Initial different human papillomavirus infection statuses and subsequent infection risk: a decade-long longitudinal...

HPV infection is a major risk factor for cervical cancer. HPV vaccine coverage remains low. Early identification of high-risk individuals with some characteristics is crucial for those with limited vaccination access.

To estimate the impact of different HPV infection statuses on subsequent infection, infection type, and coinfection. Influencing factors of long-term HPV infection status and clearance were also explored.

Data from Wuxi's cervical cancer screening (2013-2022) was used. Multivariate and multinomial logistic regression models were used to evaluate the relationship between different HPV infection statuses in the first four rounds and subsequent (the fifth round) infection, infection type, and coinfection, and the influencing factors on different HPV infection statuses during the five rounds, respectively. Survival analysis was applied to explore the HPV clearance.

A total of 20,817 females were included. Those experienced two or more HPV infections had the highest likelihood of being subsequent infection (Two or more vs. One: OR = 2.11, 95%CI: 1.61 ~ 2.76, P < 0.001). The risk of subsequent infection increases progressively (versus sustained infection-free) in one classification of HPV infection: a single transient infection (OR = 5.72, 95%CI: 4.66 ~ 7.01, P < 0.001), persistent infection (positivity in ≥ 2 consecutive rounds; OR = 10.78, 95%CI: 8.04 ~ 14.44, P < 0.001), reinfection (reversion to positivity after prior clearance; OR = 18.51, 95%CI: 11.58 ~ 29.57, P < 0.001), and lowest among those who cleared infection with no recurrence (OR = 2.99, 95%CI: 2.32 ~ 3.84, P < 0.001), highest among those with unsolved infection (OR = 23.21, 95%CI: 18.29 ~ 29.45, P < 0.001) or reinfection (OR = 18.79, 95%CI: 11.51 ~ 30.04, P < 0.001) in another classification. HPV infection status seemed not to associate with subsequent infection types and coinfection. Baseline age, at least one coinfections and HPV 16/18 infection may influence long-term HPV infection status. The median duration for HPV clearance is 1.98 years (95%CI:1.96 ~ 2.00), which significantly affected by baseline age (HR = 0.99, 95%CI: 0.98 ~ 0.99, P < 0.001) and history of coinfection (HR = 0.50, 95%CI: 0.80 ~ 1.02, P < 0.001).

When HPV vaccination coverage remains suboptimal, early identification of high-risk cervical cancer populations should prioritize characteristics including multiple/persistent/recurrence infection, coinfection, high-risk types infection, advanced age, and prolonged viral clearance time.