Abstract
BACKGROUND: High-risk human papillomavirus (HR-HPV) infection is the major risk factor for cervical cancer, which remains a significant concern, particularly in low and middle-income countries due to the lack of effective treatment and preventive measures. Examining the prevalence and distribution of HR-HPV is key to designing or reformulating policies aimed at eliminating HPV-associated cancers. METHODS: A retrospective analysis was conducted using HR-HPV genotyping data from 9,524 women aged ≥18 years of the north-central region of Ecuador, who underwent cervical sampling either in cervical cancer prevention campaigns or during gynecological outpatient clinics, between January 2015 and August 2022. Samples were tested for HR-HPV using the cobas(®) 4800 HPV Test. Infection rates and genotype distributions were assessed across years, age groups, and provinces. Multivariable logistic regression was conducted to identify independent factors associated with HR-HPV infections. Potential association profiles among genotypes were explored through Multiple correspondence analysis. RESULTS: The overall prevalence of HR-HPV was 26.87% [95% CI: 25.98, 27.77]. In particular, HPV 16 was found in 8.64% [95% CI: 8.08, 9.22] of the participants, HPV 18 in 2.85% [95% CI: 2.52, 3.20], and Other HR-HPV in 19.41% [95% CI: 18.62, 20.22]. Fluctuating prevalence trends during the study period were determined, with Other HR-HPV as the only category with a positive trend (aAPC: 3.44% [95% CI: 0.89, 6.05]; p < 0.01). The age-specific infection rate of HR-HPV showed a bimodal distribution, with the younger women (18-24 years old) harboring the highest rate. A second peak was identified in the postmenopausal group of 65-69 years old. Relative to Pichincha, Imbabura exhibited 50% higher odds ratio of HPV 16 infection (p < 0.001), while Santo Domingo de los Tsáchilas had 27% and 30% lower odds of Overall HR-HPV and Other HR-HPV infections, respectively (p < 0.01). CONCLUSIONS: This study represents the largest-scale analysis on the epidemiology of HR-HPV in Ecuador. Given the high prevalence and positive trend of Other HR-HPV, our findings underscore the need for multivalent HPV vaccines. National screening strategies may consider screening of women over the age of 65 years when clinically indicated based on the patient history or physician judgment. CLINICAL TRIAL NUMBER: Not applicable.