Human Papillomavirus Infection Rate Research Articles

Differential etiopathogenic features of vulvar squamous cell carcinomas in sub-Saharan Africa and Europe.

Two pathways have been described for vulvar squamous cell carcinomas (VSCC), one associated with human papillomavirus (HPV), and the other HPV-independent. We compared the etiopathogenic features of a series of VSCC from Mozambique, a sub-Saharan country with high prevalence of HPV and HIV, with those of Spain, a European country with low prevalence of HPV and HIV. All VSCC diagnosed at the two institutions from January 2018 to December 2020 were included (n=35 and n=41, respectively). HPV DNA detection and genotyping, and immunohistochemistry for p16 and p53 were performed. Tumors showing p16 positive staining and/or HPV DNA positivity were considered HPV-associated. 34/35 tumors (97%) from Mozambique and 8/41 (19%) from Spain were HPV-associated (P < .001). Mean age of the patients from Mozambique and Spain was 45 ± 12 and 72 ± 14, respectively (P < .001). No differences were found in terms of HPV genotypes or multiple HPV infection rates. 1/35 tumors (3%) from Mozambique and 29/41 (70%) from Spain showed abnormal p53 immunostaining (P < .001). In contrast with the predominance of HPV-independent VSCC affecting old women in Europe, most VSCC in sub-Saharan Africa are HPV-associated and arise in young women. This data may have important consequences for primary prevention of VSCC worldwide.

Detection of Human Papilloma Virus (HPV) Infection in Colorectal Cancer and Viral Genome Integration Status

Background: Colorectal cancer (CRC) is the third common cause of malignancy in Iran, and its incidence rate has been raised due to an increase in individual and environmental risk factors. Objectives: The present study aimed to define the role of human papillomavirus (HPV) infection in CRC, then by drawing a phylogenetic tree, we aimed to analysis the sequences of isolated HPVs, and finally determine the viral genome physical status for HPV-16. Methods: A nested-PCR (nPCR), direct sequencing, and INNO-LiPA HPV genotyping assay were carried out for HPV detection, and a quantitative real-time PCR assay (qRT-PCR) was conducted for the physical status of the viral genome. Results: Among 157 subsets, there were 66 cases and 91 controls. Moreover, 5.7% (9/157) were HPV positive by nPCR, among whom 9.1% (6/66) were cases and 3.3% (3/91) were control groups (P = 0.750). The qRT-PCR analysis showed three forms of integrated, episomal, and mixed forms in our three HPV-16 strains. A higher rate of HPV infection was detected in the CRC cases; however, it was not statistically significant. Conclusions: Although there were limited positive results, higher ages (&gt; 65) were related to HPV involvement and CRC outcome. Furthermore, 9.1% of the CRC cases were infected with HPVs. The HPV-16 genome integration is observed in high-grade cancer cases with severe malignancy in CRC patients.

Human Papillomavirus Infection Among Pregnant Women Living With HIV: A Systematic Review and Meta-Analysis.

In the general population, human papillomavirus (HPV) prevalence is reportedly increased during pregnancy, and emerging evidence suggests that it may be associated with adverse pregnancy outcomes. Women living with HIV (WLWH) experience higher rates of both HPV infection and certain adverse pregnancy outcomes, yet there are no prior reviews of HPV infection during pregnancy in WLWH. We conducted a systematic review and meta-analysis of pooled and type-specific HPV prevalence and associated pregnancy outcomes among pregnant WLWH and, if available, within-study comparators of women without HIV. Subgroup analyses were performed according to polymerase chain reaction primers used and geographic location. Ten studies describing HPV prevalence in 1594 pregnant WLWH were included. The pooled HPV prevalence in pregnant WLWH was 75.5% (95% confidence interval: 50.2 to 90.4) but ranged widely (23%-98%) between individual studies. Among studies that also assessed HPV prevalence in pregnant women without HIV, the pooled prevalence was lower at 48.1% (95% confidence interval: 27.1 to 69.8). Pregnant WLWH had 54% higher odds of being HPV positive compared with pregnant women without HIV. The most common HPV type detected in pregnant WLWH was HPV16. No studies reported pregnancy outcomes by the HPV status. High prevalence of HPV was documented in pregnant WLWH, exceeding the prevalence among pregnant women without HIV. The limited research on this topic must be addressed with further studies to inform the use of HPV testing as a screening modality for this population as well as the role of HPV in adverse pregnancy outcomes.

Status and epidemiological characteristics of high-risk human papillomavirus infection in multiple centers in Shenyang.

The different human papillomavirus (HPV) strains cause warts in various regions of the body. However, considering that the status and genotype distribution of HPV infection in women in Shenyang remain unknown, herein, we investigated the epidemiological characteristics of high-risk HPV (HR-HPV) infection in women in Shenyang, as well as the current state of HPV infection in Shenyang, to provide a theoretical basis for the prevention and treatment of cervical cancer. From December 2018 to December 2021, 6,432 urban and rural women from the Liaoning Cancer Hospital and the Sujiatun Women and Infants’ Hospital were assessed via the Thinprep cytology test (TCT) and HR-HPV detection. Of the 5,961 women enrolled, 739 were HPV positive (12.40%) and 562 were TCT positive (9.43%). Statistical analyses identified the following HPV risk factors: high school education or lower [OR = 1.426 (1.199–1.696), p < 0.001], age at first sexual encounter ≤ 19 years [OR = 1.496 (1.008–2.220), p = 0.046], and number of sexual partners > 1 [OR = 1.382 (1.081–1.768), p = 0.010], atypical squamous cells of undetermined significance (ASCUS) and above [OR = 10.788 (8.912–13.060), p < 0.001], non-condom-based contraception [OR = 1.437 (1.103–1.871), p = 0.007], nationalities other than Han [OR = 1.690 (1.187–2.406), p = 0.004], rural residence [OR = 1.210 (1.031–1.419), p = 0.020]. Compared to the HPV infection rate of women aged 56–65, that in women aged 35–45 [OR = 0.687 (0.549–0.860), p = 0.001] and 46–55 [OR = 0.740 (0.622–0.879), p = 0.001] decreased significantly. To conclude, risk factors of HPV infection among female patients include high school age and below, initial sexual encounter at age ≤ 19 years, number of sexual partners > 1, ASCUS and above, non-condom contraception, nationalities other than Han nationality and rural population. Collectively, this study provides insights for the improved prevention and treatment of cervical cancer.

Prevalence of cervicovaginal human papillomavirus infection and genotype distribution in Shanghai, China

BackgroundThe evaluation of human papillomavirus (HPV) prevalence rate dynamics and genotype distribution could support the adoption of more targeted prevention and treatment of cervical cancer. We aimed to assess the infection status and genotype characteristics of HPV among gynecological outpatients in Shanghai, China.MethodsClinical specimens were collected from patients attending gynaecological department of the Putuo Hospital, Shanghai University of Traditional Chinese Medicine, between January 2015 and December 2019. The cervicovaginal infection of 17 high-risk genotypes and 10 low-risk genotypes were analyzed by Luminex-based multiple assays.ResultsThe overall HPV infection rate was 18.81% (95% CI 18.31–19.30%) in Shanghai city, with high-risk, low-risk and mixed high- and low-risk HPV prevalence being 11.65% (95% CI 11.24–12.06%), 4.19% (95% CI 3.94–4.44%) and 2.96% (95% CI 2.74–3.17%), respectively. The five most prevalent high-risk genotypes were HPV-52 (2.95%), HPV-16 (2.34%), HPV-58 (2.07%), HPV-53 (1.67%) and HPV-39 (1.36%). The most common low-risk genotype was HPV-61 (1.52%), followed by HPV-6 (1.29%) and HPV-81 (1.19%). Moreover, the coverage of HPV genotype by nonavalent vaccine was 10.42%, and non-vaccine-covered high-risk genotype was 7.70%. The 15–24 years age group demonstrated the highest HPV prevalence (43.14%), and significant differences were observed among different age groups (P < 0.001).ConclusionsThis study revealed the HPV prevalence and genotype distribution among women in Shanghai city, which could serve as guidance for HPV vaccination and preventative strategies against cervical cancer in this area.

Cervical cancer screening in high-altitude areas in China: A large cross-section study of 25,173 women in northern Tibet.

BackgroundCervical cancer has become a worldwide concern owing to its high incidence and mortality rates. To date, high-altitude areas of Tibet have not benefited from any large-scale cervical cancer screening programs. Therefore, we initiated a screening program to investigate the prevalence of human papilloma virus (HPV) and HPV genotype distribution to reveal cervical cancer and its precursor which lead to morbidity among women in the city of Nagqu in northern Tib3et.MethodsA total of 25,173 women were recruited to undergo HPV genotype tests between June and December 2019. Women infected with HPV 16 and/or 18 underwent colposcopy and histological examination. Women with other high-risk HPV type (hr-HPV) underwent cytological tests to determine whether to conduct further colposcopy and histological examination for diagnosis. HPV prevalence was calculated in the total population and further stratified according to various parameters, such as age group, area location (altitude level), and single or mixed infection status. The HPV genotype distribution was also investigated accordingly. Cervical lesions revealed by further colposcopic findings were also analyzed; high-grade and malignant lesion morbidities were calculated in total and in each county. Most data were collected and analyzed using descriptive and consistency check statistical methods, and a risk factor investigation for HPV infection was performed using logistic regression models.ResultsThe total HPV infection rate among women in Nagqu was 13.42%. Of the 25,173 women in the study, 999 (3.97%) were HPV 16/18 positive, 2,379 (9.45%) were other hr-HPV-positive, and 21,795 (86.58%) were HPV-negative. The five most common HPV genotypes, accounting for more than 60% of all HPV infections in Nagqu people, were HPV 16, 58, 31, 18, and 52. Tibetan women younger than 20 years and older than 60 years were the two age groups with the highest rates of HPV infection, 26.7% and 19.8%, respectively. Among the HPV-positive women, 2,656 (78.33%) were infected with a single strain and 732 (21.67%) were infected with multiple strains (more than two genotypes). HPV prevalence increased in high-altitude areas (positive rate highest in Nyima with an altitude of 5,000 m, 23.9%) and decreased in relatively low-altitude areas (positive rate lowest in Lhari with an altitude of 4,000 m, 6.6%). Multiple analyses showed that age, parity, age at first delivery, and altitude of residence were independent factors facilitating HPV infection in Tibetan women. High-grade and malignant cervical lesions revealed by histological findings were different among living locations, with the highest rates in Xainza, Baingoin, and Nyainrong, these being 2.019%, 1.820%, and 1.116%, respectively, among women in these areas.ConclusionOur survey provides an overall perspective on HPV genotype infection and cervical lesions in women in northern Tibet. The data not only provide useful information for the treatment of cervical lesions but also has great value in terms of the primary and secondary prevention measures that can be taken for women living in these regions.Clinical Trial Registration www.chictr.org.cn, indentifier ChiCTR2000035061.

Prevalence of multiple human papillomavirus infections and association with cervical lesions among outpatients in Fujian, China: A cross-sectional study.

Multiple human papillomavirus (HPV) infections are common, but their impact on cervical lesions remains controversial. A total of 6225 female patients who underwent colposcopies/conization following abnormal cervical cancer screening results were included in the study. The final pathological diagnosis was determined by the most severe pathological grade among the cervical biopsy, endocervical curettage, and conization. Univariate and multivariate logistic regression analyses were used to investigate the association between multiple HPV infections and cervical lesions, adjusting for age, HPV genotype, gravidity and parity. In total, 33.3% (n = 2076) of the study population was infected with multiple HPV genotypes. Multiple HPV infections were more prevalent in patients younger than 25 years and older than 55 years, with the rate of multiple HPV infections at 52.8% and 44.3%, respectively. HPV16\52\18\58 are the most common HPV genotypes and usually appear as a single infection. Compared to single HR-HPV infection, multiple HR-HPV infections do not increase the risk of HSIL+, while single HR-HPV coinfected with LR-HPV seems to reduce the risk of HSIL+ (odds ratio = 0.515, confidence interval: 0.370-0.719, p < 0.001). Multiple HR-HPV infections cannot be risk-stratified for triage of HR-HPV-positive women.

Problems with catch-up HPV vaccination after resumption of proactive recommendations.

We previously reported that the suspension of the proactive recommendation for human papillomavirus (HPV) vaccination in Japan led to an increase in infection rates and incidence of cytological abnormalities, 1 Sekine M Yamaguchi M Kudo R et al. Suspension of proactive recommendations for HPV vaccination has led to a significant increase in HPV infection rates in young Japanese women: real-world data. Lancet Reg Health West Pac. 2021; 16100300 PubMed Google Scholar , 2 Yagi A Ueda Y Ikeda S et al. The looming health hazard: a wave of HPV-related cancers in Japan is becoming a reality due to the continued suspension of the governmental recommendation of HPV vaccine. Lancet Reg Health West Pac. 2022; 18100327 PubMed Google Scholar and appealed for proactive recommendations to be reinstated. 3 Ueda Y Yagi A Ikeda S Enomoto T Kimura T Beyond resumption of the Japanese government's recommendation of the HPV vaccine. Lancet Oncol. 2018; 19: 1563-1564 Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar In response to our findings, the Japanese Ministry of Health, Labour, and Welfare resumed proactive recommendations for the HPV vaccine in April, 2022, and initiated catch-up vaccinations for women who might have missed the opportunity to receive the vaccine during the period when proactive recommendations were suspended. 4 Haruyama R Obara H Fujita N Japan resumes active recommendations of HPV vaccine after 8·5 years of suspension. Lancet Oncol. 2022; 23: 197-198 Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar A large proportion of women in the target age group (17–25 years) in Japan's fiscal year 2022 will be eligible for the recommended catch-up vaccination (figure). 5 Nakagawa S Ueda Y Yagi A Ikeda S Hiramatsu K Kimura T Corrected human papillomavirus vaccination rates for each birth fiscal year in Japan. Cancer Sci. 2020; 111: 2156-2162 Crossref PubMed Scopus (24) Google Scholar To reduce the incidence of invasive cervical cancer in Japan, a catch-up vaccination programme with at least 50% coverage will be required. 6 Simms KT Hanley SJB Smith MA Keane A Canfell K Impact of HPV vaccine hesitancy on cervical cancer in Japan: a modelling study. Lancet Public Health. 2020; 5: e223-e234 Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar To date, England, Sweden, Denmark, and the USA have successfully implemented national catch-up HPV vaccination programmes. In these countries, catch-up vaccination has been reported to have substantially reduced the incidence of cervical precancer and invasive cancer. However, in England, low vaccination coverage among the catch-up generation has been reported. Coverage of three doses of the HPV vaccine was high for women who received the routine vaccination at age 12–13 years (80·9–88·0%), but lower for the catch-up cohorts (70·8–75·7% for age 14–16 years, and 38·9–48·1% for age 16–18 years). 7 Falcaro M Castañon A Ndlela B et al. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021; 398: 2084-2092 Summary Full Text Full Text PDF PubMed Scopus (116) Google Scholar Catch-up vaccination is challenging in Japan because no national HPV vaccine register exists, and immunisation histories are maintained individually by each municipality (approximately 1700) that has provided routine vaccinations. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar For example, if a woman who received the HPV vaccination at age 12–16 years in one municipality moves to a residential address in another municipality, it would not be possible to ascertain her vaccination history from the previous municipality. Thus, a woman who has received three doses of the HPV vaccine in one municipality would be advised to receive three more doses of the HPV vaccine if she moved to another municipality. Thus, the vaccination programme will rely on patient recall regarding personal vaccination history. In our previous study, 1230 women aged 20–22 years between fiscal year 2014 and fiscal year 2017 were asked in a questionnaire whether they had been vaccinated in the past. 140/308 (45·5%) of those who responded that they had not been vaccinated had received 1–3 doses of the vaccine. 8 Yamaguchi M Sekine M Kudo R et al. Differential misclassification between self-reported status and official HPV vaccination records in Japan: implications for evaluating vaccine safety and effectiveness. Papillomavirus Res. 2018; 6: 6-10 Crossref PubMed Scopus (26) Google Scholar In our current analysis of 1778 women aged 20–26 years in fiscal year 2020 (appendix), 199/879 (22·6%) of those vaccinated reported that they had never been vaccinated. Recall of women who visited clinics with their parents at age 12–16 years and received the HPV vaccine was poor.

HPV infection rates for men vs. women: Additional screening is needed (446)

<b>Objectives:</b> To evaluate the difference in oral human papillomavirus (HPV) positive prevalence among heterosexual men and women in the United States between 2011 and 2016. <b>Methods:</b> Data on respondents were obtained from the National Health and Nutrition Examination Survey from 2011-2016. Sexual orientation was self-reported by respondents. Oral rinse specimens obtained from the mobile examination centers were used to determine whether the respondents tested positive or negative for any of the 37 HPV strains and 14 high-risk HPV strains. <b>Results:</b> Of 7,333 respondents, 3530 (48.8%) identified as heterosexual males and 3803 (51.2%) as heterosexual females. Among the respondents, 9.1% (<i>n</i>=345) of males had oral HPV compared to 2.6% (<i>n</i>=119) of females (p<0.001). On multivariate analysis, we found that being divorced/separated (OR: 1.83, 95% CI: 1.05-3.2) and being a current smoker (OR: 1.56, 95% CI: 1.15-2.11) were independent predictors of testing positive for any oral HPV. On subset analysis of high-risk HPV strains, we found that 5.1% of men compared to 1.1% of women tested positive for any high-risk strain (p<0.0001). On multivariate analysis, we found that being male (OR: 4.45, 95% CI: 2.94-6.74), having five or more lifetime sexual partners (OR:7.15, 95% CI: 1.94-26.3), and having three to four alcoholic drinks per day (OR: 1.63, 95% CI: 1.05-2.55) were independent predictors of testing positive for any high-risk oral HPV. Other factors, such as age, education, smoking, and marital status, were not predictive of HPV infection. <b>Conclusions:</b> There is a higher prevalence of any and high-risk oral HPV in men compared to women. Given the increasing incidence of head and neck cancers, screening for high-risk individuals warrants consideration.

Disparities in HPV vaccination in young vs. older Hispanic adults and genital HPV prevalence (378)

<b>Objectives:</b> To compare the human papillomavirus (HPV) vaccination rates in young versus older women and correlate with genital HPV infection rates in the United States. <b>Methods:</b> HPV vaccination rates for teenage girls (13-17 years) were evaluated using the Centers for Disease Control and Prevention's TeenVax dataset between 2008 and 2018. HPV vaccinations rates on women (18-49 years) were obtained from the Behavioral Risk Factor Assessment Monitoring System from 2008 to 2016. Trends were described using average annual percent change (AAPC). Data on HPV infection were obtained on women (20-59 years) from the National Health and Nutrition Examination Survey from 2011 to 2016. HPV infection was detected through vaginal swab samples and analyzed using the Roche Linear Array HPV Genotyping Test. <b>Results:</b> Between 2008 and 2016, HPV vaccination increased annually from 3.0% to 15.1% at an increase of 23.4% per year (p<0.001). The vaccination rates for the 13-17 years versus 18-24 and 25-29, 30-34, 35-39, 40-44, 45-49 were 57.4%, 44.1%, 33.2%, 14.56%, 5.96%, 3.98%, and 2.65%, respectively. In 2018, HPV teenage vaccination rates were 61.7%, 60.6%, 57.7%, 54.2% in Hispanic, Black, Asian, and White, respectively. Between 2011 and 2016, 46.0% of other Hispanic and 35.2% of Mexican American tested positive for any genital HPV compared to 32.0% of White women (p<0.0001). On multivariate analysis, we found that other Hispanic race (OR: 1.88, p<0.0001), income below the poverty line (OR: 1.38, p=0.0072), low income (OR: 1.34, p=0.03), divorced/separated (OR: 1.67, p=0.004) and more than four lifetime sexual partners (OR: 2.69, p<0.0001) were predictors of HPV infection. <b>Conclusions:</b> Overall, HPV vaccination rates increased in both teenage and adult women. However, we found that Hispanics had higher vaccination rates as teens compared to adults.

Study of NFKB Polymorphism with HPV Infection in Women of Reproductive Age Group

Background: Human Papilloma Virus (HPV) is highly prevalent, with around 80% of women thought to be infected at some point. They are thought to produce proteins which inhibit the tumour suppressor protein p53 in cervical epithelial cells, allowing for uncontrolled cell division. The persistent HPV infection changes a premalignant lesion to cancerous state and this seems to be accompanied by a progressive loss of responsiveness to the NFƙB mediated growth inhibitory signal. This study was undertaken to provide a more precise evaluation of association of NFƙB -94ins/del ATTG promoter polymorphism and cancer risk. Methods: The study included 75 cases (unhealthy cervical pathology) and 75 controls (healthy normal cervix) belonging to reproductive age (15-44years) group. Cervical swab for HPV genotyping was performed in cobas x 480 and cobas z 480 analysers. DNA was extracted from EDTA blood sample using cobas DNA sample preparation kit. NFƙB gene polymorphism was seen by PCR-RFLP method in gel electrophoresis. Statistical analysis was done using SPSS 20. Results: Among the healthy normal cervical cytology, HPV infection rate was found to be 6.6%. In cases, maximum HPV positivity was for HPV 16. Among the study population, insertion allele was seen more in both the study groups compared to deletion allele. We found del/del genotype contribution maximum among the cases with cervical pathology. Ins/del genotype was found in cases group. In unhealthy cervix, we found that ins/ins genotype was prevalent among all the HPV strain except HPV 18 followed by del/del genotype. But, among HPV 18 strain, del/del was seen more common.

Risk of human papillomavirus infection and cervical intraepithelial lesions in Chinese renal transplant recipients.

ObjectiveWhile human papillomavirus (HPV) infection in women is associated with cervical intraepithelial neoplasia and cervical cancer, HPV testing is not often performed in routine practice for renal transplantation patients. The genotype-specific prevalence of HPV and risk factors for HPV infection are still unclear.MethodsFrom 2010 to 2020, patients receiving renal transplantation surgery (referred to as RTRs), who had been screened for HPV infection one year after transplantation were enrolled. A comparison cohort of four age- and marital status-matched healthy individuals was selected for RTRs. The clinical characteristics and cervical screening results of RTRs were analyzed.ResultsOur study included 196 female renal transplant recipients (RTRs), none of whom had been vaccinated against HPV. Overall high-risk HPV (hrHPV) infection and abnormal cytology rates in the RTR group were 23.5% and 20.9%, respectively. The odds ratios of hrHPV infection and cervical intraepithelial neoplasia grade 2+ in RTRs vs. non-RTRs were 3.033 (95% CI, 2.013-4.568) and 3.628 (95% CI, 1.863-7.067), respectively. The prevalence of HPV16 in RTRs was much higher (30.4% vs. 8.3%, P=0.002). The multi-infection rate was much higher in HPV-infected RTRs (23.9% vs. 1.14%, P<0.001). The only risk factor for hrHPV infection was the duration of immunosuppression, which increased with time.ConclusionRTRs had significantly higher HPV infection rates and increased risks of HPV-related cervical premalignancies and cancers due to the immunosuppressed state. The duration of immunosuppression is a risk factor for transplant recipients. Female RTRs may benefit from more frequent cervical cancer screening after renal transplantation than healthy women. Prospective research on HPV infection dynamics in RTRs and optimal screening methods should be further explored in the future.

Changes in High-Risk HPV Infection Prevalence and Associated Factors in Selected Rural Areas of China: A Multicenter Population-Based Study.

BackgroundThe Chinese government has taken action to prevent cervical cancer by implementing the National Cervical Cancer Screening Programme in Rural Areas (NACCSPRA), which was launched in 2009. Numerous studies have demonstrated that long-term cervical cancer screening alters human papillomavirus (HPV) infection rates and cervical disease detection. Nearly 80 million women have been screened over 10 years, representing <30% of the target population; however, in some rural areas, such as Ordos City of Inner Mongolia Autonomous Region, Xiangyuan County of Shanxi Province, and Jinyun County, and Jingning County of Zhejiang Province, programs for prevention and treatment of cervical cancer have been implemented. Numerous studies have demonstrated that long-term cervical cancer screening alters rates of human papillomavirus (HPV) infection and cervical disease detection. In this study, we aimed to determine the infection rates of high-risk HPV (hrHPV) and the detection rate of cervical lesions; and changes in factors associated with cervical cancer, to provide scientific data to inform efforts to eliminate cervical cancer in rural areas.MethodsThis was a cross-sectional, population-based, and multi-center survey. Populations from three rural areas of China (Ordos City of Inner Mongolia Autonomous Region, Xiangyuan County of Shanxi Province, and Jinyun County and Jingning County of Zhejiang Province) were selected and 9,332 women aged 20–64 years old were invited to participate in cervical cancer screening by both cytology and HPV testing. The outcomes assessed were: infection rates with hrHPV, HPV16, 18, 16/18, and other 12 hrHPV types (HPV 31,33,35,39,45,51,52,56,58,59,66 and 68); detection rates of cytological and histological lesions; and factors associated with HPV infection.ResultsA total of 9,217 women aged 45.62 ± 8.02 years were included in this study. Infection rates with hrHPV, HPV 16, 18, 16/18, and other 12 hrHPV types were 16.3%, 3.0%, 1.5%, 4.3%, and 13.6%, respectively. There were significant differences among the age-specific HPV infection rates (P < 0.05). Infection rates with hrHPV, 16, 18, 16/18, and the other 12 hrHPV types showed a single peak infection mode, with a peak age of 56–65 years old. Age, marital status, number of live births, education level, reproductive disease history, and a history of alcohol consumption were risk factors for hrHPV infection. The detection rate of cytological abnormalities was 12.98% in the study and was higher in women older than 56 years old. The detection rates of cervical intraepithelial neoplasia CIN2+ and CIN3+ in the population were 1.45% and 0.77%, respectively. The highest incidence rates of CIN2+ and CIN3+ were 32.12% and 17.51%, respectively, in the 41–45 years old group.ConclusionInfection rates with hrHPV, HPV16, and cervical lesions among our screening population were lower than the mean level in rural areas of China. Infection rates with hrHPV, HPV16, 18, and 16/18 showed a single-peak infection pattern, with the peak age of infection being 56-65 years old. Risk factors for hrHPV infection were age, history of alcohol consumption, marital status, reproductive diseases, education level, and the number of live births. Based on these data, we recommend that cervical cancer screening be offered to women older than 30 years in rural areas, particularly those aged 41–45 years.

Evaluation of 5-aminolevulinic acid-mediated photodynamic therapy in postmenopausal women with persistent HPV infection with or without cervical and vaginal low-grade squamous intraepithelial lesions (CIN1/VaIN1)

ObjectiveTo analyze the efficacy and safety of photodynamic therapy (PDT) on postmenopausal women with persistent human papillomavirus (HPV) infection with or without low-grade cervical and vaginal intraepithelial neoplasia (CIN1 and VaIN1). Materials and methodsThe clinicopathological and follow-up data of 86 postmenopausal women with HPV infection (35 cases with chronic cervicitis and 51 cases with CIN1/VaIN1) were collected. All the women in this group met these criteria: menopausal time ≥ 1 year, HPV infection time ≥ 2 years, colposcopy and pathological diagnosis of biopsy ≤ CIN1/VaIN1 before PDT treatment, and 5-aminolaevulinic acid (5-ALA) as photosensitizer treating for 6 times with a week interval. The above patients were followed up 6 months and 12 months after PDT treatment, and the follow-up contents included HPV typing, cytology, colposcopy and pathological examinations. HPV negative conversion rate and lesion remission rate are the evaluation indicators of treatment efficacy. In addition, we also assessed the safety of PDT treatment. ResultsAt 12-month follow-up, the overall HPV clearance rate was 60% (45/75), of which the negative conversion rate of 16/18 HPV was 41.38% (12/29), and non-16/18 HPV was 71.74% (33/46) (p = 0.009). In patients without lesions, the HPV clearance rate was 51.72% (15/29), while in patients with CIN1/VaIN1 (n = 46), the HPV complete remission rate and lesion regression rate were 65.22% (30/46) and 89.13% (41/46), respectively. In addition, the clearance rate of HPV in lesion regression group was significantly higher than that in lesion persistence/progression group (0.00% vs. 73.17%, p = 0.003). The adverse reactions after PDT treatment were mild, mainly manifested as increased vaginal secretions or burning/tingling. ConclusionsPhotodynamic therapy can significantly enhance the elimination rate of persistent HPV infection in postmenopausal women and reduce the progression of CIN1/VaIN1. It could be an effective conservative treatment for persistent HPV infection and CIN1/VaIN1 in postmenopausal women.

Feasibility of human papillomavirus self-sampling to combat COVID-19-related disruptions to cervical cancer screening: a cross-sectional survey

BackgroundThe prevalence of human papillomavirus (HPV) infection among Chinese women in Hong Kong has been reported to range between 7% and 11%, and high-risk HPV genotypes accounted for about 90% of cases of cervical cancer. The COVID-19 pandemic has had a major impact on a wide range of health outcomes because of limitations to the functioning of health services, including cervical cancer screening. The aim of this study was to assess HPV self-sampling as an alternative option for cervical cancer screening during the COVID-19 pandemic.MethodsA cross-sectional household survey was conducted with a residential mailing sampling approach. Under the sampling frame, addresses would be geographically randomly selected in each group and mailing invitation letters were sent to selected households. All sexually active adult household members would be eligible to join the survey. The study comprises two parts: first, a self-administrated standardised web-based questionnaire; and second, laboratory testing of HPV in self-collected cervical samples. In part one of the study, a survey link was included in the invitation letter and a telephone survey was also offered to those who were unable to complete the web-based questionnaire. Participants were asked about their lifestyle and sexual behaviour, history of cervical cancer screening and infections, acceptability of HPV self-sampling, COVID-19-related health-care disruption, and sociodemographic factors. Interested participants who completed part one study were then invited to join part two of the study by taking a self-sample to be tested for sexually transmitted infections (namely HPV, Neisseria gonorrhoeae, and Chlamydia trachomatis) for estimation of the prevalence of sexually transmitted infections among the Hong Kong population.Findings39 815 invitation letters were sent to selected households between May 1, 2021, and Dec 31, 2021. The response rate was 924 (2%) respondents who completed the web-based survey. 557 (60%) of 924 respondents were women aged 19–76 years (median 39 IQR 32–51). The overall willingness to undergo self-sampling was 364 (65%) of 557 participants, with a response rate of 166 (30%) of 557 who successfully completed part two of the study (self-sampling procedure). The overall HPV infection rate was 10% (17 of 166 self-tested participants), three (18%) of whom had never been screened. Among the 557 respondents, 144 (26%) who had never been screened for cervical cancer accepted HPV self-sampling. Among the 413 women who had ever been screened, 328 (80%) reported previously attending regular screenings. 129 (39%) of these 328 respondents indicated that their screening behaviour was affected by the health-care disruptions caused by the COVID-19 pandemic, and 93 (72%) of these 129 were willing to receive the self-sampling kit for testing, with a response rate of 34% (44 of 129) successfully completing the self-sampling procedure.InterpretationOur findings show that most women were willing to uptake self-sampling, both among those who had never been screened and especially those who previously adhered to regular screening but were affected by the COVID-19 pandemic. HPV self-sampling not only can help to tackle the barriers to cervical screening, but can also a feasible and acceptable option as an alternative cervical cancer screening during the pandemic.FundingThis study was supported by the Commissioned Health and Medical Research Fund of Food and Health Bureau of HKSAR Government (reference number CID-CUHK-E).

Risk Factors Associated With Human Papillomavirus Infection, Cervical Cancer, and Precancerous Lesions in Large-Scale Population Screening.

Cervical cancer is the most common gynecological malignancy and screening for risk factors with early detection has been shown to reduce the mortality. In this study, we aimed to analyze the characteristics and risk factors of human papillomavirus (HPV) infection and precancerous lesions in women and provide clinical evidence for developing strategies to prevent cervical precancerous lesions and cancer in women. Furthermore, we evaluated the influencing factors for high-risk HPV infection. From April 2018 to December 2021, 10,628 women were recruited for cervical cancer screening at Liaoning Cancer Hospital, Shenyang Sujiatun District Women’s and Infants Hospital, Benxi Manchu Autonomous County People’s Hospital, and Shandong Affiliated Hospital of Qingdao University. The study participants were tested to determine if they were HPV-positive (HPV +) or underwent thinprep cytology test (TCT) for atypical squamous cells of undetermined significance (ASCUS) and above. Furthermore, colposcopies and biopsies were performed for the histopathological examination. Finally, 9991 cases were included in the statistical analysis, and the factors influencing HPV infection and those related to cervical cancer and precancerous lesions were analyzed. HPV + infection, high-grade squamous intraepithelial lesion-positive (CINII +) in cervical high-grade intraepithelial neoplasia, and early cervical cancer diagnosis rates were 12.45, 1.09, and 95.41%, respectively. The potential risk factors for HPV were education ≤ high school [odds ratio (OR) = 1.279 (1.129–1.449), P < 0.001], age at initial sexual activity ≤ 19 years [OR = 1.517 (1.080–2.129), P = 0.016], sexual partners > 1 [OR = 1.310 (1.044–1.644), P = 0.020], ASCUS and above [OR = 11.891 (10.105–13.993), P < 0.001], non-condom contraception [OR = 1.255 (1.059–1.487), P = 0.009], and HSIL and above [OR = 1.541 (1.430–1.662), P < 0.001]. Compared with women aged 56–65 and 35–45 years [OR = 0.810 (0.690–0.950), P = 0.010] the HPV infection rate was significantly lower in those aged 46–55 years [OR = 0.79 (0.683–0.915), P = 0.002]. Furthermore, ≤ high school age [OR = 1.577 (1.042–2.387), P = 0.031], not breastfeeding [OR = 1.763 (1.109–2.804), P = 0.017], ASCUS and above [OR = 42.396 (28.042–64.098), P < 0.001] were potential risk factors for cervical cancer and precancerous lesions. In women with HPV infection, ≤ high school education level, initial sexual activity at ≤ 19 years of age, number of sexual partners > 1, ASCUS and above, non-condom contraception, HSIL and above were risk factors for HPV infection. Compared with women aged 56–65 years, those aged 35–45 and 46–55 years had significantly lower HPV infection rates, and high school age and below, non-breastfeeding, and ASCUS and above were all potential risk factors for cervical cancer and precancerous lesions.

The prevalence of HPV infection in Chinese solid tumor patients.

e22519 Background: Human papillomavirus (HPV) is a family of small double-stranded DNA viruses. It is associated with a series of cancer types, such as cervical, oropharyngeal, anal, vulvar, vaginal, and penile cancers. In the world, nearly 70% of HPV-related cancer cases are HPV types 16 and 18. In this study, we investigated HPV infection prevalence among a cohort of Chinese solid tumor patients. Methods: The study enrolled thousands of Chinese patients with different types of cancers. We finally collected 4,606 tumor tissue DNA (ttDNA), 7,296 plasma cell-free DNA (cfDNA), and 7,509 peripheral blood mononuclear cell genomic DNA (gDNA) samples, respectively. Using a targeted capture technique that covering the whole reference genome of HPV16 and HPV18 and the next generation sequencing (NGS) technology, we calculated the percentage of HPV16 and HPV 18 reads in all sequencing reads for each sample. Finally, we explored the prevalence of HPV infection in each cancer type. Results: Based on different types of DNA samples, the HPV infection rate was 38.75%, 28.62%, and 10.43% in ttDNA, cfDNA, and gDNA samples, respectively. Besides, the magnitudes of the mean percentage of HPV reads in all the sequencing reads in ttDNA, cfDNA and gDNA samples were 10-5, 10-6 and 10-8, respectively, while in the HPV infection positive the percentages of ttDNA, cfDNA, and gDNA samples increased to 10-4, 10-5, and 10-7, respectively. The prevalence of HPV infection rate in different cancer types was shown in table. Conclusions: ttDNA and cfDNA are better material for HPV infective detection compared with gDNA, and NGS is capable of HPV detection.[Table: see text]

Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Although most HPV infections will spontaneously resolve, a considerable proportion of them will persist, increasing the risk of anogenital dysplasia, especially within certain populations, such as patients infected with human immunodeficiency virus (HIV). Furthermore, high-risk oncogenic HPV types (HR-HPV) are the main cause of cervix and other anogenital cancers, such as cancer of the vagina, vulva, penis, or anus. HIV and HPV coinfection is common among people living with HIV (PLWH) but disproportionally affects men who have sex with men (MSM) for whom the rate of persistent HPV infection and reinfection is noteworthy. The molecular interactions between HIV and HPV, as well as the interplay between both viruses and the immune system, are increasingly being understood. The immune dysfunction induced by HIV infection impairs the rate of HPV clearance and increases its oncogenic risk. Despite the availability of effective antiretroviral therapy (ART), the incidence of several HPV-related cancers is higher in PLWH, and the burden of persistent HPV-related disease has become a significant concern in an aging HIV population. Several public health strategies have been developed to reduce the transmission of HIV and HPV and mitigate the consequences of this type of coinfection. Universal HPV vaccination is the most effective preventive tool to reduce the incidence of HPV disease. In addition, screening programs for HPV-related cervical and vulvovaginal diseases in women are well-recognized strategies to prevent cervical cancer. Similarly, anal dysplasia screening programs are being implemented worldwide for the prevention of anal cancer among PLWH. Herein, the main epidemiological features and clinical implications of HIV and HPV coinfection are reviewed, focusing mainly on the relationship between HIV immune status and HPV-related diseases and the current strategies used to reduce the burden of HPV-related disease.

Molecular Epidemiology of Human Papillomavirus Infection Among Chinese Women With Cervical Cytological Abnormalities.

BackgroundVirtually all invasive cervical cancers are caused by persistent genital human papillomavirus (HPV) infection. Therefore, HPV-based screening becomes an essential tool as one of the cervical prevention strategies to reduce the disease burden. Population-specific epidemiologic information on HPV infection among women with cytological abnormalities is essential to inform the strategy of HPV-based screening programme. The study also explored the presence of cutaneous HPV types (Beta-β and Gamma-γ) in cervical infections.MethodsA cross-sectional study on Chinese women aged ≥25 years who were referred to public specialist out-patient clinics for colposcopy or further management of cervical cytological abnormalities were recruited between 2015 and 2016 in Hong Kong. HPV was detected and typified by the novel PCR-based Next-Generation Sequencing (NGS) strategies.ResultsThe overall HPV infection rate was 74% and detected in 222 of the 300 respondents, with the prevalence of cutaneous HPV infection being 2.3%. The overall prevalence of HPV infection among women with current cytological abnormalities was 79.1% (197/249). The age-specific prevalence of HPV (any-type HPV infection) among women with cytological abnormalities reached the first peak with 87.9% in the age group of 35–39 years and gradually declined to 56.0% at 55–59 years. While a second peak occurred at 65 years or above (92.9%). HPV58 (13.7%), HPV52 (11.7%), HPV53 (11.2%), HPV16 (10.0%), HPV18 (5.2%), and HPV51 (5.2%) were the top five high-risk HPV genotypes among women with cytological abnormalities. Any-HPV type infection was significantly associated with an abnormal cervical smear (OR = 3.7; 95% CI 2.0–7.1), and high-risk HPV infection was also significantly associated with an abnormal cervical smear (OR = 6.3; 95% CI 3.0–13.5).ConclusionNew evidence on the second peak of HPV infection at ≥65 years old suggests the necessity to review the current guideline for the cervical screening program extending to age 65 and above. Moreover, the high prevalence of two HPV genotypes—high-risk HPV51 and potential high-risk HPV53, among women with cytological abnormalities—suggests further research work is needed to confirm the contributory role of HPV51 and HPV53 in cervical cancer and the need for inclusion in the next generation of the HPV vaccine.

Natural History of Anal Papillomavirus Infection in HIV-Negative Men Who Have Sex With Men Based on a Markov Model: A 5-Year Prospective Cohort Study.

ObjectiveMen who have sex with men (MSM) are at increased risk for Human papillomavirus (HPV) infection compared to women and heterosexual men. We aimed to assess the incidence, clearance and duration of anal human papillomavirus (HPV) infection in HIV-negative MSM and the influencing factors in a 5-year prospective cohort study.MethodsFrom April 2016 to April 2021, HIV-negative MSM were recruited and followed every 6 months in Urumqi, Xinjiang, China. Questionnaires and anal swabs were collected at baseline and every 6 months. We detected 37 anal HPV genotypes using the HPV Geno Array Diagnostic Kit Test. Incidence and clearance rates of anal HPV infection and the influencing factors were estimated using a two-state Markov model.ResultsA total of 585 MSM were included with a median age of 37 years [interquartile range (IQR): 31–43 years] and were followed for a median 2.8 years (IQR: 1.8–3.6 years). Incidence rates for any HPV and high-risk HPV (Hr-HPV) were 53.4 [95% confidence interval (CI): 49.1–58.0] and 39.0 (95% CI: 35.7–42.5)/1,000 person-months. Median duration of infection was 9.67 (95% CI: 8.67–10.86) and 8.51 (95% CI: 7.57–9.50) months, respectively. Clearance rates for any HPV and Hr-HPV were 50.9 (95% CI: 46.7–55.3) and 62.1 (95% CI: 56.8–66.7)/1,000 person-months, respectively. HPV16 and HPV6 had the highest incidence, lowest clearance rate and longest duration of infection among Hr-HPV and low-risk HPV (Lr-HPV) types, respectively. Receptive anal sex is a risk factor for any HPV [hazard ratio (HR) = 1.66, 95% CI: 1.16–2.38] and Hr-HPV infection (HR = 1.99, 95% CI:1.39–2.85). Recent anal sex without condom use was significantly associated with any HPV (HR = 1.80, 95% CI: 1.10–2.94) and Hr-HPV infection (HR = 2.60, 95% CI: 1.42–4.77). Age ≥35 years was significantly associated with Lr-HPV HPV infection only (HR = 1.40, 95% CI: 1.02–1.93). Both inserted and receptive anal sex (HR = 0.60, 95% CI: 0.40–0.89) and anal sex ≥2 times per week (HR = 0.61, 95% CI: 0.43–0.87) were associated with reduced Hr-HPV clearance. Six of the nine-valent vaccine types (HPV6, 11, 16, 18, 52 and 58) occurred most frequently, which indicates the need for high vaccination coverage in MSM.ConclusionsIn this cohort study, high incidence and low clearance of any HPV, Hr-HPV and individual HPV infections emphasize the importance of MSM vaccination. Modifiable behavioral factors such as condoms and drug use should be incorporated into HPV prevention strategies.