Zhou Qiao, Luo Kekai, Zhao Liangping
Department of Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Diagn Cytopathol. 2025 Nov;53(11):529-535. doi: 10.1002/dc.70005. Epub 2025 Aug 14.
To investigate the differential risk of high-grade squamous intraepithelial lesion or worse (HSIL+) associated with single versus co-infection patterns of high-risk human papillomavirus (HR-HPV) genotypes.
In this retrospective cohort study, 10,570 patients with abnormal ThinPrep cytology test results and/or HR-HPV infection who underwent colposcopy-guided cervical biopsy at Wuhan Children's Hospital (May 2021-May 2023) were enrolled. Histopathological diagnosis served as the gold standard. Multivariate logistic regression was used to analyze HSIL+ risk across HPV infection patterns, adjusting for age and viral load.
Single infections with HPV31, HPV33, or HPV58 demonstrate comparable positivity rates of HSIL+ to HPV16 monoinfection. After adjusting for confounders, logistic regression revealed that co-infection of HPV16 with low-risk HPV genotypes reduced the risk of progression to HSIL+ compared to HPV16 monoinfection (p < 0.05). Similarly, co-infections involving HPV33 or HPV58 (regardless of high/low-risk partners) were associated with lower HSIL+ risk (all p < 0.05). In contrast, HPV31 demonstrated consistent HSIL+ risk irrespective of co-infection status.
HPV16, HPV31, HPV33, or HPV58 need equivalent clinical vigilance in screening and management protocols. Co-infection with low-risk HPV genotypes attenuates HSIL+ risk in HPV16-infected individuals, and HPV33/58 co-infections (with any genotype) exhibit protective effects. Our study suggests that HPV31-associated risk might remain unaffected by co-infection, suggesting genotype-specific biological interactions. These findings highlight the importance of genotyping-guided risk stratification in cervical cancer screening.
探讨与高危型人乳头瘤病毒（HR-HPV）基因型单一感染和合并感染模式相关的高级别鳞状上皮内病变或更严重病变（HSIL+）的差异风险。
在这项回顾性队列研究中，纳入了10570例在武汉儿童医院（2021年5月至2023年5月）接受阴道镜引导下宫颈活检的薄层液基细胞学检查结果异常和/或HR-HPV感染的患者。组织病理学诊断作为金标准。采用多因素逻辑回归分析HPV感染模式下的HSIL+风险，并对年龄和病毒载量进行校正。
HPV31、HPV33或HPV58单一感染的HSIL+阳性率与HPV16单一感染相当。校正混杂因素后，逻辑回归显示，与HPV16单一感染相比，HPV16与低危型HPV基因型合并感染降低了进展为HSIL+的风险（p<0.05）。同样，涉及HPV33或HPV58的合并感染（无论高危/低危伴侣）与较低的HSIL+风险相关（所有p<0.05）。相比之下，无论合并感染状态如何，HPV31的HSIL+风险一致。
在筛查和管理方案中，HPV16、HPV31、HPV33或HPV58需要同等的临床警惕。低危型HPV基因型合并感染可降低HPV16感染个体的HSIL+风险，HPV33/58合并感染（与任何基因型）具有保护作用。我们的研究表明，HPV31相关风险可能不受合并感染的影响，提示存在基因型特异性的生物学相互作用。这些发现凸显了基因分型指导的风险分层在宫颈癌筛查中的重要性。
