{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:08:48Z","timestamp":1777637328823,"version":"3.51.4"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018568","name":"Special Fund Project for Science and Technology Innovation Strategy of Guangdong Province","doi-asserted-by":"publisher","award":["No. 210128166270630"],"award-info":[{"award-number":["No. 210128166270630"]}],"id":[{"id":"10.13039\/501100018568","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterize post-conization time-varying HPV positivity trajectories in a real-world setting with irregular follow-up, and to assess whether the association between baseline infection multiplicity (single vs. multiple) and postoperative HPV positivity is robust to testing intensity and potential informative visiting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective cohort of 872 women who underwent conization and completed \u22651 postoperative HPV test, we modeled HPV positivity (yes\/no) over continuous months since conization using generalized additive mixed models with subject-specific random effects. Time-varying between-group differences were evaluated using a group-specific time-varying parameter. To address irregular follow-up and potential informative visiting, we performed prespecified sensitivity analyses by (i) restricting to women with \u22653 postoperative HPV tests and (ii) additionally adjusting for testing intensity (number of HPV tests during follow-up). Models adjusted for age, menopausal status, admission type, health insurance type, margin status, preoperative cytology, gravidity\/parity, and postoperative hysterectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the overall cohort, postoperative HPV positivity decreased over time in both groups (per 4 months: single infection OR = 0.66, 95% CI 0.63\u20130.70; multiple infection OR = 0.71, 95% CI 0.65\u20130.78; both\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.0001). Multiple infection was associated with a persistently higher time-varying trajectory (OR = 1.22, 95% CI 1.12\u20131.32;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.0001), with differences concentrated in the early-to-mid follow-up period. Findings were consistent in sensitivity analyses restricting to women with \u22653 tests and after adjustment for testing intensity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Post-conization HPV testing occurs under irregular, potentially informative follow-up in real-world practice. Accounting for testing intensity, the association between baseline multiple infection and less favorable time-varying postoperative trajectories remained robust, supporting risk-stratified surveillance while highlighting the need to explicitly consider follow-up patterns when estimating postoperative HPV dynamics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1808122","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T06:07:12Z","timestamp":1777442832000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Informative HPV testing after conization and its impact on time-varying estimates: a GAMM-based cohort study"],"prefix":"10.3389","volume":"14","author":[{"given":"Jie","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Gynecology, Yuebei People's Hospital Affiliated to Shantou University Medical College","place":["Shaoguan, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian hong","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Yuebei People's Hospital Affiliated to Shantou University Medical College","place":["Shaoguan, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin Jie","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Gynecology, First People's Hospital of Zhaoqing","place":["Zhaoqing, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Yuebei People's Hospital Affiliated to Shantou University Medical College","place":["Shaoguan, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong bo","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Yuebei People's Hospital Affiliated to Shantou University Medical College","place":["Shaoguan, Guangdong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e164","DOI":"10.3346\/jkms.2021.36.e164","article-title":"Discrepancy between cytology and histology in cervical cancer screening: a multicenter retrospective study (KGOG 1040)","volume":"36","author":"Ouh","year":"2021","journal-title":"J Korean Med Sci."},{"key":"B2","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1186\/s12893-021-01238-8","article-title":"The effectiveness of cold-knife conization (CKC) for post-menopausal women with cervical high-grade squamous intraepithelial lesion: a retrospective study","volume":"21","author":"Li","year":"2021","journal-title":"BMC Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"698","DOI":"10.3390\/vaccines11030698","article-title":"Outcomes of high-grade cervical dysplasia with positive margins and HPV persistence after cervical conization","volume":"11","author":"Giannini","year":"2023","journal-title":"Vaccines"},{"key":"B4","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1002\/ijc.30623","article-title":"Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): a systematic review","volume":"141","author":"Hoffman","year":"2017","journal-title":"Int J Cancer."},{"key":"B5","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1007\/s00404-018-4936-9","article-title":"Risk factors of persistent HPV infection after treatment for high-grade squamous intraepithelial lesion","volume":"299","author":"So","year":"2019","journal-title":"Arch Gynecol Obstet."},{"key":"B6","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s12985-025-03047-4","article-title":"Factors related to cervicogenital high-risk human papillomavirus persistence among Chinese women: a nationwide multi-center cohort study","volume":"23","author":"Li","year":"2025","journal-title":"Virol J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e29835","DOI":"10.1002\/jmv.29835","article-title":"Cui X,et al. 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