Revisiting HPV infection pattern among urban Indonesian women in general population and its implication on health burden: A cross-sectional analysis from Indonesian Noncommunicable Disease Research 2016

Objective: To identify circulating HPV types among urban Indonesian women and their specific co-infection patterns in bid to curb HPV infection in the general population and minimize its complications. Methods: Urban Indonesian women from general population were selected as sample framework. Sample size and distribution across regions were determined by the Indonesian Bureau of Statistics (Badan Pusat Statistik, BPS), which represented the national level. Up to 35 408 cervical swab specimens were collected from August to September 2016 in 34 Indonesian provinces, categorized into six regions based on the development criteria set by the Ministry of National Development Planning (Badan Perencanaan Pembangunan Nasional, BAPPENAS). From all 1874 samples identified as HPV-positive, hybrid capture was implemented to evaluate type-specific HPV. This study analyzed descriptive data to determine the core-cluster of HPV combination. Co-occurrence HPV network was assessed using ‘qgraph’ package version 1.6.3 and computed in R version 3.6.3. Two-HPV association was analyzed in logistic regression using bias-reduction generalized linear model (brglm2) package version 0.5.1 adjusted by age and six main Indonesian regions. Results: The logistic regression analysis demonstrated that HPV type 52 had rare relationship despite its common co-occurrence, cementing its role in single HPV infection. HPV type 16 and 18 tended to form infection cluster and were strongly associated with other types. Conclusions: HPV type 52 was the most frequent HPV type among urban Indonesian women and accounted for most single infection cases. Concurrently, HPV 16 and HPV 18 accounted for most multiple infection cases and had strong tendency to attract other types, which may add further complications. However, due to lack of cytology and histological examination and information for other potential determinants, further in-depth studies are necessary to confirm whether these infection patterns truly connect to certain clinical outcomes.