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The genomic distribution map of human papillomavirus in Western China

Cambridge University Press
Epidemiology and Infection
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Abstract and Figures

Human papillomavirus (HPV) has been confirmed as the causative agent for cervical cancer. In this study, a total of 301 880 women were recruited from four different regions of Western China, with 301 880 exfoliated cervical cell samples collected from women for DNA isolation and purification. The HPV genotype was tested by polymerase chain reaction. The overall HPV prevalence rate, high-risk (HR) HPV infection rate, low-risk (LR) HPV infection rate and mixed HPV infection rate was 18.24%, 79.14%, 12.56% and 8.30%, respectively. The four most common HR HPV subtypes were HPV-52, 16, 58 and 53, which accounted for 20.49%, 19.93%, 14.54% and 10.01%, respectively. In LR HPV genotype, HPV-6 ranked the highest (28.17%), followed by HPV-81 (9.09%) and HPV-11 (3.78%). HPV genotype subgroup analysis also showed that single-type infection was the most common (77.26%) among HPV-positive individuals. Among multi-infection genotypes, double infection was the most common with frequencies of 76.04%. The overall prevalence of HPV is high in Western China, whose distribution demonstrates different patterns across different ages and regions. Viral genotypes HPV 53, 6 were frequently detected in this population, which is worth of significant clinical attention.
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Epidemiology and Infection
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Original Paper
*These authors contributed equally to this
study.
Cite this article: Chen L et al (2021). The
genomic distribution map of human
papillomavirus in Western China. Epidemiology
and Infection 149, e135, 19. https://doi.org/
10.1017/S0950268821001175
Received: 3 March 2021
Revised: 28 April 2021
Accepted: 11 May 2021
Keywords:
Cervical cancer; China; genotypes; Human
papillomavirus (HPV); prevalence
Author for correspondence:
Xiaosong Li,
E-mail: lixiaosong@cqmu.edu.cn
© The Author(s), 2021. Published by
Cambridge University Press. This is an Open
Access article, distributed under the terms of
the Creative Commons Attribution licence
(http://creativecommons.org/licenses/by/4.0/),
which permits unrestricted re-use,
distribution, and reproduction in any medium,
provided the original work is properly cited.
The genomic distribution map of human
papillomavirus in Western China
Ling Chen1,*, Yan Dong2,*, Jiao Li3,*, Jinqiu Zhao4,*, Dan Wang5,*,LiXu
6,*,
Yue Wu7, Huandong Liu8, Jungao Lu9, Zuoyi Yao10 and Xiaosong Li11
1
The Center of Experimental Teaching Management, Chongqing Medical University, Chongqing 401331, China;
2
Department of Microbiology and Immunology, Kunming Medical University, Kunming 650031, China;
3
Department
of Obstetrics and Gynecology, The First Affiliated Hospital of Xian Jiaotong University, Xian, China;
4
Department
of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China;
5
Department of Clinical Laboratory, Peoples Hospital of Rongchang District, Rongchang, Chongqing 402460,
China;
6
Department of Clinical Laboratory, the First Affiliated Hospital of AMU, Chongqing 400038, China;
7
Oncology Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China;
8
Department of Neurosurgery, Peoples Hospital of Tibet Autonomous Region, Lhasa 850000, China;
9
Department
of Clinical Laboratory, The Third Affiliated Hospital of Guizhou Medical University, Duyun 558000, China;
10
Department of General Surgery, The Chengdu Fifth Peoples Hospital, Chengdu 611130, China and
11
Clinical
Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing
400016, China
Abstract
Human papillomavirus (HPV) has been confirmed as the causative agent for cervical cancer.
In this study, a total of 301 880 women were recruited from four different regions of Western
China, with 301 880 exfoliated cervical cell samples collected from women for DNA isolation
and purification. The HPV genotype was tested by polymerase chain reaction. The overall
HPV prevalence rate, high-risk (HR) HPV infection rate, low-risk (LR) HPV infection rate
and mixed HPV infection rate was 18.24%, 79.14%, 12.56% and 8.30%, respectively. The
four most common HR HPV subtypes were HPV-52, 16, 58 and 53, which accounted for
20.49%, 19.93%, 14.54% and 10.01%, respectively. In LR HPV genotype, HPV-6 ranked the
highest (28.17%), followed by HPV-81 (9.09%) and HPV-11 (3.78%). HPV genotype sub-
group analysis also showed that single-type infection was the most common (77.26%)
among HPV-positive individuals. Among multi-infection genotypes, double infection was
the most common with frequencies of 76.04%. The overall prevalence of HPV is high in
Western China, whose distribution demonstrates different patterns across different ages and
regions. Viral genotypes HPV 53, 6 were frequently detected in this population, which is
worth of significant clinical attention.
Introduction
Cervical cancer, a leading genital cancer, is considered as the third most common gynaecologic
malignancy and the fourth most common cause of death from cancer in women, with an esti-
mation of 570 000 new cases and 311 000 new deaths in 2018 (GLOBOCAN, 2018) [1,2].
Compared with developed countries, the age-standardised incidence rate of cervical cancer
is higher in developing countries (16.7 per 100 000 vs. 12.7 per 100 000 women-years, respect-
ively) [3]. China accounts for around 14% of the worlds annual cases of cervical cancer [4,5].
Thus, cervical cancer remains a relatively heavy burden of public hygiene management with
increasing morbidity and mortality rates of cervical cancer in young women in China [6,7].
Human papillomavirus (HPV), a sexually transmitted DNA virus from the Papovaviridae
family, has been confirmed as the causative agent for cervical cancer [8]. It is estimated that
most sexually active adults have been infected by at least one HPV genotype [9]. If the infec-
tion with the high-risk (HR) HPV strains persists, which could be a well-established cause of
cervical cancer [10]. More than 200 distinct HPV genotypes have been discovered to date, of
which approximately 40 infect the mucosal epithelium of the anus and genital tract [11].
Generally, they are classified as HR HPV (carcinogenic HPV types, HR-HPV), low-risk
HPV (non-carcinogenic HPV types, LR-HPV) and intermediate-risk HPV (IR-HPV) based
on their carcinogenic risk or reported potential pathogenicity [12].
It is well known that this type of malignancy is one of the most preventable cancers.
Currently, part of comprehensive strategies aimed at control of cervical cancer is based on vac-
cination against HPV and HPV-based screening programmes, which have been demonstrated
to effectively eliminate the burden of cervical cancer worldwide [13,14]. Nonetheless, the
prevalence and genotype distribution of HPV infections are heterogeneous widespread (differ-
ences vary among nations and regions, as well as within a country), which resulted in progress
towards prevention often frustrating [15]. Hence, an accurate understanding of the regional
distribution characteristics of HPV genotypes is extremely
important for both prophylactic vaccine-based HPV development
and for HPV-based cervical cancer screening strategies.
Reports about large-scale data on the genotypic spectrum of
HPV infection are limited in China. Therefore, we conducted a
retrospective summary of the enormous amount of HPV geno-
types distribution data in China, the overall prevalence, age-
specific prevalence and genotype distribution of HPV in different
regions were also calculated and analysed. This study would
provide guidance for the development of future screening and
prevention programmes.
Materials and methods
Ethical considerations, study population and sample collection
This investigation was approved (No. 2020-173) by the Ethics
Committee of the First Affiliated Hospital of Chongqing
Medical University Ethics Review Board and informed consents
were obtained from all participants for inclusion in the study.
Briefly, this retrospective study collected 301 880 samples from
over eight clinical hospitals, womens health centres, clinics and
physical examination centres located in four different provinces
of China. For each woman, the HPV genotyping results and rele-
vant clinical information, including age and regional data were all
collected.
DNA extraction and HPV genotyping
Exfoliated cervical cell samples were collected from women by
gynaecologists or obstetricians using a specialised cervical sampler
brush for DNA isolation and purification. Based on rapid flow-
through hybridisation of nucleic acid molecules, a gene chip
detection system for nucleic acids identification of 21 HPV
types was provided by Kaipu Biochemical Company in
Chaozhou, Guangdong, China. Among 21 HPV types, there
were 14 HR-HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56,
58, 59, 66 and 68), six LR-HPV types (6, 11, 42, 43, 44 and 81)
and one IR-HPV type (53).
Subsequently, all HPV tests were performed with an HPV
genotyping panel (polymerase chain reaction (PCR)-reverse dot-
blot hybridisation method). Briefly, according to manufacturers
instructions, PCR was performed in a 25-μl reaction mixture con-
taining 1-μl extracted DNA, 0.75-μl DNA Taq polymerase and
23.25-μl PCR-mix solution containing primer system. The PCR
cycling parameters were as follows: an initial step at 95°C for 9
min, and followed by 40 amplification cycles (denaturation at
95°C for 20 s, annealing at 55°C for 30 s, 72°C for 30 s and a
final extension at 72°C for 5 min). After amplification, HPV geno-
typing was performed by hybridisation and RDB on the strips
fixed with HPV type-specific probes. The HPV type-specific
probes immobilised on nylon membranes were used for reverse-
blot hybridisation and detection of all HPV genotypes in a single
assay in accordance with the manufacturers instructions.
Simultaneously, in order to validate the HPV test, sterile water
was used as the negative control, and specimens with known
HPV genotypes as the positive control.
Statistical analysis
Data were analysed with IBM SPSS version 21.0. Sample charac-
teristics including age (women with unknown ages were
excluded), region, HPV infection result and genotypes distribu-
tion characters were summarised using frequency distributions
to generate the numbers and percentages. The χ
2
test was adopted
to compare the HPV prevalence or proportions among different
groups. A two-sided P-value of less than 0.05 (P< 0.05) was con-
sidered statistically significant.
Results
Overall HPV infection prevalence and genotype distribution
A total of 301 880 samples were collected and detected by HPV
genotype. The genotype test showed 55 071 samples were HPV
positive, the overall HPV prevalence rate was 18.24%, of which
28.14% in Tibet Autonomous Region, 18.59% in Chongqing
Municipality, 10.33% in Guizhou Province and 29.09% in
Shaanxi Province. Among the four different provinces, autono-
mous regions and municipalities, there were significant differ-
ences in the HPV prevalence (χ
2
= 6120.54, P< 0.001). The
details of genotypes distribution were shown, respectively, in the
following contents.
Age and genotype distribution of HPV infection in different
regions
The HPV prevalence in Tibet Autonomous Region
A total of 36 073 samples were obtained in Tibet Autonomous
Region and the HPV prevalence was identified as 28.14%
(n= 10 150). The highest HPV detection rate was found in the
group aged 3650 years old (detection rate = 53.40%) (Fig. 1).
Among HPV-positive women, the HR-HPV infection accounted
for 73.51% (n= 7461). In HR-HPV, type 16 (19.44%) and 52
(21.50%) were the most prevalent genotypes, followed by 53
(11.23%) and 58 (11.83%). Among 1428 cases of LR-HPV infec-
tion, the two most common LR-HPV were type 6 (14.13%) and
81 (11.15%). The rates of single and multiple (infection with 2
different HPV genotypes) infections were 70.35% (n= 7141)
and 29.65% (n= 3009), respectively, with double infections rate
at 71.32% among the multiple infections. Among the mixed
(co-infection with HR-HPV and LR-HPV) infection cases, double
HPV genotype infection took up over a half (n= 761). In multiple
infection of HR-HPV, the double HPV genotype infection was
also the highest in 1298 cases. The detailed genotype distribution
Fig. 1. Age distribution of HPV infection in Tibet Autonomous Region.
2 Ling Chen et al.
of HPV infection was described in Figures 2 and 3. Overall, the
prevalence of HPV infection in the Tibet Autonomous Region
was dominated by single HR-HPV infection, especially type 16
or 52.
HPV infection in Chongqing municipality
A total of 37 389 women was detected as HPV positive among the
201 089 samples in Chongqing Municipality, with an HPV infec-
tion rate of 18.59%. Similar to Tibet Autonomous Region, the
highest HPV detection rate was found in the group aged 3650
years old (detection rate = 52.96%) (Fig. 4). Among the infected
women, HR-HPV infection made up 81.32% (n= 30 406).
Among HR-HPV infection, the three most prevalent types were
type 16, 52 and 58, with frequencies of 20.82%, 20.80% and
15.64%, respectively. The most common LR-HPV types were
HPV 6 (35.65%), even exceeded the most prevalent HR-HPV
genotype (Figs 5 and 6). The rates of single and multiple infec-
tions were 79.00% (n= 29 537) and 21.00% (n= 7852), respect-
ively, with a double infections rate at 77.06% among the
multiple infections.
HPV infection in Guizhou Province
Among 60 205 women of Guizhou Province, the prevalence of
HPV infection was 10.33%, with 6219 cases identified as
HPV positive. In all detected age groups, the highest HPV
detection rate was found in the group aged 2030 years old
(detection rate = 43.18%) in Guizhou Province (Fig. 7). Among
HPV-positive women, the HR-HPV infection took up 62.58%
(n= 3892). Among HR-HPV infection, the four most prevalent
types were type 52, 16, 58 and 53 in descending order. The
most common LR-HPV types were HPV 6 and 11 (Figs 8 and 9).
The rates of single and multiple infections were 79.71%
(n= 4957) and 20.29% (n= 1262), respectively, with a double
infections rate at 82.96% (n= 1047) among the multiple. The
HR-HPV infection was also the dominant one in Guizhou
Province with 3892 cases (62.58%).
HPV infection in Shaanxi Province
A total of 4513 samples was recorded in Shaanxi Province, with
1313 samples identified as HPV positive (29.09%). In all detected
age groups, the highest HPV detection rate was found in the
Fig. 2. Genotype distribution of HR-HPV infection in Tibet
Autonomous Region.
Fig. 3. Genotype distribution of LR HPV infection in Tibet Autonomous Region. Fig. 4. Age distribution of HPV infection in Chongqing Municipality.
Epidemiology and Infection 3
group aged 2655 years old (detection rate = 79.06%) in Shaanxi
Province (Fig. 10). Among HPV-positive women, the HR-HPV
infection accounted for 80.05% (n= 1051). The four most preva-
lent HR-HPV types were type 16, 52, 58, 53 in descending order.
The most common LR-HPV types were HPV 6 and 81 (Figs 11
and 12). The rates of single and multiple infections were
69.92% (n= 918) and 30.08% (n= 395), respectively. Among the
multiple infections, double genotypes infections were the domin-
ant one, which made up 69.62% (n= 275).
Fig. 5. Genotype distribution of HR-HPV infection in Chongqing Municipality.
Fig. 6. Genotype distribution of LR HPV infection in Chongqing Municipality.
Fig. 7. Age distribution of HPV infection in Guizhou Province.
Fig. 8. Genotype distribution of HR-HPV infection in Guizhou Province.
Fig. 9. Genotype distribution of LR HPV infection in Guizhou Province.
Fig. 10. Age distribution of HPV infection in Shaanxi Province.
4 Ling Chen et al.
HPV genotype distribution in all positive samples
A total of 55 071 positive samples was detected in this study. We
also analysed the genotype distribution for better decision making
on the HPV vaccine tragedy. Notably, HPV 52 (11282, 20.49%),
16 (10974, 19.93%), 58 (8007, 14.54%), 53 (5513, 10.01%) were
the top four prevalent genotypes among HR-HPV, and HPV 6
(15515, 28.17%), 81 (5008, 9.09%), 11 (2082, 3.78%) were the
top three prevalent genotypes among LR-HPV. Table 1 showed
the detailed genotype distribution.
Age distribution in all positive samples
To better understand the age distribution of HPV infection, after
dividing the subjects into 14 age groups (15, 1620, 2125,
2630, 3135, 3640, 4145, 4650, 5155, 5660, 6165, 66
70, 7175, 76 years), the HPV infection prevalence of different
regions in each age group was analysed (Table 2). It could be dir-
ectly observed that HPV infection happened in all ages, and
women aged 2650 years accounted for a main part (Fig. 13).
Elder women (>50) and young girls (25) had a relatively lower
HPV infection proportion. Besides, we conducted a χ
2
test to
determine whether the difference of age distribution was signifi-
cant in different regions. The result showed that there was a sig-
nificant difference among these groups (χ
2
= 32.83, P< 0.001). We
summarised the age distribution in three HPV infection patterns,
including HR-HPV only, LR-HPV only, mixed HR-HPV and
LR-HPV HPV infections, which showed that the pattern of
HR-HPV only was the dominate infection one (Table 3).
Age distribution of dominant types
The most common five types of HPV were as follows on the basis
of the above results: the HR-HPV genotype HPV 52, HPV 16,
HPV 58, HPV 53 and LR-HPV 6. As for the five most prevalent
genotypes, we decided to further explore their distribution char-
acteristics in different age groups. Among type 52, 16, 58 and
53, the number of infection cases increased gradually and reached
its highest point in the group aged 4145 years old, while for
groups aged over 4145, the number of infection cases was
reduced. Interestingly, in type 6, the most common infection
age was found in women in 2130 years old (Fig. 14). Women
aged 3640 years old and 4650 years old also manifested an
abundant number in these five genotypes HPVs. According to
these results, we could come to the conclusion that women
aged 3650 years old account for the vast majority of these five
dominant HPV infections.
Discussion
A comprehensive estimation among women worldwide showed
that HPV prevalence in Eastern Asia including China was signifi-
cantly higher than that of both Southeastern Asia and
Fig. 11. Genotype distribution of HR-HPV infection in Shaanxi Province.
Fig. 12. Genotype distribution of LR HPV infection in Shaanxi Province.
Table 1. Genotype distribution of the total population
Genotype Cases Prevalence (%)
HR-HPV 16 10 974 19.93
18 2998 5.44
31 1971 3.58
33 3200 5.81
35 667 1.21
39 3454 6.27
45 630 1.14
51 3013 5.47
52 11 282 20.49
53 5513 10.01
56 1419 2.58
58 8007 14.54
59 1276 2.32
66 1749 3.18
68 2813 5.11
LR-HPV 6 15 515 28.17
11 2082 3.78
42 536 0.97
43 691 1.25
44 571 1.04
81 5008 9.09
Epidemiology and Infection 5
South-central Asia, where HPV prevalence were 13.6%, 6.2%,
7.5%, respectively [5]. In addition, the prevalence of HPV in
less developed countries (15.5%) was higher than that in more
developed countries (10.0%), and Eastern Asia remains the
most heavily burdened HPV region in Asia [5]. The number of
HPV infection cases varies widely among Eastern Asian countries,
as the most populous developing country, China faces a serious
burden [16]. Moreover, it has been shown that Western China
ranks the most in mortality rate and the second-most in cervical
cancer incidence rate nationwide, thus the primary prevention of
cervical cancer of Western China is particularly important [17].
In the present analysis, the overall HPV prevalence of 301 880
western Chinese women with normal cervical cytology was esti-
mated to be at 18.24%, which was higher than the average global
level, lower than that of many other countries, such as Eastern
Africa, and Russia, and higher than that of Japan and India
[5,15]. A large comparable population-based study of HPV geno-
type prevalence nationwide showed a similar overall HPV infec-
tion of 21.07% with 120 772 samples from 37 cities in China
tested [18], which was relatively higher than the overall HPV
prevalence (18.24%) in this study. Regarding the HPV prevalence
in different regional groups, this present survey also showed the
high HPV prevalence: Tibet Autonomous Region (28.14%),
Chongqing Municipality (18.59%), Guizhou Province (10.33%)
and Shaanxi Province (29.09%). Compared with region-based
data, the rates obtained in our study were different from those
previously reported data from neighbouring regions, including
Chongqing (26.20%) [19], Guizhou (16.95%) [20] and Yunnan
(12.90%) [21] of Western China. The reported results of HPV
prevalence vary from study to study as it is possibly caused by sev-
eral variables, including the large Chinese population compos-
ition and territories. Together, the overall HPV-positive rate in
the current study involving 301 880 cases was found to have
increased slightly.
When stratified by HPV genotype, the most common
HR-HPV types detected in our analysis were HPV52 (20.49%),
which was inconsistent with the previous data generated by
some Chinese population-specific investigations and some related
Table 2. Age distribution of HPV infection in Western China
Age Tibet Chongqing Guizhou Shaanxi Total
15 2 21 23 5 51 (0.09%)
1620 125 560 696 10 1391 (2.53%)
2125 560 2579 1466 64 4669 (8.48%)
2630 1139 4154 1157 147 6597 (11.98%)
3135 1172 4698 640 171 6681 (12.13%)
3640 1473 6568 565 174 8780 (15.94%)
4145 2390 7657 657 220 10 924 (19.84%)
4650 1557 5578 458 180 7773 (14.11%)
5155 847 2706 260 146 3959 (7.19%)
5660 334 1433 169 105 2041 (3.71%)
6165 308 892 71 49 1320 (2.40%)
6670 133 345 33 31 542 (0.98%)
7175 73 145 13 8 239 (0.43%)
76 37 53 11 3 104 (0.19%)
Total 10 150 37 389 6219 1313 55 071 (100%)
Fig. 13. Age distribution rate in total population.
6 Ling Chen et al.
studies reported that HPV 16 was identified as the most common
HR HPV genotype [5,18,2224]. The other three most prevalent
HR/IR-HPV types were HPV16, 58 and 53, with frequencies of
19.93%, 14.52%, 10.01%, respectively. The characteristics of
HPV distribution in our study were similar to a recent HPV
study in Guizhou, China [20]. However, a recent study enrolling
37 722 females showed that the four most prevalent genotypes
were HPV 16 (3.79%), HPV 52 (2.47%), HPV 58 (1.76%) and
HPV 53 (1.35%) [17], which was different from our data. In add-
ition, compared with a nationwide data of Chinese population-
based research from 37 cities, except for HPV53 (not reported),
the infection rates of HPV16 (4.82%), HPV52 (4.52%) and
HPV58 (2.74%) were all lower than those in our study [18].
The knowledge of HPV prevalence and subtype distribution in
different regions might facilitate the development of vaccination
programme implementation. In this study, the HPV infection
types and their proportions varied in different regions: the top
three HPV genotypes were HPV 52, 16, 58 in Tibet
Autonomous Region, HPV 16, 52, 58 in both Chongqing
Municipality and Shaanxi Province and HPV 52, 16, 58 in
Guizhou Province. Therefore, different regions showed diversity
and had their respective proportions with respect to HPV geno-
types. The differences in economic conditions, geographical cul-
tural habits, migrations and other multiple factors might affect
lifestyles among different populations, thus explaining the differ-
ence in the observed HPV prevalence.
Interestingly, among HR-HPV genotype infections, HPV53
type infection accounted for the top four in our study (10.01%).
HPV53, a traditionally non-vaccine genotype, was recognised as
a probable HR genotype and recently demonstrated to be asso-
ciated with the putative potency of viral carcinogenicity (odds
ratio, 3.92) [23,25]. Moreover, the prevalence of the HPV53
genotype gradually elevated from 2011 to 2015 [23]. It was also
reported as the fifth most common HPV type detected in
Eastern Africa and Central and Northern America [5]. Thus,
HPV prophylactic vaccines, including HPV53, may offer more
sufficient protection for women in China.
In the present study, we found that the three most common
LR-HPV types were HPV6 (28.17%), HPV81 (9.09%) and
HPV11 (3.78%). A recent analysis involving 94 489 women
from Eastern China conducted in 2019 has shown that the dom-
inant LR-HPV genotypes were HPV81 and HPV6 [26].
Furthermore, a previous cross-sectional survey conducted in
Arab women reported that HPV 81, 11 and 6 were the most com-
monly identified LR HPV genotypes in decreasing order [27],
which were inconsistent with our research. The high HPV 6
prevalence in our study was unexpected. The reasons for this
deviation of LR-HPV distribution are unclear and may be due
to the cultural differences of the nationalities. Therefore, the
HPV vaccine in China might also consider including the HPV
6 genotype.
When it comes to the HPV infection proportion of different
age subgroups, the age distribution in this study showed that
the middle age group (2650 years) presented the highest HPV
detection rate (75.53%, 71.82%, 62.75%, respectively) among HR
HPV only, LR HPV only and mixed HPV genotype subgroups,
with all subgroups indicating relatively lowest detection rate in
elderly individuals (76 years), similar to few recent studies in
China [20,28]. The most frequent age group of our HPV screen-
ing population was 2550 years, which could explain the reason
why the HPV types were distributed in this manner.
Interestingly, we also concluded that the age distribution varied
across different HPV genotypes in our study. As for the top
four HR-HPV (type 52, 16, 58 and 53), the highest HPV detection
rate was found in the group aged 4145 years old, while the high-
est HPV detection rate in LR-HPV 6 infection in the group aged
2130 years old group, which was different from a previous study
concerning HPV genotyping results in China [22]. However, our
results were consistent with the clinical phenomenon that increas-
ingly frequent diagnoses of cervical cancer occurred in middle/
old-aged Chinese women (4064 years old). Therefore, it has
become particularly important to disseminate information about
cervical diseases as well as carry out HPV infection screening in
China in line with the HPV distribution characteristics of each
age group.
Among the patients infected with multiple subtypes,
co-infections with two HPV types were the most common
(76.04%) in our study, which was comparable to the regional
results of Guangzhou, Sichuan and Macao in China from the pre-
vious reports [2931]. Many epidemiologic studies found that
infection with multiple HPV genotypes seemed to increase the
risk of developing the tissue abnormalities or high-grade lesions
that precede invasive cervical cancer considerably, because HPV
types might interact synergistically, which might contribute to
increasing the baseline risk observed with single-type infections
[27,32]. Similar results have been produced by other studies
that confirmed its association with the development of the cer-
vical carcinogenesis and increased the duration of the viral infec-
tion [33]. Therefore, it was suggested to consider diagnoses of
co-infection with HPV into the prediction outcomes of HPV
infections.
This is the first HPV distribution study with a large sample
size in China. The principal strength of this study was that the
large data enrolling 0.3 million women come from Western
China, thus making it a representative of the general women
population in China. One limitation of this study was sampling
bias, because the most frequent age group of our HPV screening
Table 3. Age distribution in different HPV infection patterns
Type
Age HR only LR only Mixed
15 32 13 6
1620 852 313 226
2125 3266 823 580
2630 5047 993 557
3135 5418 839 424
3640 7187 968 625
4145 8955 1275 694
4650 6313 893 567
5155 3137 450 372
5660 1633 177 231
6165 1043 107 170
6670 428 46 68
7175 196 12 31
76 78 8 18
Total 43 585 6917 4569
Epidemiology and Infection 7
strategy was 2550 years. Secondly, the women enrolled in this
study attended to clinics for seeking medical advice based on rou-
tine gynaecological examination and HPV prevalence results, they
always were accompanied by some clinical symptoms, which may
lead to an over-reporting of HPV prevalence in this research.
In addition, no clinical characters and cervical cytology results
were collected as part of the study, resulting in the specific risk
factors for the cervical cancer and the correlation between HPV
genotype and cervical cancer or precancerous lesions were unable
to be accurately examined. Furthermore, a follow-up study should
be conducted to track changes in genotype, cervical pathology and
cytology as there was a close relationship between cervical carcin-
oma and long-term persistent HR-HPV infections.
Thus, our results indicate that the preventative strategies
including HPV vaccine-based popularisation and related educa-
tional campaigns should start in 25-year-old females. This infor-
mation might provide valuable information for estimation of the
potential clinical benefit of HPV-based screening in China.
Conclusions
This study represents one of the most comprehensive studies of
the prevalence and genotype distribution of different HPV types
in China to date. We examined the epidemiology of HPV infec-
tion in China and confirmed the high overall HPV prevalence
rate (18.24%) in all female subjects. Moreover, in addition to com-
mon genotype HPV52, 16 and 58, particular attention should be
paid to the high prevalence of non-vaccine genotypes
(e.g. HPV53, HPV6) in China. Therefore, the future next-
generation HPV prophylactic vaccines in China should also con-
sider to include more HPV types (e.g. HPV53, HPV6). Regarding
the age-specific distribution of HPV, the highest HPV detection
rate was found in age group 2650 years old (detection rate =
74.00%). These results showed that the majority of HPV infec-
tions in China might be occurring in middle-aged women,
which reminds us to attach great importance to middle-aged
women in the prevention and control of HPV.
Data. The raw data are available on request by the editor of the publishing
journal.
Acknowledgements. This study was sponsored by the Clinical Molecular
Medicine Testing Center, The First Affiliated Hospital of Chongqing
Medical University. We would like to acknowledge all members of the
Clinical Molecular Medicine Testing Center. We appreciate all the patients
and their parents for participating in the study.
Author contributions.
YD, JL, DW, LX and JLu carried out the sample collection, laboratory detection and
drafted the manuscript. LC and XL participated in the design of the study and performed
the statistical analysis. YW, HL, ZY and XL conceived of the study, and participated in its
design and coordination and helped to draft the manuscript. All authors read and
approved the final manuscript.
Financial support. This study was funded by the Chongqing Yuzhong
District Technology Project (grant no. 20160136).
Conflict of interest. None.
Ethical standards. This study was approved by the Ethics Committee of the
First Affiliated Hospital of Chongqing Medical University Ethics Review Board
(no. 2020-173).
Data availability statement. All data generated or analysed during this
study are included in this published article.
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Epidemiology and Infection 9
... Eastern Asia (10.7%) had the second highest infection rate in Asia following Southeastern Asia (14.0%) [17].Previous reports have indicated that rates of HPV positivity range from 6.70 to 44.50% in China [18]. The overall HPV infection of Chengdu was similar to that reported in Hangzhou (22.3%) [19], Taizhou area (22.8%) [20] and Guangdong (21.06%) [21], lower than in Jiangsu (26.92%) [22], Jilin (34.40%) [23], Shandong (28.4%) [24], but higher than in Chongqing (18.59%) [25], Shanghai (17.92%) [26], Beijing (8.22%) [27]. The overall HPV infection of Aba was consistent with that reported in Xinjiang (14.02%) [28], southern Hunan (14.59%) [29], lower than in Tibet Autonomous Region (28.14%) [25], Inner Mongolia (36.0%) [30], Guangxi (18.10%) [31], but higher than in Guizhou (10.33%) [25], Shanxi (8.92%) [32], Yunnan (12.90%) [33]. ...
... The overall HPV infection of Chengdu was similar to that reported in Hangzhou (22.3%) [19], Taizhou area (22.8%) [20] and Guangdong (21.06%) [21], lower than in Jiangsu (26.92%) [22], Jilin (34.40%) [23], Shandong (28.4%) [24], but higher than in Chongqing (18.59%) [25], Shanghai (17.92%) [26], Beijing (8.22%) [27]. The overall HPV infection of Aba was consistent with that reported in Xinjiang (14.02%) [28], southern Hunan (14.59%) [29], lower than in Tibet Autonomous Region (28.14%) [25], Inner Mongolia (36.0%) [30], Guangxi (18.10%) [31], but higher than in Guizhou (10.33%) [25], Shanxi (8.92%) [32], Yunnan (12.90%) [33]. ...
... The overall HPV infection of Chengdu was similar to that reported in Hangzhou (22.3%) [19], Taizhou area (22.8%) [20] and Guangdong (21.06%) [21], lower than in Jiangsu (26.92%) [22], Jilin (34.40%) [23], Shandong (28.4%) [24], but higher than in Chongqing (18.59%) [25], Shanghai (17.92%) [26], Beijing (8.22%) [27]. The overall HPV infection of Aba was consistent with that reported in Xinjiang (14.02%) [28], southern Hunan (14.59%) [29], lower than in Tibet Autonomous Region (28.14%) [25], Inner Mongolia (36.0%) [30], Guangxi (18.10%) [31], but higher than in Guizhou (10.33%) [25], Shanxi (8.92%) [32], Yunnan (12.90%) [33]. ...
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Purpose The genotype distribution of human papillomavirus (HPV) infection varies greatly in different regions. This study aims to determine the prevalence and type-specific distribution of HPV among females from Chengdu and Aba in Sichuan Province, which differ in geographical location, economic status, and living habits. These can serve as evidence of epidemic patterns for future design and implementation of vaccination and screening programs. Methods A retrospective cross-sectional study was conducted on 144 113 women who underwent cervical screening at Chengdu Women’s and Children’s Central Hospital from January 2015 to September 2020. Meanwhile, 1799 samples from February 2018 to December 2021 were collected from Aba Maternal and Child Health Hospital. HPV DNA genotype testing was performed using real‐time PCR. The overall prevalence, annual trend, age-specific prevalence, and type distribution were analyzed. Results The overall HPV prevalence was 22.51% in Chengdu. During 2015–2020, the highest prevalence rate was observed in 2018. Age-specific HPV distribution displayed a bimodal distribution among women aged ≤25 or ≥46 years old. The top three prevalent genotypes were HPV52, -16, and -58. Although the total prevalence of HPV in Aba was 14.23%, there was an upward trend from 2018 to 2021. However, no significant differences were identified in HPV infection rate across all age groups. HPV52, -53, and -16 were the major genotypes. Furthermore, single-type HPV infections and high-risk HPV infections were identified as the most common infection types in both regions. Conclusion Our findings demonstrate the overall prevalence of HPV was still high in Chengdu and Aba. The age-specific prevalence distribution demonstrated different patterns. Non-vaccine-covered HR-HPV53, -51and LR-HPV81, -CP8304 were frequently detected, which was worth significant clinical attention. In summary, regional HPV screening provides valuable clinical guidance for cervical cancer prevention and vaccine selection in Western China.
... Collected specimens were stored as needed and sent to designated laboratories for cytology or HPV testing within a specified timeframe. Cytology adopted the liquid-based method, and HPV testing was based on the PCR method using kits that required the ability to detect at least 13 high-risk genotypes (16,18,31,33,35,39,45,51,52,56,58,59,68) and the ability to report positive results for types 16/ 18 separately. All procedures for specimen collection, storage and laboratory testing were performed according to the kit instructions. ...
... These findings were consistent with previous studies conducted by He [13,14]. We noted that the proportion of HPV 16/18 infections in women aged 35-64 years accounted for only 12.06% of the HR-HPV-positive population, which was attributed to the fact that HPV 52 and 58 were the predominant genotypes in the general population in Sichuan province, whereas HPV 16/18 had a higher proportion of infections in patients with cervical lesions, especially in high-grade lesions [15][16][17][18][19]. Unfortunately, due to the limitations of HPV testing kits, we were unable to confirm this possibility through HPV genotyping in this study. ...
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Full-text available
Cervical cancer poses a significant health challenge in developing countries, emphasizing the need for appropriate screening strategies to accelerate the elimination of this disease. This study summarized the results of a large-scale community-based cervical cancer screening program conducted in Chengdu, China, to understand the prevalence of HPV infection and cervical lesions in the population, and to compare the real-world effectiveness of two different screening methods implemented in the program. From January 2021 to December 2022, a total of 363,376 women aged 35–64 years in Chengdu received free screenings. Among these participants, 70.1% received cytology screening and 29.9% received HPV testing combined with 16/18 genotyping and cytology triage. Ultimately, 824 cases of high-grade lesions and cervical cancer were detected, with a total detection rate of cervical cancer and precancerous lesions of 226.8 per 100,000. The follow-up rate of patients with high-grade lesions and above was 98.9%, and the treatment rate was 86.6%. The overall high-risk HPV infection rate was 11.7%, with the HPV 16/18 infection rate of 1.4%. The rate of abnormal cytology results was 2.8%. The attendance rates for colposcopy and histopathology were 71.6% and 86.1%, respectively. By calculating the age-standardized rates to eliminate the different age composition between the two group, the HPV-based screening strategy had a higher rate of primary screening abnormalities (3.4% vs. 2.8%, P<0.001), higher attendance rates of colposcopy (76.5% vs. 68.9%, P<0.001) and histopathological diagnosis (94.1% vs. 78.0%, P<0.001), higher percentage of abnormal colposcopy results (76.0% vs. 44.0%, P<0.001), and higher detection rate of cervical precancerous lesions and cancer (393.1 per 100,000 vs. 156.4 per 100,000, P<0.001) compared to cytology screening. Our study indicates that the combination of HPV testing with 16/18 genotyping and cytology triage has demonstrated superior performance in cervical cancer screening compared to cytology alone in large-scale population.
... For the last 20 years, the world has made great efforts to generate epidemiological data on cervical HPV-DNA. In China, although certain studies have been performed to assess the prevalence and incidence rate of human papillomavirus genotypes in Tibet, they are based on small samples [25,26]. Our study is the first largescale sample study in Tibet. ...
... In some areas, the second peak can be observed at the age of > 45 or > 55 or > 65, while in some other areas, no second peak can be observed. In conclusion, age-specific HPV distribution is either shown as a bimodal curve (including "U" curve) [31,32] or a left inclined unimodal distribution [26]. In this study, agespecific HPV distribution showed a "U" curve. ...
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Background Data regarding human papillomavirus (HPV) prevalence and genotype distribution are limited in Shannan City, Tibet Tibetan Autonomous Region, China. The purpose of this study is to provide reliable data for guiding women in Shannan City in cervical cancer screening and HPV vaccine innoculation. Methods HPV testing was performed on women aged 16–109 years (mean age 44.03 ± 9.25 years) from Shannan City in 2019 and 2020, which was implemented technically by gynecological examination, vaginal discharge smear microscopy, cytology, and HPV detection. The overall prevalence, age-specific prevalence, and genotype distribution were analyzed. Results A total of 48,126 women received HPV testing, of which 3929 were detected human papillomavirus. The HPV-positive rate was 8.16% (3929/48,126), and the highest prevalence was in the ≤ 25-year-old age group (12.68%). After the age of 25, the prevalence rate decreased rapidly, and then slowly increased from 7.49% in the 46–55 age group to 9.82% in the ≥ 66 age group, showing a “U-shaped” pattern. The positive prevalence of HPV 16 or 18-only was 1.43%, that of other HPV genotypes except HPV 16 or 18 was 6.39%, and mixed HPV infections including HPV 16 or 18 was 0.34%. Conclusions The HPV infection rate in Shannan city is rather low, and the age-specific prevalence of HPV infection presents a “U” curve, suggesting the importance of screening among younger women and the necessity of detection among older women.
... While epidemiological studies in China have recognized the elevated prevalence of HPV52 and HPV58 among Chinese women [14], our study also unveiled a notable detection rate of HPV53 and HPV81 in cervical epithelium. Notably, the heightened prevalence of HPV81 in the Chinese population has garnered recent attention [15][16][17]. HPV53, classified as a pHR-HPV type, resides within the third major phylogenetic branch following HPV16 and HPV18, with a probable geographic inclination towards Asia and Africa [18]. A 2021 survey in Africa revealed an infection rate of up to 9% for HPV53 [19], while a contemporaneous epidemiological investigation in South Korea highlighted HPV53 as the predominant genotype [20]. ...
Article
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This study aims to investigate the phenomenon of human papillomavirus (HPV) genotype switching (HGS), assess the potential influencing factors, and evaluate the clinical impact on the severity of cervical lesions. A total of 2569 HPV positive female patients with records of more than two follow‐up visits were included from the gynecology department at the Obstetrics and Gynecology Hospital of Fudan University, covering the period from May 2012 to September 2022. Patients' age, treatments, vaccination, HPV genotypes before and after HGS, and the final pathology results from colposcopy were recorded. Multifactorial analyses and correlation tests were performed. Single HPV infections accounted for 67% of the total population, while multiple HPV infections comprised 33%. The most prevalent genotypes in single HPV infections were HPV52 (18.6%), HPV16 (12.28%), HPV58 (11.72%), HPV53 (8.63%), and HPV81 (6.81%). Among cases of multiple infections, the most common genotype combinations were HPV52 + HPV53 (3.02%), HPV52 + HPV58 (3.13%), and HPV52 + HPV81 (3.02%). HGS was detected in 38.2% of the total cases (458/1200). The status of medication treatment was not found to correlate with the occurrence of HGS. However, age, surgical treatment status, vaccination status, and the genotype of HPV infection may be correlated with HGS. HPV52, HPV58, HPV53, HPV56, and HPV81 showed a positive association with the occurrence of HGS transitioning from multiple infections to a single infection (HGS‐MS) ( p < 0.05). In contrast, HPV52, HPV16, HPV58, HPV39, HPV56, and HPV18 significantly influenced the occurrence of HGS from one single infection to another (HGS‐SS) ( p < 0.05), albeit negatively. Notably, only one type of HGS, HGS‐MS, demonstrated a positive correlation with the severity of cervical lesions. Our findings suggest that HPV genotype switching from multiple infections to single infections is associated with cervical intraepithelial neoplasia (CIN). Different patterns of HGS could result from specific HPV genotype infections, particularly HPV16. HGS‐MS is revealed to plays a catalytic role in the progression of cervical lesions.
... Although HPV 18 has been considered an important HR-HPV in cervical cancer, the prevalence of HPV 18 infection was relatively low in our study population. Several studies reported that the most common HR-HPV subtypes were HPV 52, 58, and 16 for Chinese women, in which HPV 18 was not included [56][57][58][59][60][61][62]. In addition to HPV 16, 52, and 58, HPV 53, 51, and 56 were proposed as predominant subtypes of HR-HPVs in Chinese women, because of their relatively high prevalence at all testing sites, among which HPV 53 has been highlighted by other studies on the co-infection status in Chinese women [63]. ...
Article
Full-text available
Background: Both cervical cancer and cervical intraepithelial neoplasia (CIN) are associated with human papillomavirus (HPV) infection at different anogenital sites, but the infection features of high-risk (HR) HPVs at these sites and their association with cervical lesions have not been well characterized. Given the limitation of cervical HPV 16/18 test in screening patients with high-grade CIN (CIN 2+), studies on whether non-16/18 HR-HPV subtype(s) have potential as additional indicator(s) to improve CIN 2+ screening are needed. Methods: The infection of 15 HR-HPVs in vulva, anus, vagina, and cervix of 499 Chinese women was analyzed, and CIN lesion-associated HR-HPV subtypes were revealed. Results: In addition to the well-known cervical-cancer-associated HPV 16, 52, and 58, HPV 51, 53, and 56 were also identified as high-frequency detected subtypes prevalently and consistently present at the anogenital sites studied, preferentially in multi-infection patterns. HPV 16, 52, 58, 56, and 53 were the top five prevalent subtypes in patients with CIN 2+. In addition, we found that cervical HPV 33/35/52/53/56/58 co-testing with HPV 16/18 might improve CIN 2+ screening performance. Conclusion: This study provided a new insight into HR-HPV screening strategy based on different subtype combinations, which might be used in risk stratification clinically.
... Additionally, HPV prevalence in China was 84.37% in a meta-analysis of 2950 cervical intraepithelial neoplasia (CIN)1 patients and 5393 CIN2/3 patients, but the distribution of HPV types varies across regions [13]. In western China (Tibet Autonomous Region, Chongqing, Guizhou, Shaanxi), HPV-52, 16,58, and 53 were the most commonly detected HR-HPV types, with the highest HPV detection rate observed in the 36-50 age group [14]. In Northeast China, the predominant HPV types identified in a survey of 110,927 women aged 18-80 years were HPV-16, 58, 52, 33, 53, and 18 [15]. ...
Article
Full-text available
Background Cervical cancer is associated with high‐risk human papillomavirus (HR-HPV) infection in the world. We aimed to evaluate the status of HPV infection among women in Guangzhou, China. Methods The study recruited 28,643 female patients from the Guangzhou Women and Children’s Medical Center for HPV genotype testing between 2019 and 2021. Results 5668 patients were infected with HPV, resulting in an overall infection prevalence of 19.78%. The prevalence of HR-HPV was recorded at 13.94% (both single-infections and multi-infections), probably high-risk HPV/possibly carcinogenic (pHR-HPV) as 3.51%; and low-risk HPV (LR-HPV) as 3.56%. The most common HR-HPV genotype detected was HPV-52 with an infection rate of 4.99%, followed by HPV 58 (2.18%), 16 (2.12%), 51 (1.61%), 39 (1.19%), 56 (1.09%), 59 (0.85%), 18 (0.72%), 33 (0.61%), 31 (0.53%), 35 (0.20%), 45 (0.17%). Among LR-HPV genotypes, HPV-42 was the most common (1.08%), followed by 44 (0.77%), 81 (0.68%), 6 (0.48%), 43 (0.40%), 11 (0.23%) and 83 (0.07%). The prevalence of infection among different genotypes in pHR-HPV was: 68 (1.29%), 53 (1.21%), 66 (0.77%), 82 (0.25%), 73 (0.16%). Additionally, the prevalence of single genotype HPV infection exceeded that of multiple HPV infections except HPV-59. Conclusion Our findings imply that HPV genotype infections in Guangzhou demonstrate a regional and age-related distribution. Therefore, these data can provide a substantial foundation for further epidemiologic analysis to control and prevent HPV infections in Guangzhou.
... [14] In addition, the type and pattern of HPV infection vary by geography and economy. [15,16] Past studies have reported that glucose transporters (GLUTs) are associated with the malignant transition of cervical epithelium with HPV infection. [17] In HPV-positive cervical cancer, the expression of GLUT1 indicates a worse prognosis. ...
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Besides the controversy of the association of high glycemic index and glycemic load with precancerous cervical lesions, only a few studies have examined the impact of fasting blood glucose levels on human papillomavirus (HPV) multiple infections. In the present study, we appraised the relationship between blood glucose levels and multiple HPV infections in a population of HPV-positive women with cervical high-grade squamous intraepithelial lesions (HSIL). The present study was designed as a cross-sectional correlative analysis. A total of 560 participants with a pathologically confirmed HSIL with HPV infection were included from a hospital in China during January 1, 2018, and December 31, 2019. The target variables and the outcome variables were the glucose levels at the baseline and HPV multiplicity, respectively. The odds ratio and 95% confidence intervals were calculated to estimate the risk of multiple infections via logistic regression analysis. The average age of the 560 participants was 44.63 ± 10.61 years; the nonlinear relationship was detected between the glucose levels and multiplicity of HPV, with an inflection point at 5.4. After adjusting for the full range of variables, the effect sizes and confidence intervals for the left and right sides of the inflection points were found to be 0.379 (0.196–0.732) and 5.083 (1.592–16.229), respectively. In this cross-sectional study, both high and low blood glucose levels increased the risk of multiple HPV infections, demonstrating a U-shaped relationship between the blood glucose levels and multiple HPV infections.
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Persistent human papillomavirus (HPV) infection has been associated with the development of cervical cancer. To reduce the incidence of cervical cancer and promote awareness of HPV, a government-sponsored epidemiological study was conducted from 2015 to 2018 in Zhengzhou City. A total of 184,092 women aged 25-64 years were included, of which 19,579 were infected with HPV, reflecting a prevalence of 10.64 percent (19,579/184,092). The HPV genotypes found were classified as high-risk (13 genotypes) and low-risk (8 genotypes). Single and multiple infections were detected in 13,787 (70.42 percent) and 5,792 (29.58 percent) women, respectively. The five most common high-risk genotypes detected, listed in descending order, were HPV52 (2.14 percent; 3,931/184,092), HPV16 (2.04 percent; 3,756/184,092), HPV58 (1.42 percent; 2,607/184,092), HPV56 (1.01 percent; 1,858/184,092), and HPV39 (0.81 percent; 1,491/184,092). Meanwhile, the most common low-risk genotype was HPV53 (0.88 percent; 1,625/184,092). The prevalence of HPV gradually increased with age, with the highest occurring in women aged 55-64 years. The prevalence of single-type HPV infection decreased with age, whereas that of multiple-type HPV infection increased with age. This study indicates a high burden of HPV infection in women in Zhengzhou City.
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Human papillomavirus 52 (HPV52) infection is prevalent in the Chinese population, and variations in HPV52 show correlations with oncogenicity. However, no specific variation in HPV52 was reported to show relevancy to infection characteristics. In this study, we retrieved 222 isolates of E6 and L1 full-length genes from 197 Chinese women with HPV52 infection. After sequence alignment and phylogenetic tree construction, we found that 98.39 % of the collected variants belonged to the sublineage B2 and two variants displayed incongruence between the phylogenetic tree of E6 and L1. The analysis of the infection pattern showed that the presence of C6480A/T mutation in the L1 gene was associated with single infection (P=0.01) and persistent infection (P=0.047) of HPV52, while the A6516G nucleotide change was relevant to transient infection (P=0.018). Our data also indicated that variations T309C in the E6 gene and C6480T, C6600A in L1 were more commonly presented in patients with high-grade cytology (P<0.05). One HPV52 breakthrough infection after vaccination was identified, which hinted at the immune escape post-vaccination. Young coitarche age and non-condom usage were correlated to multiple infections. This study provided insight into the polymorphism of HPV52 and revealed the impact of variations in HPV52 on its infection characteristics.
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The present study examined the prevalence of human papillomavirus (HPV) and its genotype distribution in outpatients and healthy female subjects in Wenzhou so as to develop local HPV vaccination strategies and contribute to the prevention of this disease. The present retrospective study enrolled 164,137 women, including 118,484 outpatients and 45,653 healthy female subjects from 2015 to 2020. Cervical exfoliated cells were collected from these women for DNA extraction. The DNA samples were detected with a fluorescence in situ hybridization method and 27 HPV genotypes were analyzed. The overall prevalence of HPV was 17.35%; this corresponded to a prevalence of 19.10% in the outpatient group and 12.82% in the healthy female group. HPVs 52, 58, 16, 53, and 61 were the five most prevalent HPV genotypes in the outpatient group. The five most common genotypes were HPV 52, 53, 58, 61, and 81 in the healthy female group. The HPV infection peak was estimated to be 44.65% in the 10–19 age group and 27.35% in the 60–69 age group. The burden of HPV infection in this area was high; therefore, a scientific and reasonable vaccination strategy should be adopted. The universal use of multivalent vaccines is recommended and considerable attention should be paid to HPV types that are not targeted by the vaccines. Cervical screening should be performed routinely in patients with gynecological clinical symptoms to avoid cervical intraepithelial neoplasia following persistent infection of high-risk HPV, notably in women over 60 years of age.
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Background: The knowledge that persistent human papillomavirus (HPV) infection is the main cause of cervical cancer has resulted in the development of prophylactic vaccines to prevent HPV infection and HPV assays that detect nucleic acids of the virus. WHO has launched a Global Initiative to scale up preventive, screening, and treatment interventions to eliminate cervical cancer as a public health problem during the 21st century. Therefore, our study aimed to assess the existing burden of cervical cancer as a baseline from which to assess the effect of this initiative. Methods: For this worldwide analysis, we used data of cancer estimates from 185 countries from the Global Cancer Observatory 2018 database. We used a hierarchy of methods dependent on the availability and quality of the source information from population-based cancer registries to estimate incidence of cervical cancer. For estimation of cervical cancer mortality, we used the WHO mortality database. Countries were grouped in 21 subcontinents and were also categorised as high-resource or lower-resource countries, on the basis of their Human Development Index. We calculated the number of cervical cancer cases and deaths in a given country, directly age-standardised incidence and mortality rate of cervical cancer, indirectly standardised incidence ratio and mortality ratio, cumulative incidence and mortality rate, and average age at diagnosis. Findings: Approximately 570 000 cases of cervical cancer and 311 000 deaths from the disease occurred in 2018. Cervical cancer was the fourth most common cancer in women, ranking after breast cancer (2·1 million cases), colorectal cancer (0·8 million) and lung cancer (0·7 million). The estimated age-standardised incidence of cervical cancer was 13·1 per 100 000 women globally and varied widely among countries, with rates ranging from less than 2 to 75 per 100 000 women. Cervical cancer was the leading cause of cancer-related death in women in eastern, western, middle, and southern Africa. The highest incidence was estimated in Eswatini, with approximately 6·5% of women developing cervical cancer before age 75 years. China and India together contributed more than a third of the global cervical burden, with 106 000 cases in China and 97 000 cases in India, and 48 000 deaths in China and 60 000 deaths in India. Globally, the average age at diagnosis of cervical cancer was 53 years, ranging from 44 years (Vanuatu) to 68 years (Singapore). The global average age at death from cervical cancer was 59 years, ranging from 45 years (Vanuatu) to 76 years (Martinique). Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed. Interpretation: Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. The global scale-up of HPV vaccination and HPV-based screening-including self-sampling-has potential to make cervical cancer a rare disease in the decades to come. Our study could help shape and monitor the initiative to eliminate cervical cancer as a major public health problem. Funding: Belgian Foundation Against Cancer, DG Research and Innovation of the European Commission, and The Bill & Melinda Gates Foundation.
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Background: Human papillomavirus (HPV) is one of the most common sexually transmitted viruses. Data about HPV infection in Guizhou is limited. Methods: 56,768 cervical samples were collected and genotyped for 15 main high risk and 6 main low risk HPV types. Results: 16.95% (9623/56768) of samples were HPV positive; 90.70% (8728/9623) of HPV positive women were infected by high risk HPV. High risk and high risk mix infection (1458; 70.85%) was the most common mix HPV infection type. The highest HPV detection rate was found in age group 41-45 years old (detection rate = 17.89%) (χ2 = 204.77; P < 0.001); the highest within-group HPV infection rates were found in the ≤20 (25.62%) and ≥ 61 (24.67%) years old age groups, the lowest within-group HPV infection rate was found in the 31-35 years old age group (15.02%). The highest mix infection proportions were found in the ≥61 (36.06%) and ≤ 20 (33.63%) years old age groups (χ2 = 111.21; P < 0.001), the lowest mix infection proportion was found in the 41-45 (17.42%) years old age group. The highest high risk infection proportions were found in the 26-30 (92.98%), ≥61 (92.68%), and 36-40 (92.16%) years old age groups (χ2 = 31.72; P < 0.001), the lowest high risk infection proportion was found in the ≤20 (84.96%) years old age group. HPV infection rates varied with seasons in Guizhou. Conclusions: Characteristics of HPV distribution in Guizhou were identified. There were significant differences in HPV distribution among age groups, prevention strategies should be adjusted according to the characteristics.
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Viral infections contribute as a cause of 15–20% of all human cancers. Infection by oncogenic viruses can promote different stages of carcinogenesis. Among many types of HPV, around 15 are linked to cancer. In spite of effective screening methods, cervical cancer continues to be a major public health problem. There are wide differences in cervical cancer incidence and mortality by geographic region. In addition, the age-specific HPV prevalence varies widely across different populations and showed two peaks of HPV positivity in younger and older women. There have been many studies worldwide on the epidemiology of HPV infection and oncogenic properties due to different HPV genotypes. However, there are still many countries where the population-based prevalence has not yet been identified. Moreover, cervical cancer screening strategies are different between countries. Organized cervical screening programs are potentially more effective than opportunistic screening programs. Nevertheless, screening programs have consistently been associated with a reduction in cervical cancer incidence and mortality. Developed countries have achieved such reduced incidence and mortality from cervical cancer over the past 40 years. This is largely due to the implementation of organized cytological screening and vaccination programs. HPV vaccines are very effective at preventing infection and diseases related to the vaccine-specific genotypes in women with no evidence of past or current HPV infection. In spite of the successful implementation of the HPV vaccination program in many countries all over the world, problems related to HPV prevention and treatment of the related diseases will continue to persist in developing and underdeveloped countries.
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Viral infections contribute as a cause of 15-20% of all human cancers. Infection by oncogenic viruses can promote different stages of carcinogenesis. Among many types of HPV, around 15 are linked to cancer. In spite of effective screening methods, cervical cancer continues to be a major public health problem. .ere are wide differences in cervical cancer incidence and mortality by geographic region. In addition, the age-specific HPV prevalence varies widely across different populations and showed two peaks of HPV positivity in younger and older women. .ere have been many studies worldwide on the epidemiology of HPV infection and oncogenic properties due to different HPV genotypes. However, there are still many countries where the population-based prevalence has not yet been identified. Moreover, cervical cancer screening strategies are different between countries. Organized cervical screening programs are potentially more effective than opportunistic screening programs. Nevertheless, screening programs have consistently been associated with a reduction in cervical cancer incidence and mortality. Developed countries have achieved such reduced incidence and mortality from cervical cancer over the past 40 years. .is is largely due to the implementation of organized cytological screening and vaccination programs. HPV vaccines are very effective at preventing infection and diseases related to the vaccine-specific genotypes in women with no evidence of past or current HPV infection. In spite of the successful implementation of the HPV vaccination program in many countries all over the world, problems related to HPV prevention and treatment of the related diseases will continue to persist in developing and underdeveloped countries.
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Background: The aim of this paper was to conduct a baseline survey of HPV infection in unvaccinated women in Xinjiang Uyghur Autonomous Region before the mass use of HPV vaccine. Methods: Between 2008 and 2018, the HPV genotype detected by a PCR-based hybridization gene chip assay of 37,722 women who were from Gynecology Department and Health Management Center of the First Affiliated Hospital of Xinjiang Medical University were tested HPV genotype by a PCR-based hybridization gene chip assay. All statistical analysis methods were performed with this statistical software including Python version 3.6.1, R Software 3.5.1 and Excel 2011. Results: The total positive rate for HPV was 14.02%, the most prevalent genotypes were HPV 16 (3.79%), HPV 52 (2.47%), HPV 58 (1.76%), HPV 53 (1.35%) and HPV 31 (0.72%). The single infection (11.34%) and high-risk HPV (HR-HPV) infection (9.72%) was the main prevalence of HPV. Age-specific HPV distribution was presented as a bimodal curve, while the youngest age group (≤25 years) presented the highest HPV infection rate (20.78%), which was followed by a second peak for the 36-40 age group. According to the ethnic stratification, the HPV infection prevalence ranging from the high to low was: Mongol (16.36%), Hui (15.15%), Kazak (14.47%), Han (14.43%), Other (14.37%), Uygher (10.96%). From 2009 to 2013, the HPV infection rate fluctuated but did not changed much. It peaked in 2014 and then fell significantly, reached the bottom point in 2017 and rose slightly in 2018. In 2015, the infection rate of HPVl6 and 52 in the population was almost the same (both 3.40%) the infection rate of HPV52 type (3.31%) was higher than that of HPVl6 type (2.18%) and became the dominant type in 2016. Conclusions: We present data regarding the prevalence and type distribution of HPV infection, which could serve as the valuable reference to guide nationwide cervical cancer screening. These baseline data enable the estimates of maximum HPV vaccine impact across time and provide critical reference measurements which are important to the assess of clinical benefits and potential harms in HPV vaccination and the increase in non-vaccine HPV types.
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Background Data regarding human papillomavirus (HPV) prevalence and genotype distribution are limited in Shandong Province, China. Therefore, we investigated the recent HPV prevalence and genotype distribution among females in Shandong and aimed to provide comprehensive data to guide HPV-based cervical cancer screening and HPV vaccination for this population of Chinese women. Methods HPV testing results of 94,489 females were retrospectively reviewed and extracted from the database of Jinan KingMed Diagnostics, the largest independent pathology laboratory in Shandong Province, China. HPV was detected by a HPV genotyping panel from January 2011 to June 2017. The overall prevalence, age-specific prevalence, and genotype distribution were analyzed. Results A total of 26,839 cases (28.4%) were HPV-positive, with 4.3% positive for low- or undetermined-risk HPV (lr-/urHPV)-only, 18.1% positive for high-risk HPV (hrHPV)-only, and 6.1% positive for mixed lr-/urHPV and hrHPV infections. Single HPV infections accounted for 62.8%, while the rest were multiple HPV infections of two or more genotypes. HPV16 (5.8%), HPV52 (5.1%), HPV58 (3.5%), HPV51 (2.6%), and HPV56 (2.3%) were the five most common hrHPV genotypes; while HPV81 (2.8%), HPV53 (2.8%), and HPV6 (2.3%) were the three most common lr-/urHPV genotypes. HPV18 (1.7%) was only the ninth most common hrHPV genotype. HPV16 but not HPV52 was more common in single infections than in multiple infections. The distribution of both mixed lr-/urHPV and hrHPV as well as overall HPV infections demonstrated a bimodal pattern across age groups, of which the first peak appeared in the younger group and the second peak was found in older women. A similar age-specific distribution was observed in multiple infections of three or more subtypes as well. Moreover, the proportion of mixed lr-/urHPV and hrHPV infection significantly increased, while those of lr-/urHPV-only and hrHPV-only infections declined as the number of co-infections increased during the study period. Conclusion This large daily clinical practice report shows that HPV prevalence and genotype distribution are different in this population, who had limited cervical cancer screening service, compared to those in developed countries. Therefore, different strategies should be developed for HPV-based cervical cancer screening and vaccine-based HPV prevention in Shandong Province.
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Endocytic trafficking plays a major role in transport of incoming human papillomavirus (HPVs) from plasma membrane to the trans Golgi network (TGN) and ultimately into the nucleus. During this infectious entry, several cellular sorting factors are recruited by the viral capsid protein L2, which plays a critical role in ensuring successful transport of the L2/viral DNA complex to the nucleus. Later in the infection cycle, two viral oncoproteins, E5 and E6, have also been shown to modulate different aspects of endocytic transport pathways. In this review, we highlight how HPV makes use of and perturbs normal endocytic transport pathways, firstly to achieve infectious virus entry, secondly to produce productive infection and the completion of the viral life cycle and, finally, on rare occasions, to bring about the development of malignancy.
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Background: Human papillomavirus (HPV) DNA testing is an important method in cervical cancer screening. However, the studies on prevalence and genotype distribution of HPV among women in northeastern Guangdong Province of China are very limited. Methods: A total of 28,730 women attending the Department of Gynecology of Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University between January 1st, 2013 and June 1st, 2015 were enrolled in this study. HPV type-specific distribution was tested using flow-through hybridization and gene chip. Results: The overall prevalence of HPV infection was 19.81%, among which 79.09% were infected with high-risk HPV subtypes in the subjects. The 5 most predominant genotypes were HPV16, 52, 58, 18 and 81. Most HPV infections were observed in women aged 41-50 and women aged 30-59 accounted for a proportion of over 80%. Conclusions: Our findings suggested a high burden of HPV infection among women in northeastern Guangdong Province of China. We identified the top 5 HPV genotypes as well as the age-specific distribution of HPV infections in this area.
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Human papillomavirus infection plays a key role in the development of cervical cancer. To establish a foundation for HPV-based screening and vaccination programs, we investigated the HPV prevalence and genotypic distributions in Chinese women from Zhejiang Province. Between 2011 and 2015, a total of 961,029 samples from 2021 clinical hospitals were tested HPV genotype by a PCR-based hybridization gene chip assay, and 443,890 samples were evaluated cervical cytology by liquid-based cytology analysis. Our results showed that the positive rate for HPV was 20.54%, which ranged from 28.72% to 17.81% and varied by year of recruitment. Age-specific prevalence showed a “two-peak” pattern, with the ≤20-year-old group presenting the highest HPV infection rate, followed by 61–70-year-old group. Overall, the most prevalent genotypes were HPV16, 52 and 58. Additionally, the odds ratios for the prevalence of the HR-HPV, LR-HPV and HPV-negative groups with abnormal cytology were 12.56, 3.21 and 0.06, respectively. Among genotypes, HPV 16 has been found to have the highest OR, followed by HPV58, 18, 52. Here, we present data regarding the prevalence and type distribution of HPV infection, which can serve as valuable reference to guide nationwide cervical cancer screening and HPV vaccination programs.
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This article provides a status report on the global burden of cancer worldwide using the GLOBOCAN 2018 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer, with a focus on geographic variability across 20 world regions. There will be an estimated 18.1 million new cancer cases (17.0 million excluding nonmelanoma skin cancer) and 9.6 million cancer deaths (9.5 million excluding nonmelanoma skin cancer) in 2018. In both sexes combined, lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death (18.4% of the total cancer deaths), closely followed by female breast cancer (11.6%), prostate cancer (7.1%), and colorectal cancer (6.1%) for incidence and colorectal cancer (9.2%), stomach cancer (8.2%), and liver cancer (8.2%) for mortality. Lung cancer is the most frequent cancer and the leading cause of cancer death among males, followed by prostate and colorectal cancer (for incidence) and liver and stomach cancer (for mortality). Among females, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death, followed by colorectal and lung cancer (for incidence), and vice versa (for mortality); cervical cancer ranks fourth for both incidence and mortality. The most frequently diagnosed cancer and the leading cause of cancer death, however, substantially vary across countries and within each country depending on the degree of economic development and associated social and life style factors. It is noteworthy that high‐quality cancer registry data, the basis for planning and implementing evidence‐based cancer control programs, are not available in most low‐ and middle‐income countries. The Global Initiative for Cancer Registry Development is an international partnership that supports better estimation, as well as the collection and use of local data, to prioritize and evaluate national cancer control efforts. CA: A Cancer Journal for Clinicians 2018;0:1‐31. © 2018 American Cancer Society