Persistent high-risk human papillomavirus (hrHPV) infections predispose to long follow-ups in cervical cancer screening. We aimed to examine the role of different persistent hrHPV genotypes in causing cervical disease in long-term follow-up. This study included 76 482 women who participated in Finland's national cervical cancer screening program in the Tampere region between 2012 and 2023. Partial HPV genotyping identified HPV16, HPV18, and 12 other hrHPV-types. Participants were grouped by age: less than 40, 40-50, and more than 50 years. Women with persistent HPV infections and baseline cytology of atypical squamous cells of undetermined significance (ASC-US) or milder were followed to assess their risk of developing high-grade squamous intraepithelial lesion or worse (HSIL+). Out of 4646 baseline HPV-positive women with ASC-US or lower cytology, 38.0% (n = 1765) had a type-specific persistent infection. The mean interval between consecutive positive samples was 15.8 months (range: 0.5-4 years). HPV16 demonstrated the highest persistence rate (39.8%). HPV16 coinfection was associated with the highest risk of HSIL+ (hazard ratio: 2.34, 95% confidence interval: 1.38-3.97) and significantly slower viral clearance (HR: 0.35, 95% CI: 0.17-0.70) compared with other hrHPV genotypes. The youngest age group (<40 years) was more prone to developing HSIL+ (P < 0.001) but cleared persistent infections significantly faster (P = 0.0028) than older cohorts. Our findings highlight that the oncogenic potential and persistence potential of the specific partial HPV genotypes vary across age groups. These differences should be considered when designing follow-up stratification strategies for cervical cancer screening programs.
Numminen et al. (Tue,) studied this question.