Background: Worldwide, cervical cancer is the second most common cancer in women. High-risk human
papillomavirus (HPV) play a crucial role in the etiology of cervical cancer and the most prevalent genotype is
HPV16. HPV 16 intratypic variants have been reported to differ in their prevalence, biological and biochemical
properties. The present study was designed to analyze and identify HPV type 16 E6 variants among patients with
cervical cancer in Morocco.
Methods: A total of 103 HPV16 positive samples were isolated from 129 cervical cancer cases, and variant status
was subsequently determined by DNA sequencing of the E6 gene.
Results: Isolates from patients were grouped into the European (E), African (Af) and North-American (NA1)
phylogenetic clusters with a high prevalence of E lineage (58.3%). The Af and NA1 variants were detected in 31.1%
and 11.6% of the HPV16 positive specimens, respectively, whereas, only 3% of cases were prototype E350T. No
European-Asian (EA), Asian (As) or Asian-American (AA) variants were observed in our HPV16-positive specimens.
At the amino acid level, the most prevalent non-synonymous variants were L83V (T350G), H78Y (C335T), E113D
(A442C), Q14D (C143G/G145T) and R10I (G132T), and were observed respectively in 65%, 41.8%, 38.8%, 30.1% and
23.3% of total samples.
Moreover, HPV16 European variants were mostly identified in younger women at early clinical diagnosis stages.
Whereas, HPV16 Af variants were most likely associated with cervical cancer development in older women with
pronounced aggressiveness.
Conclusion: This study suggests a predominance of E lineage strains among Moroccan HPV 16 isolates and raises
the possibility that HPV16 variants have a preferential role in progression to malignancy and could be associated
with the more aggressive nature of cervical cancer