The risk of cervical lesions caused by HPV16/18 combined with other high-risk and low-risk HPV types: A retrospective study

Abstract

Abstract Background HPV16 and 18 are the most common high-risk human papillomavirus (HPV) types causing cervical lesions. Women with HPV16 and/or 18(HPV16/18) infections are the main targets for cervical screening. But the HPV16/18 infection status is complex, and clarifying the risk of different infection patterns for cervical lesions is essential for subsequent management options. Our study aimed to assess the risk of HPV16 or 18 combined with other high-risk(HR) and/or low-risk(LR) HPV types for cervical lesions and their clinical characteristics. Methods In this retrospective study, we analyzed the clinical data of 3,217 patients with HPV16/18 infection.We divided HPV16 or HPV18 multiple infections into 8 patterns: HPV16 + HR, HPV16 + LR, HPV16 + HR + LR, HPV18 + HR, HPV18 + LR, HPV18 + HR + LR, HPV16 + 18 and HPV16 + 18 + other-HPV. The analysis of data was performed by Chi-square test and multinational logistic regression. P < 0.05 was considered statistically significant. Results Among the HPV16/18 positive population, multiple infections accounted for 41.5% (1336/3217), and multiple infections were mainly associated with LSIL while single infection was more associated with HSIL+. And the risk of cervical lesions varied with different infection patterns. After adjusting co-factors, multiple logistic regression showed that compared with single HPV16 or 18 infection, HPV16 + HR and HPV18 + HR had a higher risk for LSIL(OR = 1.659, 95%=1.278–2.153; OR = 1.744,95%=1.046–2.907) while HPV16 + LR had a lower risk for HSIL+(OR = 0.477, 95%CI = 0.277–0.822). Conclusion Single HPV16 or 18 infection is more relevant to HSIL + with respect to multiple infections. Multiple infections may be transient that mainly lead to LSIL. Different infection patterns of multiple infections have different risks for cervical lesions, HPV16 or 18 combined with other HR-HPV are associated with a higher risk of LSIL, but HPV16 combined with LR-HPV decreases the risk of HSIL+. We propose that there is antagonistic relationship between HPV16 and some LR-HPV types.