Human papillomavirus and cervical neoplasia: A case‐control study in Taiwan

As part of a large‐scale, community‐based cervical neoplastic screening project in rural Taiwan, a case‐control study was undertaken to evaluate the etiologic role of human papillomavirus (HPV) infection in this mainly monogamous (2% reported having multiple sexual partners) female population. A total of 88 biopsy‐confirmed cases and 261 cytologically normal controls were selected for the study. The case group included 40 cases of cervical intraepithelial neoplasia (CIN) 1, 9 of CIN 2, 36 of CIN 3 and 3 cases of invasive cancer. Cervical swabs collected at screening from study subjects were tested for HPV DNA by an LI consensus primer polymerase chain reaction (PCR)‐based technique. HPV DNA was found in 92% of high‐grade cases (CIN 2‐3 and invasive cancer); 54% of low‐grade cases (CIN I); and 9% of controls. HPV was significantly associated with both high‐grade and low‐grade cervical neoplasia. As reported in Western countries, HPV 16 was the predominant type among HPV‐positive high‐grade cases. However, HPVs 52 and/or 58 combined were the most common types among HPV‐positive low‐grade cases and controls. Among women without any high‐risk HPV infection (types 16, 18, 31 or 45), those with multiple‐type HPV infection had a higher risk for high‐grade cervical neoplasia than those with single‐type infection. Overall, 91% of high‐grade cases and 50% of low‐grade cases could be attributed to HPV infection. Our results show that, even in this monogamous population, HPV is the major risk factor for high‐grade cervical neoplasia. © 1995 Wiley‐Liss, Inc.