title: Significance of HPV-58 infection in women who are HPV-positive, cytology-negative and living in a country with a high prevalence of HPV-58 infection.
abstract: OBJECTIVE
  Cervical cytology and human papillomavirus (HPV) DNA co-testing is recommended as a screening method for detecting cervical lesions. However, for women who are HPV-positive but cytology-negative, the appropriate management and significance of HPV-58 infection remain unknown.
  
  
  METHODS
  This study of prevalent HPV detected at baseline with a median follow-up of 3.2 years evaluated the risk factors associated with cervical abnormalities and assessed the significance of HPV-58 infection. A total of 265 women were enrolled. All high-grade squamous intraepithelial lesions (HSIL) that were detected by cytology were confirmed by histology. Histological diagnoses of cervical intraepithelial neoplasia 2/3 were classified as HSIL. Women were classified into four groups according to the HPV genotype that was detected at their first visit: HPV-58 (n = 27), HPV-16 (n = 52; 3 women had HPV-58 co-infection), ten other high risk (HR) types (n = 79), or low/undetermined risk types (n = 107).
  
  
  RESULTS
  Of 265 women, 20 (7.5%) had HSIL on their follow-up examinations. There were significant differences in the cumulative incidence of HSIL between the four groups (p<0.001). The 5-year cumulative incidence rates of HSIL were 34.0% (95% CI: 17.3-59.8%) in HPV-58 positive cases, 28.0% (95% CI: 13.8-51.6) in HPV-16 positive cases, 5.5% (95% CI: 2.1-14.0%) in one of the ten other types of HR-HPV positive cases, and 0% in women with low/undetermined risk HPV. When seen in women with HR-HPV (n = 158), persistent HPV infection was a significant factor associated with the development of HSIL (hazard ratio = 15.459, 95% CI: 2.042-117.045). Women with HPV-58 had a higher risk (hazard ratio = 5.260, 95% CI: 1.538-17.987) for the development of HSIL than women with HPV-16 (hazard ratio = 3.822, 95% CI: 1.176-12.424) in comparison with women with other types of HR-HPV.
  
  
  CONCLUSIONS
  HPV-58 has a high association with the development of HSIL in women who are HPV-positive and cytology-negative.
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Joon Seon
authors.initials: JS
authors.lastname: Song
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Kim
authors.forename: Jene
authors.initials: J
authors.lastname: Choi
authors.forename: Gyungyub
authors.initials: G
authors.lastname: Gong
authors.forename: Chang Ohk
authors.initials: CO
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology*; D003581:Cytodiagnosis; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics*; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology / Q000453:epidemiology