Background
Cervical cancer remains a major public health problem in India, largely driven by persistent infection with high-risk human papillomavirus (hrHPV). Community-based HPV DNA testing is an effective strategy for early detection and prevention of cervical cancer, particularly in low-resource settings. However, large-scale real-world data on HPV genotype distribution from community screening programs in South India are limited. Understanding age-wise and genotype-wise prevalence patterns is essential for optimizing screening strategies and informing vaccination and triage policies.
Objectives
To determine the prevalence and genotype distribution of high-risk HPV among community women in South India using the Roche Cobas® 4800 HPV DNA testing platform.
Methods
A community-based cross-sectional cervical cancer screening program was conducted among asymptomatic women in South India. Cervical samples were collected using standard collection devices and transported under recommended conditions to a centralized molecular diagnostics laboratory. HPV DNA testing was performed using the Cobas® 4800 system (Roche Diagnostics), which individually detects HPV16 and HPV18 and collectively detects a pool of other high-risk (OHR; HPV 31,33,35, 39,45, 51, 52. 56, 58, 59, 66, 68) genotypes. Test outcomes were categorized as HPV negative, HPV16 positive, HPV18 positive, OHR positive, mixed infection (more than one hrHPV detected), or invalid.
Results
A total of 33,672 asymptomatic community women were screened for HPV DNA. Overall, 2,124 women (6.3%) tested positive for high-risk HPV, while 31,266 (92.9%) were HPV negative. The genotype distribution was as follows: HPV16 in 457 women (1.4%), HPV18 in 165 (0.5%), OHR genotypes in 1,320 (3.9%), and mixed infections in 182 (0.5%). Invalid results were observed in 282 samples (0.8%).
Age-wise analysis showed that HPV negativity remained consistently high across all age groups: 11,983/12,852 (93.2%) in women aged 31–40 years, 10,460/11,293 (92.6%) in 41–50 years, and 5,800/6,264 (92.6%) in 51–60 years. The prevalence of other high-risk (OHR) HPV genotypes was comparable across age groups, with 500/12,852 (3.9%), 446/11,293 (3.9%), and 244/6,264 (3.9%) in the respective age categories. HPV16 positivity showed a slight increasing trend with age, observed in 159/12,852 (1.2%), 158/11,293 (1.4%), and 94/6,264 (1.5%) women in the 31–40, 41–50, and 51–60 year groups, respectively. HPV18 prevalence remained low across all age groups, detected in 59/12,852 (0.5%), 70/11,293 (0.6%), and 22/6,264 (0.4%) women, respectively. The association between age group and HR HPV prevalence was statistically significant (p = 0.017), indicating a modest but meaningful variation in genotype distribution across age groups.
 Conclusions
This large community-based screening study demonstrates a overall HR HPV prevalence (6.3%) among women in South India, with OHR genotypes being more common than HPV16 and HPV18. The statistically significant age-wise variation in genotype distribution highlights the need for age-appropriate triage and follow-up strategies. Since several individual OHR genotypes are known to independently drive cervical carcinogenesis, these findings emphasize the limitation of assays that only provide pooled OHR results. Therefore, incorporation of extended HPV genotyping in community screening programs would enable identification of specific high-risk genotypes, improve risk stratification, guide appropriate triage and follow-up, and support more targeted public health interventions and vaccination impact assessment.