Association of human papillomavirus type 16 and its genetic variants with cervical lesion in Korea. APMIS 2016; 124: 950-957. Persistent human papillomavirus type 16 (HPV16) is the major risk factor for cervical cancer. HPV16 intratypic variants differ in their geographical distribution and oncogenic potential. This study aimed to analyze the distribution of HPV16 variants and their association with cervical lesion histopathology in Korean women. In total, 133 HPV16-positive cervical samples from women admitted to Seoul National University Boramae Hospital were analyzed by sequencing E6, E7, and L1 genes and the long control region (LCR), and the variant distribution according to cervical lesion grade was determined. Isolates were grouped into a phylogenetic lineage, and A1-3, A4, C, and D sublineages were detected in 54.1, 37.8, 0.7, and 7.4% of samples, respectively. The most commonly observed LCR variations were 7521G>A (91.5%), 7730A>C (59.6%), and 7842G>A (59.6%). Furthermore, A4 or D sublineage-positive women had a higher risk for cervical cancer than women who were positive for A1-3. Among HPV phylogenetic clusters, A1-3 was the predominant sublineage, and within A1-3, the 350G polymorphism was highly frequent. These results differed from those of previous studies in Korea and other Asian countries. The findings suggest that cervical neoplasia incidence in HPV16-infected patients could be affected by the distribution of HPV16 variants in the population.Key words: Human papillomavirus 16; variant; cervical cancer; cervical intraepithelial neoplasia; case-control study.Sue Shin, Department of Laboratory Medicine, Seoul National University Boramae Hospital, 156-707, 20 Boramaero-5-gil, Dongjak-gu, Seoul, Korea. e-mail: jeannie@snu.ac.krThe incidence rate of cervical cancer in Korea is higher than that in other developed countries. In 2012, the reported incidence was 14.2 cases per 100 000 women, with 3584 new cases and 889 deaths (1). Persistent infection by oncogenic human papillomaviruses (HPV) is strongly associated with the development of cervical neoplasia. Oncogenic HPV type 16 (HPV16) accounts for approximately 65% of cervical cancer worldwide (2) and is the most common HPV type associated with cervical cancer in Korea (3).The HPV oncogenes, E6 and E7, are consistently expressed in cervical cancers, and these genes are involved in HPV-mediated carcinogenesis (4). Currently, HPV16 intratypic variants, which have nucleotide sequence variations of ≤2% as compared with the HPV16 prototype, are classified into four major lineages based on whole-genome sequencing: A, which includes the A1-3 (previously named European), and A4 (Asian) sublineages; B (African 1); C (African 2); and D [including Asian-American (AA) and North American (NA)] (5). The long control region (LCR) adjacent to the downstream region of E6 contains the early promoter and regulatory elements involved in viral DNA replication and transcription (6). Epidemiological studies have reported that HPV16 variants confer different risks of vira...