Genotype Distribution and Prevalence of High-Risk Human Papillomavirus Based on 20,103 Self-Collected Samples From 13 Regions of China

Objective: To investigate the epidemiological characteristics of high-risk human papillomavirus (HR-HPV) infection and the genotype distribution of HR-HPV in different regions of China using self-collected vaginal samples. Study Design and Setting: A total of 20,136 women aged 30–59 years were recruited from 13 provinces in China from September 2018 to July 2020. All participants registered, signed electronic informed consent, and filled in individual information voluntarily using an internet-based cervical cancer screening platform, then received a self-sampling kit. The samples were tested for 14 types of HR-HPV using the SeqHPV and BMRT HPV PCR assays. Results: After excluding 33 samples because of labeling errors or insufficient amounts of HPV DNA in specimens, 20,103 women (99.84%) were ultimately analyzed with a mean age of 44.31 ± 7.70 years. The overall prevalence of HR-HPV infection was 13.86%. The vast majority of HR-HPV (77.18%) were still a single type. Among 13 regions, Inner Mongolia had the highest prevalence (21.55%), while the lowest prevalence was in Jilin (9.51%). The following factors were found to be significantly associated with HR-HPV infection: age, sexual behavior, irregular screening, and economic level. The top five most common HR-HPV subtypes were HPV-52 (3.42%), HPV-58 (2.29%), HPV-16 (2.17%), HPV-39 (1.35%), and HPV-51 (1.30%), while HPV18 (0.86%) was the less prevalent. The prevalence of infection with a single type of HR-HPV was 10.70% and the prevalence of infection with multiple types was 3.16%. The prevalence curve of age-specific HR-HPV was V-shaped from 30 years to 59 years, with a lower prevalence observed in women aged 40–44 years (12.35%) and infection subsequently increasing with age. The proportion of women aged 30–34 years with HPV-16 (17%) was much higher than the proportion in other age groups, and the prevalence of HPV-18 (6%) was highest in women aged 45–49 years. The undeveloped regions (according to the GDP) had the highest prevalence of specific combinations of HR-HPV subtypes, of which HPV-16/HPV-18 infections decreased with increasing GDP. Furthermore, a more number of sexual partners and age of first sexual intercourse <20 years were risk factors for HPV infection, whereas education and barrier contraception were protective factors. Conclusion: The prevalence, genotype distribution, epidemiological characteristics and influencing factors of HR-HPV infection based on self-sampling varied in different regions of China. It is therefore crucial to develop specific plans for cervical cancer screening in different regions. Using the Internet for self-sample screening way could a much greater increase the coverage of cervical cancer screening. Clinical Trial Registration Details: Chinese Clinical Trial Website (https://www.chictr.org.cn, ChiCTR2000032331). Funding Information: The study was supported by Association for Maternal and Child Health Studies (No. 2018AMCHS00801); the National Key Research and Development Program of China (No. 2016 YFC1302901). Declaration of Interests: None. Ethics Approval Statement: The study was approved by the Ethics Committee of the Peking University People’s Hospital (2018PHB056-01) in Beijing, China.