Factors Associated with Increased Risk of High-Grade Cervical Squamous Intraepithelial Lesions in Women with Common HR-HPV Infection in Yangqu County, Shanxi Province

Abstract Background: To explore the factors associated with high-grade cervical squamous intraepithelial lesions (HSIL) in women with the common high-risk, human papillomavirus (HR-HPV) infection. Methods: Twenty thousand Han women (20-65 years) were enrolled. A questionnaire on demographic characteristics and factors related to cervical lesions was administered and a cervical liquid-based cytology test was conducted for each participant. We identified 1325 cases with atypical squamous cells of undetermined significance (ASC-US); 68 were excluded for refusal to consent, and 1257 patients were further assessed by HPV typing, colposcopy biopsy, and histopathological examination. Of these, 372 patients with pathologically diagnosed cervical intraepithelial neoplasia (CIN) became the case group, and 877 patients with a normal cervix (NC) became the control group (total participants 1249). HPV infection types were detected by flow-through hybridization. Results: From the 20,000 women assessed 877 had ASC-US with a NC (4.39%) and 372 had CIN (1.86%), including 247 with low-grade cervical squamous intraepithelial lesions (LSIL) (1.24%) and 125 with HSIL (0.63%). Of these 460 had HR-HPV infection, and the five most frequent types were 16, 52, 58, 56, and 33. After adjusting for demographics and other related variables, HPV16 was associated with an 11.363 times (95% CI: 6.639-19.449) higher risk of HSIL, while HPV58 was associated with a 5.758 times (95% CI: 2.542-13.045) higher risk of HSIL. HPV52 infection was not associated with an increased risk of HSIL. Menopause was a common protective factor against infection with HPV16 and HPV58, while multiple parity was a risk factor for HPV16 infection. Low educational attainment, high frequency of perineal washing, and low frequency of underwear changing were risk factors for HPV58 infection. HPV16, HPV58, other HR-HPV types, and younger age at menarche were risk factors for HSIL, while menopause and tea drinking were protective factors.Conclusion: The detection rate of HSIL was relatively high (0.63%). The most common highly pathogenic HR-HPV types in this area are HPV16 and HPV58. Focusing efforts on the prevention of local highly pathogenic HPV infections and identifying the risk factors associated with HSIL after infection are important to reduce the incidence of HSIL and cervical cancer.