Multiple infections containing the top five prevalent HPV genotypes and their impact on cervical lesions in Changzhou, China

Patterns of Co-infection of HPV52 With Other HPV Genotypes and Their Risks of Cervical Precancer and Carcinoma

Human papillomavirus 52 (HPV52) is the second most frequent HPV type in high-grade squamous intraepithelial lesion (HSIL) cases in China. However, few researchers have explored the co-infection of HPV52 with other HPV genotypes and their correlation with cervical lesions. In this study, 13,809 HPV52-positive patients visiting the Obstetrics and Gynecology Hospital of Fudan University from 2018 to 2023 were included in the first stage to investigate the risk of cervical lesions among different multiple infection patterns. Another 443 HPV52-positive patients were further included for sequence alignment and phylogenetic analysis. In the current study, the most common HPV52 dual-infection patterns were as follows: HPV16 + HPV52, HPV52 + HPV58, HPV52 + HPV53, and HPV52 + HPV81. Compared with HPV52 single infection, the risk of HSIL+ was increased in HPV16 + HPV52 (OR = 3.47, 95% CI: 2.56, 4.69) and HPV52 + HPV58 (OR = 1.99, 95% CI: 1.35, 2.92) groups. The most common triple-infection patterns were HPV16 + HPV52 + HPV53 and HPV52 + HPV53 + HPV81, followed by HPV52 + HPV53 + HPV58. HPV53 was the most common co-infection type with HPV52 in cases of triple or more multiple infections. However, compared with dual infection, the addition of HPV53 did not affect the risk of HSIL+. Two synonymous mutations, G207A (p = 0.029) and C1203T (p = 0.021), showed statistically significant differences in distribution between single and multiple infection groups. Our results demonstrated that HPV52 showed preferences for co-infection with HPV16, 585,381. HPV52 co-infection with HPV16 and HPV58 increased the risk of HSIL+, while co-infection with HPV53 did not increase the risk of HSIL+. Virus variants with certain mutations may be more susceptible to multiple infections.

Opportunities and challenges for human papillomavirus vaccination in China

Current estimates of the HPV infection rate in China vary by geographic region (9.6-23.6%), with two age peaks in prevalence in women ≤20-25 years of age and 50-60 years of age. HPV-16, 52 and 58 are the most commonly-detected HPV genotypes in the Chinese population. In China, five HPV vaccines are licensed and several others are undergoing clinical trials. Multiple RCTs have shown the efficacy and safety of the bvHPV (Cervarix), Escherichia coli-produced bvHPV (Cecolin), Pichia pastoris-produced bvHPV (Walrinvax), qvHPV (Gardasil) and 9vHPV (Gardasil-9) vaccines in Chinese populations, including two studies showing long-term efficacy (≥8 years) for the bvHPV and qvHPV vaccines. Real-world data from China are scarce. Although modeling studies in China show HPV vaccination is cost-effective, uptake and population coverage are relatively low. Various policies have been implemented to raise awareness and increase vaccine coverage, with the long-term aim of eliminating cervical cancer in China.

The prevalence of multiple or single HPV infection and genotype distribution in healthy Chinese women: A systemic review

BACKGROUND

We analyzed the prevalence and genotype distribution of multiple- or single-type cervical human papillomavirus (HPV) infections in a population of women in mainland China.

METHODS

PubMed, MEDLINE, and Chinese databases (CNKI, VIP, and Wan Fang) were searched for studies on HPV prevalence and the examination of this relationship. All analyses were performed using STATA (version 12.0). Data from selected studies were extracted into tables, and all included studies were weighted and summarized.

RESULTS

Thirty studies were included. The prevalence of single types (10.4%) and multiple types (4.7%) primarily occurred in healthy Chinese women, in which the dominant single-type infection was HPV16 (1.6%), 52 (1.5%), 58 (1.0%), and 18 (0.5%), and the dominant type of multiple infection was HPV16 (0.7%), 52 (0.7%), 58 (0.6%), and 18 (0.3%). The prevalence in North and South China was 14.3%, in which the prevalence of the single type was 10.41% and 8.27%, and the prevalence of multiple types was 4.00% and 6.52%, respectively.

CONCLUSION

Mainland China exhibits unique type-specific single and multiple HPV infections. Overall single or multiple HPV prevalence varied across regions of China, whereas type-specific HPV differences were relatively small.