Abstract
Human papillomavirus 52 (HPV52) is the second most frequent HPV type in high-grade squamous intraepithelial lesion (HSIL) cases in China. However, few researchers have explored the co-infection of HPV52 with other HPV genotypes and their correlation with cervical lesions. In this study, 13,809 HPV52-positive patients visiting the Obstetrics and Gynecology Hospital of Fudan University from 2018 to 2023 were included in the first stage to investigate the risk of cervical lesions among different multiple infection patterns. Another 443 HPV52-positive patients were further included for sequence alignment and phylogenetic analysis. In the current study, the most common HPV52 dual-infection patterns were as follows: HPV16 + HPV52, HPV52 + HPV58, HPV52 + HPV53, and HPV52 + HPV81. Compared with HPV52 single infection, the risk of HSIL+ was increased in HPV16 + HPV52 (OR = 3.47, 95% CI: 2.56, 4.69) and HPV52 + HPV58 (OR = 1.99, 95% CI: 1.35, 2.92) groups. The most common triple-infection patterns were HPV16 + HPV52 + HPV53 and HPV52 + HPV53 + HPV81, followed by HPV52 + HPV53 + HPV58. HPV53 was the most common co-infection type with HPV52 in cases of triple or more multiple infections. However, compared with dual infection, the addition of HPV53 did not affect the risk of HSIL+. Two synonymous mutations, G207A (p = 0.029) and C1203T (p = 0.021), showed statistically significant differences in distribution between single and multiple infection groups. Our results demonstrated that HPV52 showed preferences for co-infection with HPV16, 585,381. HPV52 co-infection with HPV16 and HPV58 increased the risk of HSIL+, while co-infection with HPV53 did not increase the risk of HSIL+. Virus variants with certain mutations may be more susceptible to multiple infections.