The correlation between HPV viral load and cervical lesions is poorly known, and the significance of HPV viral load in the detection and treatment of cervical lesions is still controversial [17, 19]. Therefore, this study aimed to analyze the correlation between the HR-HPV viral load and different cervical lesion degrees, and the value of HR-HPV viral load in the early diagnosis and prediction of cervical lesions. The results suggest that cervical lesions are closely related to HR-HPV infection. Higher HR-HPV viral load in cervical lesions was associated with a higher risk of high-grade cervical lesions. Nevertheless, the HR-HPV DNA load could be used for triage [15].
In this population, the rate of HPV positivity among the screened women was 13.5%, which is a little lower than the national rate in China [22]. The patients with CIN III and CC were older than those with normal results, CIN I, and CIN II, which is consistent with the literature, i.e., that age is a risk factor for advanced cervical lesions [1, 4, 9, 20].
Since the integration of the HPV DNA into the host cells is necessary for malignant transformation by the E6 and E7 proteins, the HBV DNA load has been suggested to be used as a marker of the risk of dysplasia and CC [17, 23]. In addition, the quantification of the DNA load could have a direct relationship with the risk of cervical lesions [24–26]. Many HPV infections will not lead to cervical lesions since a persistent infection is necessary for malignant transformation, and many infections are self-resolving [27]. Therefore, high viral loads should suggest persistent infections, and high viral loads indicate a lower possibility of self-resolution [28]. Hildesheim et al. [29] showed that a viral load threshold of 10 pg/mL indicated persisting HPV infection. Nevertheless, this association is still controversial [21, 30]. Lorincz et al. [21] reported that there was no association between the viral load of 13 HR-HPVs and the risk of CIN III and CC, while Wu et al. [24] showed that the HPV-18 viral load was low in precancerous lesions but high in CC. On the other hand, the present study supports the hypothesis that high HR-HPV viral loads are associated with more advanced cervical lesions. This view is supported by Long et al. [19], who showed that the viral load of HPV-16, HPV-58, and HPV-33 was associated with high-grade cervical lesions, as well as by other studies in various populations [13–19, 31–33]. Berggrund et al. [14] showed that the HR-HPV viral load could indicate the course of the infection, as well as the presence of CIN II, CIN III, and CC. A previous study also showed a correlation between the HC2 viral load and CIN grade [34]. Nevertheless, a study suggested that a single measure of HOV viral load could not reliably indicate the presence of CIN [35]. Therefore, future studies could consider performing serial measurements.
This study has limitations. It was performed at a single center, and the sample size was relatively small, mainly because not all patients underwent HC2 analysis. The data that could be analyzed were limited to those available in the medical charts. The exact HPV subtype was not available for many patients, who were simply indicated as positive in their chart. Additional studies are still necessary to refine our understanding of the relationship between HPV DNA load and cervical lesions. Since only HR-HPV-positive patients were included, the frequency of HR-HPV positivity in each pathological group could be analyzed.