Prevalence, Incidence, and Clearance of Human Papillomavirus Infection in Female Sex Workers With and Without Human Immunodeficiency Virus in South China

ABSTRACT The natural history of human papillomavirus (HPV) infection among female sex workers (FSWs) with and without HIV in China remains poorly characterized. We conducted three rounds of community‐based cross‐sectional surveys in Kaiyuan, China (November 2017–2018), enrolling 785 FSWs aged ≥ 16 years. A longitudinal sub‐cohort of 172 individuals with ≥ 2 visits was formed for further analysis. Eligible FSWs completed questionnaires and provided blood and cervical samples for testing HIV, Syphilis, HCV, HSV and HPV. Generalized Estimating Equation (GEE) models compared HPV prevalence by HIV status in the cross‐sectional data; Wei‐Lin‐Weissfeld (WLW) Cox models compared HPV incidence, persistence and clearance by HIV status in the longitudinal sub‐cohort data. HIV‐positive individuals had significantly higher HPV prevalence (57.4% vs. 34.8%, OR = 1.65, 95%CI: 1.36–2.01) but similar incidence (119.0 vs. 82.2/1000 person‐months [PMs], HR = 1.07 [0.57–2.02]) and persistence (141.9 vs. 76.4/1000 PMs, HR = 0.74 [0.28‐1.93]) versus HIV‐negative peers. This disparities in HPV prevalence were primarily attributable to significantly reduced clearance rates among HIV‐positive status (104.1 vs. 149.7/1000 PMs, HR = 0.36 [0.20–0.66]). Younger age (< 25 years, adjusted OR = 2.27 [1.35–3.82]) and providing low‐fee sexual services (adjusted OR = 1.64 [1.04–2.60]) were identified as independent risk factors for HPV infection. HIV‐positive FSWs bear a high burden of HPV infection, primary driven by impaired viral clearance rather than increased acquisition.