A 10‐year Retrospective Analysis on HPV Genotype Switching in a Tertiary Center in China: Infection Characterization and Clinical Outcome

This study aims to investigate the phenomenon of human papillomavirus (HPV) genotype switching (HGS), assess the potential influencing factors, and evaluate the clinical impact on the severity of cervical lesions. A total of 2569 HPV positive female patients with records of more than two follow-up visits were included from the gynecology department at the Obstetrics and Gynecology Hospital of Fudan University, covering the period from May 2012 to September 2022. Patients' age, treatments, vaccination, HPV genotypes before and after HGS, and the final pathology results from colposcopy were recorded. Multifactorial analyses and correlation tests were performed. Single HPV infections accounted for 67% of the total population, while multiple HPV infections comprised 33%. The most prevalent genotypes in single HPV infections were HPV52 (18.6%), HPV16 (12.28%), HPV58 (11.72%), HPV53 (8.63%), and HPV81 (6.81%). Among cases of multiple infections, the most common genotype combinations were HPV52 + HPV53 (3.02%), HPV52 + HPV58 (3.13%), and HPV52 + HPV81 (3.02%). HGS was detected in 38.2% of the total cases (458/1200). The status of medication treatment was not found to correlate with the occurrence of HGS. However, age, surgical treatment status, vaccination status, and the genotype of HPV infection may be correlated with HGS. HPV52, HPV58, HPV53, HPV56, and HPV81 showed a positive association with the occurrence of HGS transitioning from multiple infections to a single infection (HGS-MS) (p < 0.05). In contrast, HPV52, HPV16, HPV58, HPV39, HPV56, and HPV18 significantly influenced the occurrence of HGS from one single infection to another (HGS-SS) (p < 0.05), albeit negatively. Notably, only one type of HGS, HGS-MS, demonstrated a positive correlation with the severity of cervical lesions. Our findings suggest that HPV genotype switching from multiple infections to single infections is associated with cervical intraepithelial neoplasia (CIN). Different patterns of HGS could result from specific HPV genotype infections, particularly HPV16. HGS-MS is revealed to plays a catalytic role in the progression of cervical lesions.