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Prevalence of human papillomavirus by geographical regions, sexual orientation and HIV status in China: a systematic review and meta-analysis
  1. Xiaomeng Ma1,2,
  2. Qian Wang3,
  3. Jason J Ong4,
  4. Christopher K Fairley4,5,
  5. Shu Su5,6,
  6. Peng Peng2,
  7. Jun Jing2,
  8. Linhong Wang3,
  9. Nyi Nyi Soe2,
  10. Feng Cheng2,
  11. Lei Zhang2,4,5,6
  1. 1 Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2 Research Centre for Public Health, School of Medicine, Tsinghua University, Beijing, China
  3. 3 Maternal and Child Healthcare Center, Chinese Center for Disease Control and Prevention, Beijing, China
  4. 4 Central Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
  5. 5 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  6. 6 School of Public Health and Preventive Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
  1. Correspondence to Prof. Feng Cheng, Research Centre for Public Health, School of Medicine, Tsinghua University, Beijing 100084, China; fcheng{at} and Dr. Lei Zhang, Central Clinical School Monash University Faculty of Medicine, Nursing and Health Sciences Clayton Victoria Australia ; lei.zhang1{at}


Objective Human papillomavirus (HPV) infection causes multiple cancers in both women and men. In China, both HPV vaccination and cervical cancer screening coverages are low. We aim to investigate the temporal and geographical trends of HPV DNA prevalence in heterosexual men, women, men who have sex with men (MSM) and people living with HIV (PLHIV) in China.

Methods We conducted a systematic review, collecting publications in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Data from January 2000 to May 2017. A total of 247 studies were selected for this meta-analysis to estimate pooled HPV prevalence, incidence of cervical cancer and risk of infection for subgroups. Meta-regression was applied to identify contributing factors to prevalence heterogeneities.

Results The national HPV prevalence was 15.6% (95% CI (14.4% to 16.9%)) in women with normal cervical cytology, and Central China had the highest prevalence (20.5% (15.2% to 25.8%)). HPV prevalence in heterosexual men (14.5% (11.3% to 17.7%)) was comparable with that of women (OR=1.09 (0.98 to 1.17)), but HPV prevalence in MSM (59.9% (52.2% to 67.6%)) was significantly higher than that in heterosexual men (OR=8.81 (8.01 to 9.69)). HIV-positive women (45.0% (38.4% to 51.6%)) and HIV-positive MSM (87.5% (82.3% to 90.9%)) had 4.67 (3.61 to 6.03) and 6.46 (5.20 to 8.02) times higher risk of HPV infection than their HIV negative counterparts.

Conclusion HPV infection is prevalent in China, particularly in Central China, in comparison with the global level and neighbouring countries. Targeted HPV vaccination for women, MSM and PLHIV and scale-up of cervical screening for women are priorities in curbing the HPV epidemic in China.

  • Hpv
  • meta-analysis
  • Hiv
  • gay men
  • women

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  • XM and QW contributed equally.

  • Handling editor Jackie A Cassell

  • Contributors XM and QW were both liable for the data collection, data cleaning, statistical analysis and figure plotting. PP reviewed and double-checked the literature search strategy. XM and LZ wrote the first version of the manuscript. JJO, CKF, SS, PP, LZ and NNS reviewed the manuscript and contributed to modification. JJ, LW and FC reviewed and commented on the draft. LZ and FC cosupervised the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.