvement is a major objective  Tribal Health Board

4. Origins  IHS treaties 1784  AA – 104,000 Indians  Several tribes assume partial or full responsibility of health care  Numerous health problems – alcoholism, Diabetes, CA, infant mortality

5. Aberdeen Area Today  Pine Ridge Hospital – serves 17,000. 46 bed hospital  Rosebud Hospital – serves 10,000. 35- bed hospital

6. Background  Cervical cancer is a leading cause of cancer mortality in NA women  The Aberdeen Area has higher rate of cervical cancer mortality than other NA areas (15/100,000)

7. Hypothesis  We hypothesized that oncogenic types of HPV are more prevalent in the Aberdeen Area Native American population

8. Study Design  All patients presenting for Pap smear screening were asked to participate  After a Pap smear was obtained, an additional Digene swab was collected for HPV testing  DNA isolated from swabs  PCR amplification using L1 consensus primer was performed on all samples  Roche HPV strips were used to determine high risk HPV types 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 55, 56, 58, 59, 68, MM4, MM7, MM9 and low risk types (6, 11, 40, 42, 53, 54, 57, 66, MM8).

9. PCR after DNA isolation

10. HPV Genotyping

14. Results  287 samples obtained  Age range 18-78  61 patients were HPV positive (21.2%), but many had multiples types (one patient had 6 types of HPV at once!)  68% were high-risk types –58% were non HPV 16 18 high risk types.

15. Clifford; Lancet vol 366 Sept 2005 Europe HPV prevalence 1.3%-7.8%

16. Clifford; Lancet vol 366 Sept 2005 Sub Saharan Africa HPV prevalence 24.7%

17. Aberdeen Area HPV prevalence 21.2%

19. Conclusion  The Aberdeen area Native American population has an HPV prevalence of 21.2% (higher than most high risk populations)  Current type specific HPV vaccines against HPV 16 and 18 would miss a significant percentage of the HPV infection in the Aberdeen Area population.

20. Update on project  Pineridge clinic – approved and implemented study. 16 patients enrolled.  Sioux Falls- approved and implemented study. 175 patients enrolled.  Rosebud – approved and no patients enrolled  Need for person at study site

24. Clifford; Lancet vol 366 Sept 2005 Asia: HPV prevalance 1.6%-14.0% depending on country

25. Clifford; Lancet vol 366 Sept 2005 South America HPV prevalence 10.8%-15.5%