Type-specific Distribution of Cervical hrHPV Infection and the Association with Cytological and Histological Results in a Large Population-based Cervical Cancer Screening Program: Baseline and 3-year Longitudinal Data

Abstract

Objectives: This study aimed to describe the study design, and to analyze the type-specific distribution of cervical high-risk human papillomavirus (hrHPV) infection and its association with cytological and histological results in a large population-based screening program in Buji Street, Shenzhen, China. Methods: A total of 10,186 women aged 21-70 years were co-tested by Cobas4800 HPV assay and liquid-based cytology. Women were referred to colposcopy by virtue of being HPV16/18-positive, Other hrHPV-positive/ cytology >ASCUS, or HPV-negative/ cytology >LSIL. Three-year histological follow-up data were recorded. Results: The overall prevalence of hrHPV infection was 11.1%; among them, the highest type was Other hrHPV (8.9%), followed by HPV16 (1.6%) and HPV18 (0.6%). Moreover, the prevalence of hrHPV and that of HPV16 increased with cytological severity (Ptrend <0.001). In the baseline phase, 106 women had cervical intraepithelial neoplasia 2/3 (CIN2/3) and six had cervical cancers. During 3-year follow-up, 12 cases of CIN2/3 and no cancers were identified. For HPV16-positive women with normal cytology, the baseline risks of CIN2/3 or worse (CIN2+/CIN3+) were 15.5% (7.0-23.9%) and 4.2% (1.4-8.5%) respectively. For Other hrHPV-positive women with normal cytology, the cumulative 3-year risks of CIN2+/CIN3+ were 3.1% (1.0-5.2%) and 0.7% (0.3-2.1%) respectively. Strikingly, 75.8% (322/425) of abnormal cytology and 50.9% (29/57) HSIL cytology were attributed to Other hrHPV infection in HPV-positive women. Similarly, Other hrHPV infection led to large proportions of CIN2 (62.7%) and CIN3+ (43.9%) over 3-year follow-up. Conclusions: The co-testing modality is a feasible, effective and safe option for cervical cancer screening in urban population. Great importance should also be attached to 'genotypes excluding HPV16/18' and separate detection of each genotype when considering screening and vaccination strategy.

Roles of extended human papillomavirus genotyping and multiple infections in early detection of cervical precancer and cancer and HPV vaccination

“…The findings above support the crucial role of extended genotyping in cervical screening [8], and provide evidence for the development of new technology for the detection of HPV types. In addition, this study was conducted at three counties in Henan Province, China with a shortage of cytologists.…”

“…Whether extended genotypes (hrHPV genotypes except for HPV16/18) should be considered for triage or not is still well worth investigating. Recently, we showed in a large study that 75.8% of abnormal cytology and 50.9% HSIL cytology were attributed to other hrHPV infection among HPV-positive women, and 62.7%/43.9% of CIN2/CIN3+ were caused by other hrHPV infection over 3-year follow-up [8]. Moreover, the introduction of vaccines could lead to the eradication of HPV16/18 [9][10][11], better understanding of extended genotyping provides information for establishing favorable screening policies following the introduction of vaccines [12].…”

The association of cervicovaginal Langerhans cells with clearance of human papillomavirus

“…Clearance of HPV infection is encouraging alternative to eliminate ICC. Our and other prospective observational studies indicated that 85%, 50% and 5-10% of HPV infections could be cleared spontaneously in cervical intraepithelial neoplasia (CIN) 1, 2 and 3 respectively (4)(5)(6). Nevertheless, mechanisms of natural HPV clearance were largely unknown.…”

Which is the best management for women with normal cervical cytologic findings despite positivity for non-16/18 high risk human papillomaviruses?

“…Women who are NILM but positive for HR-HPV account for most of the subjects with positive screening results encountered in routine practice, ranging from 6.7 to 14.9% (15)(16)(17)(18). In the overall population, the distribution of HPV genotypes in a decreasing order of frequency is 16, 52, 31, 51, 18, 58, 39, 33, and 59 (19).…”

“…The results are presented in Table 1. A systematic review of 42 African studies testing for HPV infection in 17,273 women who were NILM (mostly from eastern Africa, with some from western, southern, and northern Africa) found that the most common HPV genotypes were HPV16, 52,35,18,58,51,45,31,53, and 56 in descending order (24). However, there were wide region-based variations in HPV infection rates.…”