Analysis of HPV Infection and its Genetic Subtypes among Women in Lhasa Area

Analysis of HPV Infection and its Genetic Subtypes among Women in Lhasa Area | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL Natural Sciences This is a preprint and has not been peer reviewed. Data may be preliminary. 24 June 2025 V1 Latest version Share on Analysis of HPV Infection and its Genetic Subtypes among Women in Lhasa Area Authors : Xianwei Ke , Qiang Xu , Bayangzong Bian , Mengmei Zhang , and Fangfang Zhou 0000-0002-2018-3209 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.175077724.44043605/v1 324 views 179 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective:The objective of this study is to facilitate a comprehensive understanding of the human papillomavirus (HPV) infection and its genotypic subtype distribution characteristics among women in Lhasa. The study will provide a theoretical basis for the prevention, diagnosis and treatment of cervical cancer in this region.Methods：HPV samples were collected from 8273 subjects at Fukang Hospital of Tibet University from January 2023 to December 2024, and 17 genetic subtypes of HPV were detected by multiplex polymerase chain reaction (PCR) with universal primers. Of these, 15 were high-risk HPV and 2 were low-risk HPV.Results：Among the 8,273 samples examined, 708 were found to be positive for HPV, yielding a positive detection rate of 8.56%. Of these cases, 54 were male, with an infection rate of 14.67%. The total number of female cases was 654, with an infection rate of 8.27%. The full spectrum of 17 genetic subtypes was detected. The five most prevalent high-risk types were HPV52, HPV58, HPV16, HPV56 and HPV39, in that order. In addition, both low-risk types, HPV6 and HPV11, were identified. Amongst the 654 female infected individuals, 503 cases (76.91%) exhibited a single infection, 107 cases (16.36%) exhibited a double infection, and 44 cases (6.73%) exhibited a multiple infection. A statistically significant difference in the positive rate of HPV was identified among women of different age groups (P<0.05).Conclusion: The high-risk types of HPV infection in women undergoing physical examination in the Lhasa region were HPV52, HPV58, HPV16, HPV56 and HPV39. These were predominantly monoinfected, with obvious heterogeneity in subtype categories and age distribution. It is therefore vital that these types of HPV receive sufficient attention in the infection prevention work in this region. Analysis of HPV Infection and its Genetic Subtypes among Women in Lhasa Area Xianwei Ke 1,* ，Qiang Xu 2,* ,Bayangzong Bian 1 ，MengmeiZhang 3,# ，Fangfang Zhou 4,# 1 Department of Laboratory,Fokind Hospital Affiliated to Tibet University，Lhasa，China； 2 Department of Hepatology, Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine，Urumqi，China； 3 Department of Clinical Laboratory, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China； 4 Department of Laboratory,Shanghai Eighth People’s Hospital, Shanghai,China Correspondence to:Fangfang Zhou， [email protected] * Co-first authors： Xianwei Ke and Qiang Xu contributed equally to this work # Corresponding authors： MengmeiZhang and Fangfang Zhou contributed equally to this work. Keywords: HPV Infection; Genetic Subtype;Cervical Cancer;Positive Distribution Abstract Objective:The objective of this study is to facilitate a comprehensive understanding of the human papillomavirus (HPV) infection and its genotypic subtype distribution characteristics among women in Lhasa. The study will provide a theoretical basis for the prevention, diagnosis and treatment of cervical cancer in this region.Methods：HPV samples were collected from 8273 subjects at Fukang Hospital of Tibet University from January 2023 to December 2024, and 17 genetic subtypes of HPV were detected by multiplex polymerase chain reaction (PCR) with universal primers. Of these, 15 were high-risk HPV and 2 were low-risk HPV.Results：Among the 8,273 samples examined, 708 were found to be positive for HPV, yielding a positive detection rate of 8.56%. Of these cases, 54 were male, with an infection rate of 14.67%. The total number of female cases was 654, with an infection rate of 8.27%. The full spectrum of 17 genetic subtypes was detected. The five most prevalent high-risk types were HPV52, HPV58, HPV16, HPV56 and HPV39, in that order. In addition, both low-risk types, HPV6 and HPV11, were identified. Amongst the 654 female infected individuals, 503 cases (76.91%) exhibited a single infection, 107 cases (16.36%) exhibited a double infection, and 44 cases (6.73%) exhibited a multiple infection. A statistically significant difference in the positive rate of HPV was identified among women of different age groups (P<0.05).Conclusion: The high-risk types of HPV infection in women undergoing physical examination in the Lhasa region were HPV52, HPV58, HPV16, HPV56 and HPV39. These were predominantly monoinfected, with obvious heterogeneity in subtype categories and age distribution. It is therefore vital that these types of HPV receive sufficient attention in the infection prevention work in this region. 1. Introduction Human papillomavirus (HPV) is a mucosal and skin epithelial virus that is the primary causative agent of cervical epithelial hyperplasia and cervical cancer [1]. There are more than 100 HPV subtypes, of which more than 30 can infect the mucous membranes of the human reproductive tract. The pathogenicity of the different subtypes varies greatly, and the proliferative lesions caused by them are classified into two categories: It is acknowledged that there are two distinct categories of human papillomavirus (HPV): high-risk and low-risk types. The former have been associated with an increased risk of developing cervical cancer [2]. Cervical cancer is among the most prevalent malignant neoplasms afflicting women globally, representing the second most significant cause of mortality among women after breast cancer. Notably, the incidence of this condition is exhibiting a marked decrease in age, indicating a shift towards a younger demographic. According to the statistics of the World Health Organization (WHO), in 2020, there were almost 110,000 new cases of cervical cancer and almost 59,000 deaths in China. It is noteworthy that almost all cases of cervical cancer (99.7%) were associated with HPV infection [3, 4]. HPV16 and HPV18 are currently recognised as the subtypes with the strongest carcinogenic potential among high-risk HPV types, and approximately 70% of cervical cancer cases are related to them. A plethora of studies have identified significant variations in HPV prevalence status, the peak age of infection, and viral subtypes across diverse regions, geographic environments, and ethnic groups [5].HPV-DNA testing has emerged as a predominant method for primary cervical cancer screening and diagnosis from an etiological perspective, exhibiting characteristics such as rapid speed and high sensitivity[5].The present study principally analyses the human papillomavirus (HPV) infection and the distribution characteristics of each genotype in women undergoing physical examination in Lhasa. The study provides a basis for and rational suggestions for the future clinical prevention, diagnosis and treatment evaluation of cervical cancer and its pre-cancerous lesions in the plateau region of China. 2. MATERIALS AND METHODS math_shortcuts 2.1.Study subjects Retrospectively analysed 8273 clinical samples of HPV genotyping test performed in Fukang Hospital affiliated to Tibet University from January 2023 to December 2024, among the study subjects, there were 368 males and 7905 females, with ages ranging from 15-94 years old. The age division intervals were ≤20 years old, 20-30 years old, 31-40 years old, 41-50 years old, 51-60 years old, and >60 years old.Inclusion criteria: Women in Lhasa with a history of sexual life; Except during the menstrual period, pregnancy or lactation period; No vaginal medication was administered within 3 days before the examination. There was no sexual activity, vaginal irrigation or vaginal operation within 24 hours before sampling. Patients without a history of cervical surgery, conization of the cervix, hysterectomy or pelvic radiotherapy; The materials are complete. At the same time, HPV typing tests are conducted. Exclusion criteria: Those who have undergone cervical cancer surgery. 2.2.1.Sample collection The samples of female subjects were collected by exposing the cervical opening with a dilator, wiping away the secretions of the cervical opening with a cotton swab, slowly withdrawing the cervical brush by gently rotating it clockwise for 4~5 weeks tightly against the cervical opening, putting the head of the cervical brush into the elution tube with cytosolic preservation solution, screwing the cap on tightly, marking the samples well, and keeping the tube in an upright position. Samples from male subjects were sent for testing immediately after the clinician collected secretions from the anus, glans or directly from the glans with a swab moistened with 0.9% Nacl solution. HPV genotyping nucleic acid detection kit (Shanghai Zhijiang Biotechnology Co., Ltd.) was used to detect HPV typing on the specimens. Positive diagnostic criteria: HPV-DNA ≥ 1.0 pg/ml [6]. 2.2.2.DNA extraction DNA was extracted in strict accordance with the instructions of HPV Nucleic Acid Typing Test Kit (Flow Fluorescence Hybridisation Method). 2.2.3.Polymerase chain reaction Amplification conditions were as follows: 95 ℃ for 5 min; 95 ℃ for 30 s, 58 ℃ for 30 s, 72 ℃ for 30 s, 5 cycles; 95 ℃ for 30 s, 55 ℃ for 30 s, 72 ℃ for 30 s, 35 cycles; and 72 ℃ for 3 min. Hybridisation conditions were as follows: 95 ℃ for 5 min for denaturation; 48 ℃ for 30 min for hybridisation; and 48 ℃ for 15 min for incubation. 2.2.4. Genotype detection A total of 17 HPV genotypes were detected, including 2 low-risk HPV types (6 and 11) and 15 high-risk HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 82, 66 and 68). 2.3.Statistical methods The data were analysed using SPSS 22.0 software, non-normally distributed data were expressed as quartiles, count data were expressed as rates, and comparisons between groups were made using the χ2 test. The difference was considered statistically significant at P<0.05. 3. RESULTS 3.1. HPV infection In the total population of 8,273 subjects, 368 males and 7,905 females were included in the study.HPV typing detected 708 infected patients, with an infection rate of 8.56%. Of these, 54 were male, with an infection rate of 14.67%, and 654 were female, with an infection rate of 8.27%. The details are displayed in Table 1.Due to the smaller number of male infected patients, female infected patients were selected for the subsequent studies in this paper. Table 1. Basic information of the 8273 subjects Gender Number of cases of subjects (%) Age[M（Q1，Q3）] Number of positive cases (%) Male 368（4.45） 35（29，44） 54（14.67） Female 7905（95.55） 44（35，54） 654（8.27） Total 8273 44（35，53） 708 3.2. Analysis of HPV subtype infection Among the 654 female infected cases, 46 cases of low-risk type were identified, with an infection rate of 0.58%, accounting for 7.03% of the HPV infected cases; 608 cases of high-risk type were identified, with an infection rate of 7.69%, accounting for 92.97% of the HPV infected cases. A total of 654 cases were analysed, revealing 15 high-risk subtypes. The five high-risk HPV gene subtypes with the highest detection rates were, in order, HPV52, HPV58, HPV16, HPV56 and HPV39 (see Table 2 for details). In contrast, the low-risk HPV gene subtypes were HPV6+11. math_shortcuts Table 2. Analysis of HPV subtype infection Type HPV Type Number of cases/case Percentage/% High-Risk HPV16 78 11.93 HPV18 33 5.05 HPV31 16 2.45 HPV33 19 2.91 HPV35 10 1.53 HPV39 48 7.34 HPV45 7 1.07 HPV51 38 5.81 HPV52 117 17.89 HPV56 50 7.65 HPV58 91 13.91 HPV59 25 3.82 HPV82 12 1.83 HPV66 33 5.05 HPV68 31 4.74 Low-Risk HPV6 46 7.03 HPV11 46 7.03 3.3. Distribution of the number of HPV infections among women of different ages The number of participants in different age groups varied, with the largest number of participants in the 41-50 age group (2,209, accounting for 27.94%), followed by the 31-40 age group (1,964, 24.85%), accounting for a combined proportion of more than 50% (52.79%). The age group of ≤20 years old had the smallest number of participants in the detection of HPV infections, with only 93, but the highest positive detection rate of 29.03%, which was significantly higher than that of other groups. The age group ≤20 years old had the lowest number of participants, only 93, but the highest positive detection rate, 29.03%, was significantly higher than that of other groups. Multiple infections were predominant, which might be related to the high risk of infection due to the immature development of the immune system of adolescents, the high number of congregate activities, and the poor awareness of safety. The positive detection rate in the middle-age and young-age group (21-50 years old) exhibited a downward trend, from 12.14% in the 21-30 years old group to 5.61% in the 41-50 years old group. In this age group, the risk of infection is reduced due to enhanced physical function, fortified immunity and relatively stable working and living environments. The prevalence of infection was found to be 7.38% among individuals aged 51-60 and 8.58% among those aged >60. The heightened risk of infection in the elderly is attributable to several factors. Firstly, there is a decline in physical function, which weakens the immune system. Secondly, the presence of various underlying diseases increases susceptibility. For further details, please refer to Figure 1 and Table 3. Table 3. Distribution of HPV infection weights among women of different ages [n (%)] math_shortcuts Age/years Number of participants Number of positive detections Single infection Double infection Multiple infection ≤20 93（1.17） 27（29.03） 10（10.78） 4（4.31） 13（14.02） 21-30 1071（13.55） 130（12.14） 93（8.68） 28（2.61） 9（0.84） 31-40 1964 （24.85） 169（8.60） 133（6.77） 30（1.53） 6（0.31） 41-50 2209（27.94） 124（5.61） 111（5.03） 10（0.45） 3（0.14） 51-60 1368（17.30） 101（7.38） 78（5.70） 14（1.02） 9（0.66） ＞60 1200（15.18） 103（8.58） 78（6.50） 21（1.74） 4（0.33） χ2 0.41 122.33 34.6 312.8 1030.5 P-value 0.33 ＜0.001 ＜0.001 ＜0.001 ＜0.001 Figure 1 .Relationship between participation ratio and positive detection ratio by age group 3.4. Distribution of HPV genotype subtypes in women of different age groups In the group of women with an age of ≤20 years, high-risk HPV types 16, 18, and 58 were predominant. In the group of women with an age between 21 and 30 years, high-risk HPV types 52, 16, 68, and 51 were predominant. In the group of women with an age between 31 and 40 years, high-risk HPV types 52, 58, 16, and 58 were predominant. In the 41-50 age group, high-risk HPV types 51, 56, 16 and 52 were identified as predominant. In the 51-60 age group, high-risk HPV types 58, 16, 52 and 39 were identified as predominant. In the >60 age group, high-risk HPV types 52, 58, 16, 56 and 66 were identified as predominant. Table 4 .Distribution of HPV subtypes among women of different age groups HPV Type ≤20 year 21-30 year 31-40 year 41-50 year 51-60 year ＞60 year High-Risk HPV16 4 15 16 16 14 13 HPV18 4 5 8 8 5 3 HPV31 0 4 2 2 5 3 HPV33 3 0 7 4 2 3 HPV35 0 2 5 13 2 1 HPV39 0 9 13 2 7 6 HPV45 0 0 2 8 2 1 HPV51 1 12 12 27 3 2 HPV52 0 19 35 11 14 22 HPV56 1 9 14 18 6 9 HPV58 4 11 19 4 18 21 HPV59 1 5 8 4 5 2 HPV82 2 2 3 2 1 2 HPV66 0 10 7 3 4 9 HPV68 1 13 8 2 4 3 Low-Risk HPV6 6 14 10 4 9 3 HPV11 6 14 10 4 9 3 Figure 2. Heat map of the distribution of HPV subtypes among women of different age groups 3.5.Distribution of infection weight and HPV subtypes In the 654 cases of female infection, 503 cases were single-infected, primarily with HPV types 52, 58, 16, 39 and 56; 107 cases were double-infected, primarily with HPV types 52, 58, 16, 51 and 56; 30 cases were triple-infected, primarily with HPV types 58, 18, 52, 16 and 39; and 4 cases were infected with more than one type. The most prevalent HPV types among cases with multiple infections were HPV 52, 58, 56 and low-risk types 6 and 11, as illustrated in Figure 3. Figure 3. Distribution of infection weights and HPV subtypes 4.DISCUSSION According to global data, cervical cancer is the fourth most prevalent cancer in terms of incidence and mortality, with the majority of cases occurring in developing countries [7, 8]. Human papillomavirus (HPV) is a major causative agent, with HPV16 and HPV18 being the most prevalent high-risk types [9].In 2020, the WHO launched the Eliminate Cervical Cancer programme, and with the increasing popularity of HPV vaccines, there is a need for continuous updating of the epidemiology of HPV infections. This is important for understanding the current status and distribution characteristics of HPV infections in the region. As evidenced by the extant literature, there are numerous HPV subtypes, which are typically classified into low-risk and high-risk subtypes according to their pathological activity and carcinogenic risk. Among them, the low-risk subtypes represented by types 6, 11, 30, 42, 43, and 44 are usually responsible for warts, flat warts, and other diseases [10], whereas the high-risk subtypes represented by types 16, 18, 31, 33, 35, and 45 are very likely to cause cervical cancer. In this study, the HPV infection rate of women in Lhasa was found to be 8.27%, which was significantly lower than the overall HPV infection rate of women in mainland China (15.5%-24.3%) [11]. Furthermore, the highest detection rate of type 52 in Lhasa was consistent with the findings of Yixi Jinba [12]. Further analysis of the number of individuals involved in the detection of different age groups revealed variability. The group most involved in the detection of the 41-50 age group reflected the higher initiative of middle-aged and young people in health screening, which may be related to the stronger sense of health among this age group. The unit organisation of the medical examination exhibited a high coverage rate. The positive rate of HPV detection exhibited an ’inverted U-shaped’ trend, with two peaks at ≤20 years old (29.The prevalence of positive cases was found to be 0.3% in the 0–20 age group, 8.58% in the 21–50 age group, and >60 years old (8.58%), with a consistent decline in positivity rate observed across age groups from 21 to 50 years (from 12.14% to 5.61%) and a subsequent rise after 51 years. These findings suggest the presence of substantial variations in the risk of infection across different age demographics. Notably, individuals aged ≤20 years exhibited the highest positivity rate, with the predominance of the oncogenic type 16/18 strain, which is associated with an increased expression of viral receptors. During the process of puberty, the presence of α5β1 integrins on the surface of cervical epithelial cells has been observed to facilitate the adhesion and subsequent colonisation of highly oncogenic types [13].Secondly, it was found that individuals ≤20 years of age primarily exhibited multiple infections, which may be attributable to the superposition of the following factors: the primary cervical epithelium remains immature, the immune system is not yet fully mature, the defence ability against pathogens is weak, and the sexual life is premature and characterised by a lack of self-protection awareness. Secondly, individuals ≤20 years of age predominantly engaged in frequent sexual activities (e.g., The risk of carcinogenesis was found to be increased by factors including school dormitories, participation in group sports, unstable sexual partners, smoking, drinking, and poor hygiene habits. These factors were found to increase the risk of adsorption of high carcinogenic types and colonization [13]. Research has identified a heightened risk of infection with high-risk HPV and subsequent development of cervical cancer in young women. Recent reports have indicated that the prevalence of high-risk HPV infection among adolescents aged 15-19 years in mainland China is as high as 30.55% [14]. This finding underscores the importance of implementing early screening and prevention strategies for HPV infection in younger age groups. Secondly, multiple infections were found to be predominant in individuals ≤20 years of age. This phenomenon may be attributed to several factors. Firstly, age is an important factor associated with HPV infection. Secondly, young women are more likely to engage in frequent sexual intercourse, have multiple sexual partners, and consequently, are more susceptible to HPV infection. Furthermore, the cervix of adolescents is considered to be immature, primarily consisting of columnar cells and exhibiting chemotaxis. Initiation of sexual activity at an early age has been demonstrated to increase the susceptibility to HPV, particularly within the transformation zone, which is more prone to developing precancerous lesions [16].This phenomenon may be associated with immune system dysfunction and the reactivation of latent HPV during the menopausal transition. The increase in positivity observed among individuals over the age of 51 may be attributable to immune dysregulation and the reactivation of latent HPV during the menopausal transition. Individuals over the age of 51 are considered to be in the menopausal period, a phase characterised by a decline in ovarian function, hormonal levels, and immune system function, as well as alterations in vaginal microbiology. These changes can increase susceptibility to infection [17, 18].The predominant distribution of type 52 in individuals aged between 21 and 40 years is consistent with a multicentre study conducted in China [19]. Furthermore, the high prevalence of this type in East Asian populations may be related to the specific modulation of the p53/pRb pathway in local populations by the viral E6/E7 proteins. The results of the present study demonstrated that 76.91% of female patients were single infected, 16.36% were double infected, and 6.73% were multiple infected; HPV type 52 occupied the top position in single infection, double infection, and multiple infection. As indicated by related studies, the presence of a single persistent HPV infection has been demonstrated to elevate the risk of developing cervical cancer by a factor of 19.9, while the existence of multiple persistent HPV infections has been shown to escalate the risk by an even more substantial margin of 31.8 times [20，21]. This finding indicates that single persistent infection and mixed infection are the primary risk factors for cervical cancer, and further research is necessary to ascertain whether HPV type 52 contributes to an increase in the incidence of cervical cancer. The pattern of mixed infection is subject to variation. Currently, HPV vaccines that have been marketed are of the 2-valent variety (HPV16, 18 types), the 4-valent variety (HPV6, 11, 16, 18 types), and the 9-valent variety (HPV6, 11, 16, 18, 31, 33, 45, 52, 58 types). It has been demonstrated that the 9-valent HPV vaccine offers a broader spectrum of preventive benefits; however, its cost is significantly higher and may present a financial challenge for many households. Consequently, the urgent development of multivalent HPV vaccines that are suitable for diverse populations across various regions is of paramount importance in the reduction of HPV positivity rates and the incidence of cervical cancer. It has also been reported that there may be cross-immunity against HPV, and among people who received the 2-valent HPV vaccine, the vaccine not only protects against HPV 16 and 18 infections, but also provides cross-protection against HPV 35, 52, 58, and 68. Cervical cancer and its precancerous lesions are influenced by numerous factors, and the role of biological factors in the development of cervical cancer has been a subject of considerable interest in recent years. It is widely recognised that HPV infection is the exact cause of cervical cancer. There is currently no specific drug available for the treatment of HPV; treatment is usually based on prevention and improvement of autoimmunity. The most effective measure for the prevention of cervical cancer is to carry out HPV testing and vaccination. The results of this study demonstrate that HPV DNA typing can be utilised for the differential diagnosis of cervicitis, cervical precancerous lesions and cervical cancer. Furthermore, it can be employed to triage patients based on the positive rate of high-risk subtypes, thereby reducing the number of unnecessary biopsies of cervical histopathology under e-colposcopy. Additionally, it can enhance the experience of women undergoing the test while concomitantly reducing the rate of underdiagnosis. 5.CONCLUSION This study aimed to investigate the current status of HPV infection among women in Lhasa, a high-altitude region, from 2023 to 2024. Compared to the mainland, the overall HPV infection rate in this area is relatively low. However, the infection rate was found to be higher in younger age groups and among older patients. To reduce the incidence of cervical cancer, it is essential to strengthen health education, promote HPV vaccination, and implement regular cervical cancer screening programs. Additionally, targeted interventions for high-risk groups should be enhanced to minimize the risk of future HPV infections. math_shortcuts LIMITATIONS OF THE STUDY This study was a retrospective analysis. The data sources and specimen types were relatively limited, including only the HPV-DNA test results from a single medical institution, which may have introduced potential biases in the positive rate. Additionally, there was a lack of TCT examinations and pathological tissue evaluations for positive cases. Future studies should focus on integrating TCT examination results and cervical pathological tissue analyses for HPV-DNA positive patients to comprehensively assess their infection status. Ideally, long-term follow-up studies for such patients would provide a stronger theoretical foundation for the prevention and treatment of cervical cancer. ACKNOWLEDGEMENTS We would like to express our gratitude to all the medical staff at Fukang Hospital of Tibet University for their support and cooperation in this HPV testing project. We also want to thank all eligible women who participated in the study, as well as our guiding mentors and the data analysis team. Your efforts have made this research possible. Funding Medical Research Projects of Shanghai Eighth People’s Hospital (SHBY202516); Special Project for Young Medical Science and Technology Talents in the Autonomous Region’s Health and Wellness Field（WJWY-202330）. CONFLICT OF INTEREST STATEMENT This research did not involve any conflicts of interest. References 1. Khan S, Rehman MU, Shakeela Q, Ahmed S, Hayat A. Investigation of HPV DNA, in-silico validation and role of E6 protein in colorectal carcinogenesis. Braz J Biol. 2025 May 26;84:e288324. doi: 10.1590/1519-6984.288324. PMID: 40435002. 2. Clifford GM, Smith JS, Plummer M, Muñoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer. 2003 Jan 13;88(1):63-73. doi: 10.1038/sj.bjc.6600688. PMID: 12556961; PMCID: PMC2376782. 3. ICO HPV Information Centre. Human Papillomavirus and Related Diseases Report. China, 2018. 4. Filho A M, Laversanne M, Ferlay J,et al.The GLOBOCAN 2022 cancer estimates: Data sources, methods, and a snapshot of the cancer burden worldwide[J].International Journal of Cancer, 2025, 156(7).DOI:10.1002/ijc.35278. 5. SHEN Qionghua. Role of HPV DNA typing in the differential diagnosis of cervical lesions and cervical cancer[J]. Laboratory Medicine, 2019, 34(6): 498-501. 6. Jinfeng Chang,Cheng Ma,Yuxia Tian,et al.Prevalence and risk factors for HPV infection among women in Laiwu[J].Chin J Nosocomoil，2023，33 (23)：3625-3629.doi：10.11816/cn.ni.2023-230568. 7. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. doi: 10.3322/caac.21492. Epub 2018 Sep 12. Erratum in: CA Cancer J Clin. 2020 Jul;70(4):313. doi: 10.3322/caac.21609. PMID: 30207593. 8. Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, Arbyn M, Basu P, Bray F, Vaccarella S. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023 Feb;11(2):e197-e206. doi: 10.1016/S2214-109X(22)00501-0. Epub 2022 Dec 14. PMID: 36528031; PMCID: PMC9848409. 9. Mirabello L, Yeager M, Cullen M, et al. HPV16 Sublineage Associations With Histology-Specific Cancer Risk Using HPV Whole-Genome Sequences in 3200 Women. J Natl Cancer Inst. 2016 Apr 29;108(9):djw100. doi: 10.1093/jnci/djw100. PMID: 27130930; PMCID: PMC5939630. 10. Malik S, Sah R, Muhammad K, et al. Tracking HPV Infection, Associated Cancer Development, and Recent Treatment Efforts-A Comprehensive Review. Vaccines (Basel). 2023 Jan 1;11(1):102. doi: 10.3390/vaccines11010102. PMID: 36679945; PMCID: PMC9860736. 11. Guo, W., Hu, Z., Yan, J. et al. Epidemiological study of human papillomavirus infection in 105,679 women in Wuhan, China. BMC Infect Dis 24, 1111 (2024). 12. YIXI Jinba, WANG Gaoxue, BASANG Ciren, GASONG Zhuoga, PU Zhi, CIREN Yangjin, BIAN Zhen, LIU Zhijuan, DU Juan. HPV Survey and Analysis of Women in Xizang[J]. Medical Journal of Peking Union Medical College Hospital. DOI: 10.12290/xhyxzz.2024-0914. 13. Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev. 2003 Jan;16(1):1-17. doi: 10.1128/CMR.16.1.1-17.2003. PMID: 12525422; PMCID: PMC145302. 14. Wang R, Guo XL, Wisman GB, Schuuring E, Wang WF, Zeng ZY, Zhu H, Wu SW. Nationwide prevalence of human papillomavirus infection and viral genotype distribution in 37 cities in China. BMC Infect Dis. 2015 Jul 4;15:257. doi: 10.1186/s12879-015-0998-5. PMID: 26142044; PMCID: PMC4491249. 15. Zhao FH, Tiggelaar SM, Hu SY, Xu LN, Hong Y, Niyazi M, Gao XH, Ju LR, Zhang LQ, Feng XX, Duan XZ, Song XL, Wang J, Yang Y, Li CQ, Liu JH, Liu JH, Lu YB, Li L, Zhou Q, Liu JF, Zhao N, Schmidt JE, Qiao YL. A multi-center survey of age of sexual debut and sexual behavior in Chinese women: suggestions for optimal age of human papillomavirus vaccination in China. Cancer Epidemiol. 2012 Aug;36(4):384-90. doi: 10.1016/j.canep.2012.01.009. Epub 2012 Feb 27. PMID: 22377277; PMCID: PMC5523958. 16. Yu Hui;Xu Jia;Wu Huan,et al.Follow-up Analysis of HPV Infection in Females under 20 Years Old Attending a Hospital in Wuhan[J].Acta Medicinae Universitatis Scientiae et Technologiae Huazhong, 2019, 48(5):594-598.DOI:CNKI:SUN:TJYX.0.2019-05-020. 17. Ya Gong,Deling Duan,Xiong He,et al.Analysis of HPV infection characteristics and mixed infection genotypes in female genitourinary tract in Guangzhou area[J].Int J Lab Med,2021,42(10):1238-1241,1245.DOI:10.3969/j.issn.1673-4130.2021.10.019. 18. Qi Qige,Chen Zhiying,Zuo Guizhu,et al.Analysis of Cervical Lesion Biopsy and HPV-DNA Results in Perimenopausal Women[J].Int J Lab Med, 2017(7).DOI:10.3969/j.issn.1673-4130.2017.07.043. 19. JI Wen-ting;DI Wen. Human Papillomavirus in Cervical Diseases：An Update[J]. Journal of International Obstetrics and Gynecology, 2013, 40(2): 138-141. 20. Qi, S., Tang, X., Ye, N. et al. Epidemiological characteristics of human papillomavirus in Guangzhou, China—A retrospective analysis of 76,898 cases. BMC Public Health 25, 2061 (2025). 21. Ding H, Jin H, Tang Y. HPV genotype distribution and cervical lesions in Chongqing: a comprehensive analysis of 229,770 females (2015‒2023). BMC Infect Dis. 2025 May 27;25(1):760. Supplementary Material File (fig.docx) Download 159.46 KB Information & Authors Information Version history V1 Version 1 24 June 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Natural Sciences Authors Affiliations Xianwei Ke Fokind Hospital Affiliated to Tibet University View all articles by this author Qiang Xu Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine View all articles by this author Bayangzong Bian Fokind Hospital Affiliated to Tibet University View all articles by this author Mengmei Zhang Shanghai Tenth People's Hospital View all articles by this author Fangfang Zhou 0000-0002-2018-3209 [email protected] Jiangsu University View all articles by this author Metrics & Citations Metrics Article Usage 324 views 179 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Xianwei Ke, Qiang Xu, Bayangzong Bian, et al. Analysis of HPV Infection and its Genetic Subtypes among Women in Lhasa Area. Authorea . 24 June 2025. DOI: https://doi.org/10.22541/au.175077724.44043605/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.175077724.44043605/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9ffc6e850ff452ad',t:'MTc3OTQ1OTMxMw=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();