The prevalence of high risk human papillomavirus of females in western China: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Mengpei ^1,2 ,  YIN Rutie ^1,2 , LI Kemin ^1,2 , LUO Yan ¹

1. Department of Obstetrics and Gynecology, the West China Second University Hospital of Sichuan University, Chengdu, 610041, P.R.China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, P.R.China;

Corresponding?author：

YIN Rutie, Email: yrtt2013@163.com

Keywords：

Western China; Female; Genital tract; Human papillomavirus; Epidemiology; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.201905076

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Objectives To systematically review the epidemiology of high-risk human papillomavirus (HPV) infections in western Chinese females.Methods PubMed, Web of Science, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect epidemiological studies on female genital high-risk HPV infection in western China from January 2000 to July 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using R software.Results A total of 35 studies involving 149 037 objects were included. The results of meta-analysis showed that: the total infection rate of high-risk HPV in the northwest was 12.21% (95%CI 10.0% to 16.72%), and that in the southwest was 17.48% (95%CI 13.55% to 21.4%). The infection rate of high-risk HPV among healthy females in the northwest was 10.03% (95%CI 10.0% to 11.67%), while that in the southwest was 14.94% (95%CI 11.51% to 18.38%). CINⅠ, CINⅡ-Ⅲ and cervical cancer patients in the northwest with high-risk HPV infection rate were 70.31% (95%CI 49.0% to 91.61%), 84.29% (95%CI 68.36% to 100.22%) and 89.35% (95%CI 74.15% to 104.55%), respectively. The infection rates of patients with corresponding lesions in the southwest were 59.06% (95%CI 45.87% to 72.25%), 83.79% (95%CI 76.62% to 90.96%), and 81.07% (95%CI 67.77% to 94.37%), respectively.Conclusions Current evidence shows that the epidemiological pattern of female genital high-risk HPV infection in western China is basically consistent with overseas. The high-risk HPV subtypes are subtype 16, 18, 31, 52, 53 and 58. The HPV vaccine used in China has basically covered the prevalent high-risk HPV subtypes in Western China. The wide application of vaccine may reduce the incidence and mortality of cervical precancerous lesions and cervical cancer, which will ensure reproductive health females in Western China. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： ZHANG Mengpei, YIN Rutie, LI Kemin, LUO Yan. The prevalence of high risk human papillomavirus of females in western China: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(11): 1268-1275. doi: 10.7507/1672-2531.201905076 Copy

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2.	Human papillomavirus and related diseases in China. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre), 2018. Available at: https://hpvcentre.net/.
3.	Lowy DR, Solomon D, Hildesheim A, et al. Human papillomavirus infection and the primary and secondary prevention of cervical cancer. Cancer, 2008, 113(7 Suppl): 1980-1993.
4.	胡尚英, 鄭榮壽, 趙方輝, 等. 1989 至 2008 年中國女性子宮頸癌發病和死亡趨勢分析. 中國醫學科學院學報, 2014, 36(2): 119-125.
5.	Sinno AK, Saraiya M, Thompson TD, et al. Human papillomavirus genotype prevalence in invasive vaginal cancer from a registry-based population. Obstet Gynecol, 2014, 123(4): 817-821.
6.	Li K, Yin R, Wang D, et al. Human papillomavirus subtypes distribution among 2309 cervical cancer patients in west China. Oncotarget, 2017, 8(17): 28502-28509.
7.	Zhao XL, Hu SY, Zhang Q, et al. High-risk human papillomavirus genotype distribution and attribution to cervical cancer and precancerous lesions in a rural Chinese population. J Gynecol Oncol, 2017, 28(4): e30.
8.	Zhang L, Bi Q, Deng H, et al. Human papillomavirus infections among women with cervical lesions and cervical cancer in Eastern China: genotype-specific prevalence and attribution. BMC Infect Dis, 2017, 17(1): 107.
9.	Zhong TY, Zhou JC, Hu R, et al. Prevalence of human papillomavirus infection among 71, 435 women in Jiangxi province, China. J Infect Public Health, 2017, 10(6): 783-788.
10.	武澤軒. HPV 疫苗應用概述. 科學技術創新, 2017, (28): 43-44.
11.	Wells G. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute, 2011.
12.	Abulizi G, Li H, Mijiti P, et al. Risk factors for human papillomavirus infection prevalent among Uyghur women from Xinjiang, China. Oncotarget, 2017, 8(58): 97955-97964.
13.	Husaiyin S, Niyazi M, Wang LH, et al. HPV infection among Uygur women in a rural area of Hetian Prefecture, Xinjiang Uygur Autonomous Region, China. Biomed Environ Sci, 2013, 26(11): 934-936.
14.	Mijit F, Ablimit T, Abduxkur G, et al. Distribution of human papillomavirus (HPV) genotypes detected by routine Pap smear in Uyghur-Muslim women from Karasay Township Hotan (Xinjiang, China). J Med Virol, 2015, 87(11): 1960-1965.
15.	Niyazi M, Husaiyin S, Han L, et al. Prevalence of and risk factors for high-risk human papillomavirus infection: a population-based study from Hetian, Xinjiang, China. Bosn J Basic Med Sci, 2016, 16(1): 46-51.
16.	Wang X, Ji Y, Li J, et al. Prevalence of human papillomavirus infection in women in the Autonomous Region of Inner Mongolia: A population-based study of a Chinese ethnic minority. J Med Virol, 2018, 90(1): 148-156.
17.	韓娜娜, 邵文裕, 馬焱, 等. 2009-2013 年新疆維吾爾自治區 HPV 在不同宮頸病變中的基因型分布情況及其臨床意義. 中國婦幼保健, 2014, 29(23): 3721-3724.
18.	唐努爾·阿不力米提. HPV 各亞型在新疆和田喀爾賽鄉維吾爾族婦女中的分布研究. 烏魯木齊: 新疆醫科大學, 2009.
19.	段秀方, 蘆曉紅, 張喜龍. 快速導流雜交分型技術檢測寧夏地區人乳頭瘤病毒(HPV)感染基因型分布特點. 中國衛生檢驗雜志, 2014, 24(16): 2388-2390.
20.	狄麗努爾·熱孜木, 再努爾·阿布都熱衣木, 古扎麗努爾·阿不力孜, 等. 新疆喀什伽師縣維吾爾族婦女 HPV 的分布研究. 新疆醫科大學學報, 2013, 36(9): 1357-1361, 1356.
21.	何禮霞, 何俊勇, 曾莉, 等. 3443 例體檢女性宮頸高危型人乳頭瘤病毒感染狀況分析. 現代預防醫學, 2013, 40(20): 3748-3750, 3755.
22.	Baloch Z, Yuan T, Wang B, et al. Ethnic and geographic variations in HPV prevalence and genotype distribution in north-western Yunnan, China. J Med Virol, 2016, 88(3): 532-540.
23.	Baloch Z, Li Y, Yuan T, et al. Epidemiologic characterization of human papillomavirus (HPV) infection in various regions of Yunnan Province of China. BMC Infect Dis, 2016, 16: 228.
24.	Sun LL, Jin Q, Li H, et al. Population-based study on the prevalence of and risk factors for human papillomavirus infection in Qujing of Yunnan province, southwest China. Virol J, 2012, 9: 153.
25.	Tang Y, Zheng L, Yang S, et al. Epidemiology and genotype distribution of human papillomavirus (HPV) in southwest China: a cross-sectional five years study in non-vaccinated women. Virol J, 2017, 14(1): 84.
26.	Zou H, Sun Y, Zhang G, et al. Positivity and incidence of human papillomavirus in women attending gynecological department of a major comprehensive hospital in Kunming, China 2012-2014. J Med Virol, 2016, 88(4): 703-711.
27.	趙菊芬, 李茜, 張琴, 等. 云南紅河和文山地區女性宮頸人乳頭瘤病毒感染基因亞型分布狀況研究. 中國全科醫學, 2012, 15(18): 2036-2038.
28.	楊赟平, 楊雙雙, 張莉萍. 重慶地區婦女高危型 HPV 感染現狀及年齡的分層分布. 重慶醫學, 2013, 42(3): 249-250, 254.
29.	Long W, Yang Z, Li X, et al. HPV-16, HPV-58, and HPV-33 are the most carcinogenic HPV genotypes in Southwestern China and their viral loads are associated with severity of premalignant lesions in the cervix. Virol J, 2018, 15(1): 94.
30.	Peng J, Yuan Y, Shen F, et al. Cervical cancers manifest a high rate of infection by a high-risk human papilloma virus subtype but a very low rate of infection by a low-risk subtype in the Guiyang district of China. J Cancer, 2017, 8(7): 1263-1270.
31.	Baloch Z, Yuan T, Yindi S, et al. Prevalence of genital human papillomavirus among rural and urban populations in southern Yunnan province, China. Braz J Med Biol Res, 2016, 49(6): e5254.
32.	Baloch Z, Yue L, Yuan T, et al. Status of human papillomavirus infection in the ethnic population in Yunnan province, China. Biomed Res Int, 2015, 2015: 314815.
33.	Baloch Z, Yasmeen N, Li Y, et al. Prevalence and risk factors for human papillomavirus infection among Chinese ethnic women in southern of Yunnan, China. Braz J Infect Dis, 2017, 21(3): 325-332.
34.	祝愿. 青海地區回族婦女宮頸癌 HPV 譜及組織類型相關性研究. 西寧: 青海大學, 2016.
35.	Wang L, Wang P, Ren Y, et al. Prevalence of high-risk human papillomavirus (HR-HPV) genotypes and multiple infections in cervical abnormalities from Northern Xinjiang, China. PLoS One, 2016, 11(8): e0160698.
36.	Wu EQ, Yu XH, Zha X, et al. Distribution of human papillomavirus genotypes in archival cervical lesions in eastern inner Mongolian autonomous region, China. Int J Gynecol Cancer, 2009, 19(5): 919-923.
37.	Du R, Chen ZF, Li XH, et al. Human papillomavirus infection among Uyghur women with cervical intraepithelial neoplasia in Xinjiang area. Eur J Gynaecol Oncol, 2015, 36(5): 564-568.
38.	王楠. 貴州省部分少數民族婦女宮頸癌的 HPV 譜研究. 遵義: 遵義醫學院, 2011.
39.	Wu EQ, Zhang GN, Yu XH, et al. Evaluation of high-risk human papillomaviruses type distribution in cervical cancer in Sichuan province of China. BMC Cancer, 2008, 8: 202.
40.	Yuanyue L, Baloch Z, Yasmeen N, et al. The distribution of human papillomavirus genotypes in cervical cancer and intraepithelial neoplasia lesions among Chinese women in Yunnan Province. J Infect Public Health, 2018, 11(1): 105-110.
41.	Chen Z, Meng W, Du R, et al. Genotype distribution and the relative risk factors for human papillomavirus in Urumqi, China. Exp Ther Med, 2013, 6(1): 85-90.
42.	Li K, Yin R, Li Q, et al. Analysis of HPV distribution in patients with cervical precancerous lesions in Western China. Medicine (Baltimore), 2017, 96(29): e7304.
43.	Jiang W, Marshall Austin R, Li L, et al. Extended human papillomavirus genotype distribution and cervical cytology results in a large cohort of chinese women with invasive cervical cancers and high-grade squamous intraepithelial lesions. Am J Clin Pathol, 2018, 150(1): 43-50.
44.	Yang L, Yang H, Wu K, et al. Prevalence of HPV and variation of HPV 16/HPV 18 E6/E7 genes in cervical cancer in women in South West China. J Med Virol, 2014, 86(11): 1926-1936.
45.	Li J, Mei J, Wang X, et al. Human papillomavirus type-specific prevalence in women with cervical intraepithelial neoplasm in Western China. J Clin Microbiol, 2012, 50(3): 1079-1081.
46.	Li J, Zhang D, Zhang Y, et al. Prevalence and genotype distribution of human papillomavirus in women with cervical cancer or high-grade precancerous lesions in Chengdu, western China. Int J Gynaecol Obstet, 2011, 112(2): 131-134.
47.	Ogilvie GS, van Niekerk D, Krajden M, et al. Effect of screening with primary cervical HPV testing vs cytology testing on high-grade cervical intraepithelial neoplasia at 48 months: the HPV focal randomized clinical trial. JAMA, 2018, 320(1): 43-52.
48.	Wright TC, Stoler MH, Behrens CM, et al. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol, 2015, 136(2): 189-197.
49.	Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol, 2012, 137(4): 516-542.
50.	Clifford GM, Smith JS, Plummer M, et al. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer, 2003, 88(1): 63-73.
51.	Xu HH, Wang K, Feng XJ, et al. Prevalence of human papillomavirus genotypes and relative risk of cervical cancer in China: a systematic review and meta-analysis. Oncotarget, 2018, 9(20): 15386-15397.
52.	Wu Y, Chen Y, Li L, et al. Associations of high-risk HPV types and viral load with cervical cancer in China. J Clin Virol, 2006, 35(3): 264-269.
53.	Li Y, Wang Y, Jia C, et al. Detection of human papillomavirus genotypes with liquid bead microarray in cervical lesions of northern Chinese patients. Cancer Genet Cytogenet, 2008, 182(1): 12-17.
54.	Hooi DJ, Lissenberg-Witte BI, Kenter G, et al. Human papillomavirus (HPV) prevalence and associated risk factors in women from Cura?ao. PLoS One, 2018, 13(7): e0199624.
55.	Zhao P, Liu S, Zhong Z, et al. Prevalence and genotype distribution of human papillomavirus infection among women in northeastern Guangdong province of China. BMC Infect Dis, 2018, 18(1): 204.
56.	Qian L, Zhang Y, Cui D, et al. Analysis of epidemiological trends in human papillomavirus infection among gynaecological outpatients in Hangzhou, China, 2011-2015. BMC Infect Dis, 2017, 17(1): 393.
57.	Zhao R, Zhang WY, Wu MH, et al. Human papillomavirus infection in Beijing, People's Republic of China: a population-based study. Br J Cancer, 2009, 101(9): 1635-1640.

1. Human papillomavirus and related cancers in word. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre), 2018. Available at: https://hpvcentre.net/.
2. Human papillomavirus and related diseases in China. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre), 2018. Available at: https://hpvcentre.net/.
3. Lowy DR, Solomon D, Hildesheim A, et al. Human papillomavirus infection and the primary and secondary prevention of cervical cancer. Cancer, 2008, 113(7 Suppl): 1980-1993.
4. 胡尚英, 鄭榮壽, 趙方輝, 等. 1989 至 2008 年中國女性子宮頸癌發病和死亡趨勢分析. 中國醫學科學院學報, 2014, 36(2): 119-125.
5. Sinno AK, Saraiya M, Thompson TD, et al. Human papillomavirus genotype prevalence in invasive vaginal cancer from a registry-based population. Obstet Gynecol, 2014, 123(4): 817-821.
6. Li K, Yin R, Wang D, et al. Human papillomavirus subtypes distribution among 2309 cervical cancer patients in west China. Oncotarget, 2017, 8(17): 28502-28509.
7. Zhao XL, Hu SY, Zhang Q, et al. High-risk human papillomavirus genotype distribution and attribution to cervical cancer and precancerous lesions in a rural Chinese population. J Gynecol Oncol, 2017, 28(4): e30.
8. Zhang L, Bi Q, Deng H, et al. Human papillomavirus infections among women with cervical lesions and cervical cancer in Eastern China: genotype-specific prevalence and attribution. BMC Infect Dis, 2017, 17(1): 107.
9. Zhong TY, Zhou JC, Hu R, et al. Prevalence of human papillomavirus infection among 71, 435 women in Jiangxi province, China. J Infect Public Health, 2017, 10(6): 783-788.
10. 武澤軒. HPV 疫苗應用概述. 科學技術創新, 2017, (28): 43-44.
11. Wells G. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute, 2011.
12. Abulizi G, Li H, Mijiti P, et al. Risk factors for human papillomavirus infection prevalent among Uyghur women from Xinjiang, China. Oncotarget, 2017, 8(58): 97955-97964.
13. Husaiyin S, Niyazi M, Wang LH, et al. HPV infection among Uygur women in a rural area of Hetian Prefecture, Xinjiang Uygur Autonomous Region, China. Biomed Environ Sci, 2013, 26(11): 934-936.
14. Mijit F, Ablimit T, Abduxkur G, et al. Distribution of human papillomavirus (HPV) genotypes detected by routine Pap smear in Uyghur-Muslim women from Karasay Township Hotan (Xinjiang, China). J Med Virol, 2015, 87(11): 1960-1965.
15. Niyazi M, Husaiyin S, Han L, et al. Prevalence of and risk factors for high-risk human papillomavirus infection: a population-based study from Hetian, Xinjiang, China. Bosn J Basic Med Sci, 2016, 16(1): 46-51.
16. Wang X, Ji Y, Li J, et al. Prevalence of human papillomavirus infection in women in the Autonomous Region of Inner Mongolia: A population-based study of a Chinese ethnic minority. J Med Virol, 2018, 90(1): 148-156.
17. 韓娜娜, 邵文裕, 馬焱, 等. 2009-2013 年新疆維吾爾自治區 HPV 在不同宮頸病變中的基因型分布情況及其臨床意義. 中國婦幼保健, 2014, 29(23): 3721-3724.
18. 唐努爾·阿不力米提. HPV 各亞型在新疆和田喀爾賽鄉維吾爾族婦女中的分布研究. 烏魯木齊: 新疆醫科大學, 2009.
19. 段秀方, 蘆曉紅, 張喜龍. 快速導流雜交分型技術檢測寧夏地區人乳頭瘤病毒(HPV)感染基因型分布特點. 中國衛生檢驗雜志, 2014, 24(16): 2388-2390.
20. 狄麗努爾·熱孜木, 再努爾·阿布都熱衣木, 古扎麗努爾·阿不力孜, 等. 新疆喀什伽師縣維吾爾族婦女 HPV 的分布研究. 新疆醫科大學學報, 2013, 36(9): 1357-1361, 1356.
21. 何禮霞, 何俊勇, 曾莉, 等. 3443 例體檢女性宮頸高危型人乳頭瘤病毒感染狀況分析. 現代預防醫學, 2013, 40(20): 3748-3750, 3755.
22. Baloch Z, Yuan T, Wang B, et al. Ethnic and geographic variations in HPV prevalence and genotype distribution in north-western Yunnan, China. J Med Virol, 2016, 88(3): 532-540.
23. Baloch Z, Li Y, Yuan T, et al. Epidemiologic characterization of human papillomavirus (HPV) infection in various regions of Yunnan Province of China. BMC Infect Dis, 2016, 16: 228.
24. Sun LL, Jin Q, Li H, et al. Population-based study on the prevalence of and risk factors for human papillomavirus infection in Qujing of Yunnan province, southwest China. Virol J, 2012, 9: 153.
25. Tang Y, Zheng L, Yang S, et al. Epidemiology and genotype distribution of human papillomavirus (HPV) in southwest China: a cross-sectional five years study in non-vaccinated women. Virol J, 2017, 14(1): 84.
26. Zou H, Sun Y, Zhang G, et al. Positivity and incidence of human papillomavirus in women attending gynecological department of a major comprehensive hospital in Kunming, China 2012-2014. J Med Virol, 2016, 88(4): 703-711.
27. 趙菊芬, 李茜, 張琴, 等. 云南紅河和文山地區女性宮頸人乳頭瘤病毒感染基因亞型分布狀況研究. 中國全科醫學, 2012, 15(18): 2036-2038.
28. 楊赟平, 楊雙雙, 張莉萍. 重慶地區婦女高危型 HPV 感染現狀及年齡的分層分布. 重慶醫學, 2013, 42(3): 249-250, 254.
29. Long W, Yang Z, Li X, et al. HPV-16, HPV-58, and HPV-33 are the most carcinogenic HPV genotypes in Southwestern China and their viral loads are associated with severity of premalignant lesions in the cervix. Virol J, 2018, 15(1): 94.
30. Peng J, Yuan Y, Shen F, et al. Cervical cancers manifest a high rate of infection by a high-risk human papilloma virus subtype but a very low rate of infection by a low-risk subtype in the Guiyang district of China. J Cancer, 2017, 8(7): 1263-1270.
31. Baloch Z, Yuan T, Yindi S, et al. Prevalence of genital human papillomavirus among rural and urban populations in southern Yunnan province, China. Braz J Med Biol Res, 2016, 49(6): e5254.
32. Baloch Z, Yue L, Yuan T, et al. Status of human papillomavirus infection in the ethnic population in Yunnan province, China. Biomed Res Int, 2015, 2015: 314815.
33. Baloch Z, Yasmeen N, Li Y, et al. Prevalence and risk factors for human papillomavirus infection among Chinese ethnic women in southern of Yunnan, China. Braz J Infect Dis, 2017, 21(3): 325-332.
34. 祝愿. 青海地區回族婦女宮頸癌 HPV 譜及組織類型相關性研究. 西寧: 青海大學, 2016.
35. Wang L, Wang P, Ren Y, et al. Prevalence of high-risk human papillomavirus (HR-HPV) genotypes and multiple infections in cervical abnormalities from Northern Xinjiang, China. PLoS One, 2016, 11(8): e0160698.
36. Wu EQ, Yu XH, Zha X, et al. Distribution of human papillomavirus genotypes in archival cervical lesions in eastern inner Mongolian autonomous region, China. Int J Gynecol Cancer, 2009, 19(5): 919-923.
37. Du R, Chen ZF, Li XH, et al. Human papillomavirus infection among Uyghur women with cervical intraepithelial neoplasia in Xinjiang area. Eur J Gynaecol Oncol, 2015, 36(5): 564-568.
38. 王楠. 貴州省部分少數民族婦女宮頸癌的 HPV 譜研究. 遵義: 遵義醫學院, 2011.
39. Wu EQ, Zhang GN, Yu XH, et al. Evaluation of high-risk human papillomaviruses type distribution in cervical cancer in Sichuan province of China. BMC Cancer, 2008, 8: 202.
40. Yuanyue L, Baloch Z, Yasmeen N, et al. The distribution of human papillomavirus genotypes in cervical cancer and intraepithelial neoplasia lesions among Chinese women in Yunnan Province. J Infect Public Health, 2018, 11(1): 105-110.
41. Chen Z, Meng W, Du R, et al. Genotype distribution and the relative risk factors for human papillomavirus in Urumqi, China. Exp Ther Med, 2013, 6(1): 85-90.
42. Li K, Yin R, Li Q, et al. Analysis of HPV distribution in patients with cervical precancerous lesions in Western China. Medicine (Baltimore), 2017, 96(29): e7304.
43. Jiang W, Marshall Austin R, Li L, et al. Extended human papillomavirus genotype distribution and cervical cytology results in a large cohort of chinese women with invasive cervical cancers and high-grade squamous intraepithelial lesions. Am J Clin Pathol, 2018, 150(1): 43-50.
44. Yang L, Yang H, Wu K, et al. Prevalence of HPV and variation of HPV 16/HPV 18 E6/E7 genes in cervical cancer in women in South West China. J Med Virol, 2014, 86(11): 1926-1936.
45. Li J, Mei J, Wang X, et al. Human papillomavirus type-specific prevalence in women with cervical intraepithelial neoplasm in Western China. J Clin Microbiol, 2012, 50(3): 1079-1081.
46. Li J, Zhang D, Zhang Y, et al. Prevalence and genotype distribution of human papillomavirus in women with cervical cancer or high-grade precancerous lesions in Chengdu, western China. Int J Gynaecol Obstet, 2011, 112(2): 131-134.
47. Ogilvie GS, van Niekerk D, Krajden M, et al. Effect of screening with primary cervical HPV testing vs cytology testing on high-grade cervical intraepithelial neoplasia at 48 months: the HPV focal randomized clinical trial. JAMA, 2018, 320(1): 43-52.
48. Wright TC, Stoler MH, Behrens CM, et al. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol, 2015, 136(2): 189-197.
49. Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol, 2012, 137(4): 516-542.
50. Clifford GM, Smith JS, Plummer M, et al. Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. Br J Cancer, 2003, 88(1): 63-73.
51. Xu HH, Wang K, Feng XJ, et al. Prevalence of human papillomavirus genotypes and relative risk of cervical cancer in China: a systematic review and meta-analysis. Oncotarget, 2018, 9(20): 15386-15397.
52. Wu Y, Chen Y, Li L, et al. Associations of high-risk HPV types and viral load with cervical cancer in China. J Clin Virol, 2006, 35(3): 264-269.
53. Li Y, Wang Y, Jia C, et al. Detection of human papillomavirus genotypes with liquid bead microarray in cervical lesions of northern Chinese patients. Cancer Genet Cytogenet, 2008, 182(1): 12-17.
54. Hooi DJ, Lissenberg-Witte BI, Kenter G, et al. Human papillomavirus (HPV) prevalence and associated risk factors in women from Cura?ao. PLoS One, 2018, 13(7): e0199624.
55. Zhao P, Liu S, Zhong Z, et al. Prevalence and genotype distribution of human papillomavirus infection among women in northeastern Guangdong province of China. BMC Infect Dis, 2018, 18(1): 204.
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Chinese Journal of Evidence-Based Medicine

The prevalence of high risk human papillomavirus of females in western China: a meta-analysis

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