Type‐ and age‐specific natural history of high‐risk human papillomavirus infections in healthy women: A prospective cohort study in China

As cervical cancer screening shifts from cytology to HPV testing, clarifying the type- and age-specific natural history of HR-HPV is crucial, especially in regions with bimodal prevalence patterns where longitudinal data remain limited. We analyzed baseline HR-HPV-positive participants from the control arm of a bivalent HPV-16/18 vaccine trial in China, with follow-up over 5.5 years. Cox regression and competing risk models were applied to evaluate the progression, clearance, and persistence of these HR-HPV infections. Among 534 HR-HPV-positive women at baseline, 98 CIN2+ lesions were identified (52 at baseline, 46 during follow-up). HPV-16 and HPV-31 exhibited the highest immediate CIN2+ risk (21.1%), followed by HPV-33 (17.1%) and HPV-58 (12.7%). When stratified by baseline cytology, the LSIL+ group showed the highest immediate risk of CIN2+ (29.5% among the HR-HPV-positive participants), followed by the ASC-US (10.5%). In the longitudinal analysis, competing risk models revealed significant type-specific differences in progression (Gray's test P = 0.0158) and clearance (Gray's test P