Abstract

Background: The association between metabolic risk factors and human papillomavirus (HPV) infection is under debate. This study aimed to investigate the associations between metabolic risk factors and HPV infection, while also providing updated data on the prevalence of HPV infection in the post-vaccine era in China.
Methods: This multi-center cross-sectional study involved 684,632 adult women who had undergone a standard health screening in 2019. HPV infection prevalence was estimated. Linear and nonlinear associations between HPV infection and metabolic risk factors were assessed, such as body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), and low-density lipoprotein (LDL).
Results: The standardized prevalence of overall and high-risk HPV infection was 16.2% (95% confidence interval [95%CI]: 15.1-17.3) and 12.8% (95%CI: 11.8-13.7), respectively. The most prevalent genotypes were HPV-52, HPV-58, HPV-16, and HPV-53. HPV infection was negatively associated with BMI, with women in the highest quartile having the lowest odds of infection compared to those in the lowest quartile (odds ratio[OR]=0.84, 95%CI: 0.78-0.91, P<0.0001), indicating a significant linear trend (Ptrend<0.0001). Nonlinear associations were observed for SBP (Pnon-linearity<0.0001), FPG (Pnon-linearity<0.0001) and LDL (Pnon-linearity=0.008). The overall HPV risk was observed to decrease with increasing SBP, especially when SBP was below 114 mmHg. Both FPG and LDL were positively associated with HPV risk. ORs were more pronounced when FPG was less than 4.9 mmol/L and LDL was between 2.7 and 3.5 mmol/L. However, for women aged over 50 years, the dose-response curves initially showed a rising trend, followed by a decline. 
Conclusions: The prevalence of HPV infection in China remains high and may be associated with metabolic risk factors. Longitudinal studies are needed to validate the association between metabolic risk factors and HPV infection.