The Association Between Multiple Human Papillomavirus Infection And Risk Of Cervical Disease

ObjectiveThis study was designed to explore to epidemiological characteristics of multiple human papillomavirus(HPV)infections and evaluate its impact on the risk of cervical disease.MethodsA cross-sectional study of 5963 women aged 16-87 years who attended a colposcopy service at the cervical outpatient clinic of our hospital from October 2016 to April 2020 was carried out.The final cervical pathological results were divided into three categories: inflammation,≤LSIL and HSIL+.Univariate and multivariate logistic regression models were used to assess correlations between multiple HPV infections with or without type16/18 and the risk of cervical disease.Additionally,772 patients with normal cervical cytology and high-risk HPV infection without type16/18 was selected as study population,Kruskal-Wallis rank-sum test was used to compare the difference cervical pathological between multiple and single high-risk HPV infections.Results1.Multiple HPV infections accounted for 32.3% of the total HPV infected population,and it was most prevalent in young females.The most commonly occurrence of HPV coinfection is 59 type,while HPV16/18 co-occurred less frequently than other oncogenic HPV types.2.Compared with single high-risk HPV infection,coinfection with more than one type of high-risk HPV infections was associated with significantly increased severity of cervical lesions(OR=1.312,[95%CI=1.155-1.49],P<.001),while coinfection with low-risk HPV was associated with a lower risk of HSIL+(OR=0.708,[95% CI=0.177-0.776],P < 0.05).After excluding HPV16/18 infections,it was still found that multiple high-risk HPV infections was associated with increased severity of cervical lesions(OR=1.198,[95%CI=1.008-1.423],P=0.04).3.Among the 772 patients with normal cervical cytology and high-risk HPV infections without type 16/18,the prevalence of HSIL+ in patients with multiple high-risk HPV infections was significantly higher than that in patients with single type high-risk HPV infection(7.6% vs 5.6%,P<0.001).Conclusion1.The occurrence of HPV coinfection is associated on age and HPV type,it is most prevalent in young females.The most commonly occurrence of HPV coinfection is 59 type,while HPV16/18 co-occurred less frequently than other oncogenic HPV types.2.Compared with single high-risk HPV infection,coinfection with more than one type of high-risk HPV infections was associated with significantly increased severity of cervical lesions,while coinfection with low-risk HPV was associated with a lower risk of HSIL+.There may be synergistic between high-risk HPV,while competition between high-risk HPV and low-risk HPV.3.For multiple high-risk HPV infections except for 16/18 type,missed diagnosis of HSIL+ may happen if we only use cytology triage.Multiple HPV infections may be a potential risk indicator for cervical cancer screening based on HPV testing.