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Amato M, Santonocito S, Bruno MT, Polizzi A, Mastroianni A, Chaurasia A, Isola G. Oral and periodontal manifestation related during human papilloma virus infections: Update on early prognostic factors. Heliyon 2024; 10:e31061. [PMID: 38813162 PMCID: PMC11133762 DOI: 10.1016/j.heliyon.2024.e31061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/11/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024] Open
Abstract
Human Papilloma Virus (HPV) is considered one of the most common sexually transmitted infections and has been shown to play an important role in the pathogenesis of squamous cell carcinomas (SCC) of the cervix and head and neck. Manifestations of HPV infections can be manifold, ranging from asymptomatic infections to benign or potentially malignant lesions to intraepithelial neoplasms and invasive carcinomas. The heterogeneity of clinical manifestations from HPV infection depends on the interactions between the viral agent and the host, a direct consequence of the ability on the part of HPV is to remain silent and to evade and convey the action of the host immune system. The oral mucosa represents one of the tissues for which HPV has a distinct tropism and is frequently affected by infection. While much information is available on the role that HPV infection plays in the development of SCC in the oral cavity, there is less information on asymptomatic infections and benign HPV-induced oral lesions. Therefore, the purpose of this review is to analyze, in light of current knowledge, the early clinical and bio-humoral prognostic features related to the risk of HPV malignant transformation, focusing on subclinical conditions, benign lesions, and the correlation between oral infection and infection in other districts. The data show that the main risk associated with HPV infection is related to malignant transformation of lesions. Although HPV-driven OPSCC is associated with a better prognosis than non-HPV-driven OPSCC, primary prevention and early detection of the infection and affected genotype are essential to reduce the risk of malignant neoplastic complications and improve the prognosis.
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Affiliation(s)
- Mariacristina Amato
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Maria Teresa Bruno
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Research Center of “Human Papilloma Virus” University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Alessandro Mastroianni
- Dentistry Unit, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, 00133, Rome, Italy
| | - Akhilanand Chaurasia
- Department of Oral Medicine & Radiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Research Center of “Human Papilloma Virus” University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Grace D, Grewal R, Jollimore J, Lachowsky N, Nisenbaum R, Ogilvie G, Sauvageau C, Tan DHS, Coutlée F, Burchell AN. Vaccine Effectiveness Against 12-Month Incident and Persistent Anal Human Papillomavirus Infection Among Gay, Bisexual, and Other Men Who Have Sex With Men. J Infect Dis 2023; 228:89-100. [PMID: 36655513 PMCID: PMC10304758 DOI: 10.1093/infdis/jiad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Real-world evidence of human papillomavirus (HPV) vaccine effectiveness (VE) against longitudinal outcomes is lacking among gay, bisexual, and other men who have sex with men (GBM). We compared 12-month incidence and persistence of anal HPV infection between vaccinated and unvaccinated GBM. METHODS We recruited GBM aged 16-30 years in Montreal, Toronto, and Vancouver, Canada, from 2017 to 2019. Participants were followed over a median of 12 months (interquartile range, 12-13 months). Participants self-reported HPV vaccination and self-collected anal specimens for HPV DNA testing. We calculated prevalence ratios (PR) for 12-month cumulative incidence and persistence with ≥1 quadrivalent vaccine type (HPV 6/11/16/18) between vaccinated (≥1 dose at baseline) and unvaccinated participants using a propensity score-weighted, modified Poisson regression. RESULTS Among 248 participants, 109 (44.0%) were vaccinated at baseline, of whom 62.6% received 3 doses. PRs for HPV 6/11/16/18 were 0.56 (95% confidence interval [CI], .24-1.31) for cumulative incidence and 0.53 (95% CI, .25-1.14) for persistence. PRs were 0.23 (95% CI, .05-1.03) and 0.08 (95% CI, .01-.59) for incidence and persistence, respectively, among participants who received their first dose at age ≤23 years and 0.15 (95% CI, .03-.68) and 0.12 (95% CI, .03-.54) among participants who were sexually active for ≤5 years before vaccination. CONCLUSIONS Findings support national recommendations for HPV vaccination at younger ages or soon after sexual debut.
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Affiliation(s)
- Catharine Chambers
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Joseph Cox
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre - Research Institute, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique de Montréal, Montréal, Québec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Rosane Nisenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Gina Ogilvie
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chantal Sauvageau
- Institut National de Santé Publique du Québec, Québec, Québec, Canada
| | | | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ann N Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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3
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Wierzbicka M, San Giorgi MRM, Dikkers FG. Transmission and clearance of human papillomavirus infection in the oral cavity and its role in oropharyngeal carcinoma - A review. Rev Med Virol 2023; 33:e2337. [PMID: 35194874 PMCID: PMC10078185 DOI: 10.1002/rmv.2337] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 01/28/2023]
Abstract
The majority of sexually active individuals becomes infected with human papillomavirus (HPV) at least once in their lifetime. Pathways for HPV transmission vary across different mucosal sites per individual. They include autoinoculation within one host, direct transmission between individuals (including perinatal transmission and transmission during sexual activity), and indirect transmission through contact with hands. The authors aim to clarify the prevalence and route of transmission per anatomic site, inter- and intra-individually, using a narrative review of the literature. In conclusion, transmission of HPV to the oral cavity and oropharynx is hypothesised to occur mainly through sexual contact. Transmission of particles through saliva has not been proven and daily living activities are not a documented source of HPV infection. Oropharyngeal HPV related cancer survivors and their partners do not show increased risk of infection during sexual intercourse. Transmission of HPV to the oral cavity (autoinoculation with fingers or transmission through saliva in deep kissing) is probably of limited importance.
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Affiliation(s)
- Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, Poznan, Poland
| | - Michel R M San Giorgi
- Department of Otorhinolaryngology, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Chambers C, Deeks SL, Sutradhar R, Cox J, de Pokomandy A, Grennan T, Hart TA, Lambert G, Moore DM, Coutlée F, Burchell AN. Anal Human Papillomavirus Prevalence Among Vaccinated and Unvaccinated Gay, Bisexual, and Other Men Who Have Sex With Men in Canada. Sex Transm Dis 2022; 49:123-132. [PMID: 34561370 PMCID: PMC8746886 DOI: 10.1097/olq.0000000000001560] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Starting in 2015, human papillomavirus (HPV) vaccine has been publicly funded for gay, bisexual, and other men who have sex with men (GBM) 26 years or younger in Canada. METHODS Self-identified GBM who reported having sex with another man within the past 6 months were enrolled using respondent-driven sampling (RDS) between February 2017 and August 2019 in Montreal, Toronto, and Vancouver, Canada. Men aged 16 to 30 years self-collected anal specimens for HPV-DNA testing. Prevalence was estimated using RDS-II weights. We compared the prevalence of quadrivalent (HPV-6/11/16/18) and 9-valent (HPV-6/11/16/18/31/33/45/52/58) vaccine types between GBM who self-reported HPV vaccination (≥1 dose) and those reporting no vaccination using a modified Poisson regression for binary outcomes. RESULTS Among 645 GBM who provided a valid anal specimen (median age, 26 years; 5.9% HIV positive), 40.3% reported receiving ≥1 dose of HPV vaccine, of whom 61.8% received 3 doses. One-quarter were infected with ≥1 quadrivalent type (crude, 25.7%; RDS weighted, 24.4%). After adjustment for potential confounders, vaccinated GBM had a 27% lower anal prevalence of quadrivalent types compared with unvaccinated GBM (adjusted prevalence ratio [aPR], 0.73; 95% confidence interval [CI], 0.54-1.00). Lower prevalence ratios were found among vaccinated participants who were vaccinated >2 years before enrollment (aPR, 0.47; 95% CI, 0.25-0.86) or received their first vaccine dose at age ≤23 years (aPR, 0.64; 95% CI, 0.42-0.99). Point estimates were similar for ≥2 or 3 doses and 9-valent types. CONCLUSIONS Human papillomavirus vaccination was associated with a lower anal prevalence of vaccine-preventable HPV types among young, sexually active GBM. Findings will help inform shared decision making around HPV vaccination for GBM and their healthcare providers.
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Affiliation(s)
- Catharine Chambers
- From the Dalla Lana School of Public Health, University of Toronto
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Unity Health Toronto, Toronto
| | - Shelley L. Deeks
- From the Dalla Lana School of Public Health, University of Toronto
- Department of Health and Wellness, Government of Nova Scotia, Halifax
| | - Rinku Sutradhar
- From the Dalla Lana School of Public Health, University of Toronto
- ICES, Sunnybrook Research Institute, Toronto
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University
| | | | - Troy Grennan
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver
| | - Trevor A. Hart
- From the Dalla Lana School of Public Health, University of Toronto
- Department of Psychology, Ryerson University, Toronto
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, Montréal
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver
| | - François Coutlée
- Département de microbiologie, infectiologie et immunologie, Université de Montréal
- Laboratoire de virologie moléculaire, Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal
| | - Ann N. Burchell
- From the Dalla Lana School of Public Health, University of Toronto
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Unity Health Toronto, Toronto
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
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5
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Abstract
Since their discovery as the etiologic agents of cervical cancer in the mid-1970s, human papillomaviruses (HPVs) have been linked with a growing number of epithelial-derived tumors, including head and neck squamous cell carcinomas. HPV demonstrates a particular predilection for causing tumors of the oropharynx, with the majority of cases involving infection with high-oncogenic risk HPV-16. People living with HIV are at increased risk of infection with HPV- and HPV-related oral complications even with adequate control of their HIV infection with antiretroviral therapy. In this chapter, we discuss the molecular mechanisms that underlie HPV-mediated oncogenesis in the oropharynx. We also describe the progress that has been made in understanding the epidemiology of oral HPV infection and the determinants of oral HPV-related pathology. Finally, we examine what can be done to treat and prevent oral HPV infection, benign lesions, and cancer, particularly in the context of the HIV-positive patient.
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Lin CC, Hsieh MC, Hung HC, Tsao SM, Chen SC, Yang HJ, Lee YT. Human papillomavirus prevalence and behavioral risk factors among HIV-infected and HIV-uninfected men who have sex with men in Taiwan. Medicine (Baltimore) 2018; 97:e13201. [PMID: 30407359 PMCID: PMC6250439 DOI: 10.1097/md.0000000000013201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus (HPV) infection is associated with cancer and can be prevented through vaccination. Few studies from Taiwan have reported on HPV infection among human immunodeficiency virus (HIV)-infected subjects. The aim of this study was to examine the prevalence of HPV infection among men who have sex with men (MSM) with and without HIV infection in Taiwan, and explore the behavioral risk factors thereof.We conducted a cross-sectional study in Taiwan during 2013 to 2016 to collect data on MSM aged 20 years or older. We used a questionnaire in a face-to-face interview, and subsequently collected oral, anal, and genital specimens from HIV-infected and HIV-uninfected subjects. Multivariate analysis was performed to predict factors associated with high-risk HPV (HR-HPV) positivity.Overall, 279 subjects, including 166 (59.5%) HIV-uninfected and 113 (40.5%) HIV-infected men were enrolled. Compared to HPV-negative subjects, HPV-positive subjects had significantly higher rates of receptive anal sex (91.3% vs 75.6%), substance use (22.6% vs 11%), history of sexually transmitted infections (75.7% vs 38.4%), anogenital or oral warts (39.1% vs 6.72%), syphilis (32.2% vs 11.6%), and HIV infection (69.6% vs 20.1%). We detected 489 HPV deoxyribonucleic acid (DNA) types (through 379 viable specimens), of which 43.6%, 5.7%, 56.4%, and 10.4% were HR-HPV type, HPV type 16, low-risk HPV types, and HPV type 6, respectively. In multivariate analysis, HIV-infected subjects had a significantly higher prevalence of HR-HPV infection (adjusted odds ratio, 5.80; 95% confidence interval, 2.57-13.11), compared to HIV-uninfected subjects.These results suggest that the prevalence of HPV infection was high among HIV-infected MSM. Additionally, anal HPV infection was observed to be common among both HIV-infected and HIV-uninfected MSM in Taiwan. The prevalence of oral and genital HPV infection, HR-HPV DNA types, and multiple HPV types was higher in HIV-infected subjects than in HIV-uninfected subjects. As only 35% of subjects practiced safe sex, we recommend routine HPV vaccination with 4-valent HPV or 9-valent HPV vaccines for both MSM, and HIV-infected subjects.
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Affiliation(s)
- Chia-Chun Lin
- Division of Infectious Diseases, Department of Internal Medicine
- Department of Public Health, College of Health Care and Management
| | - Ming-Chang Hsieh
- Department of Medical Laboratory and Biotechnology, College of Medical Sciences and Technology
- Department of Clinical Laboratory, Chung Shan Medical University Hospital
| | - Hung-Chang Hung
- Division of Gastroenterology, Department of Internal Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou
- Department of Healthcare Administration, Central Taiwan University of Science and Technology
| | - Shih-Ming Tsao
- Division of Infectious Diseases, Department of Internal Medicine
- School of Medicine, College of Medicine
- Institute of Biochemistry, Microbiology and Immunology
| | - Shiuan-Chih Chen
- School of Medicine, College of Medicine
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Hao-Jan Yang
- Department of Public Health, College of Health Care and Management
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Yuan-Ti Lee
- Division of Infectious Diseases, Department of Internal Medicine
- School of Medicine, College of Medicine
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7
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Tam S, Fu S, Xu L, Krause KJ, Lairson DR, Miao H, Sturgis EM, Dahlstrom KR. The epidemiology of oral human papillomavirus infection in healthy populations: A systematic review and meta-analysis. Oral Oncol 2018; 82:91-99. [PMID: 29909908 DOI: 10.1016/j.oraloncology.2018.04.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/02/2018] [Accepted: 04/07/2018] [Indexed: 10/16/2022]
Abstract
Human papillomavirus (HPV) is a potentially oncogenic sexually transmitted infection. As the incidence of oropharyngeal cancer (OPC) caused by oral HPV infections is rising, further investigation into the natural history of such infections is needed. This systematic review and meta-analysis aimed to synthesize data on the prevalence, incidence, clearance, and persistence of oral HPV infections in healthy individuals. A systematic review of literature published between January 1995 and August 2017 was conducted using Ovid MEDLINE, PubMed, Embase, and the Cochrane Library. Meta-analysis of prevalence and incidence data was conducted. Clearance and persistence data were extracted. Sixty-six studies met the inclusion criteria. Meta-analysis demonstrated an overall prevalence of 7.7% for all types of HPV and 1.4% for high-risk HPV16. The overall incidence was 4.38 cases per 1000 person-months for all HPV types and 0.92 cases per 1000 person-months for HPV16. This systematic review and meta-analysis demonstrated that oral HPV infection has a lower prevalence and incidence than cervicogenital HPV infection in healthy individuals. Nonetheless, oral HPV is still an important concern, given its oncogenicity and the rising incidence of oropharyngeal cancer. Consistency of methodology will allow for better future comparisons, particularly of infection clearance and persistence.
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Affiliation(s)
- Samantha Tam
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
| | - Shuangshuang Fu
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA.
| | - Li Xu
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1445, Houston, TX 77030, USA.
| | - David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA.
| | - Hongyu Miao
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA.
| | - Erich M Sturgis
- Department of Head and Neck Surgery, Division of Surgery, and Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
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Farsi NJ, Rousseau MC, Schlecht N, Castonguay G, Allison P, Nguyen-Tan PF, Souliéres D, Coutlée F, Hier M, Madathil S, Franco EL, Nicolau B. Aetiological heterogeneity of head and neck squamous cell carcinomas: the role of human papillomavirus infections, smoking and alcohol. Carcinogenesis 2017; 38:1188-1195. [PMID: 29029021 DOI: 10.1093/carcin/bgx106] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/26/2017] [Indexed: 12/19/2022] Open
Abstract
Tobacco and alcohol consumption are the main risk factors for head and neck squamous cell carcinoma (HNSCC). In addition, human papillomavirus (HPV) infection plays a causal role in oropharyngeal cancer (OPC), a subset of HNSCC. We assessed the independent effects of tobacco, alcohol and HPV infection on OPC risk in the head and neck cancer (HeNCe) Life study, a hospital-based case-control study of HNSCC with frequency-matched controls by age and sex from four Montreal hospitals. Interviewers collected information on socio-demographic and behavioural factors. We tested exfoliated oral cells for HPV DNA by polymerase chain reaction (PCR). We included only OPC cases (n = 188) and controls (n = 427) without missing values for HPV, smoking or alcohol. We examined associations by estimating odds ratios (ORs) and corresponding 95% confidence intervals (CI) using unconditional logistic regression. Smoking (OR = 1.90, 95% CI: 1.04-3.45) and alcohol (OR = 2.74, 95% CI: 1.45-5.15) were associated with an increased risk of OPC independent of HPV status. Positivity for HPV 16 among heavy smokers and heavy alcohol users was associated with a 30.4-fold (95% CI: 8.94-103.26) and 18.6-fold (95% CI: 5.75-60.13) elevation in risk of OPC relative to participants who were HPV negative, respectively. Moreover, the combined effect of heavy smoking and alcohol comsumption with HPV 16 infection substantially increased OPC risk (OR = 48.76, 95% CI: 15.83-150.17) and (OR = 50.60, 95% CI: 15.96-160.40), respectively. Our results support the independent roles of smoking, alcohol and HPV infection in OPC risk and a possible combined effect. Efforts should be made to tackle these major risk factors simultaneously.
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Affiliation(s)
- Nada J Farsi
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Saudi Arabia.,Division of Oral Health and Society, Faculty of Dentistry, McGill University, Canada.,Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Canada
| | - Marie-Claude Rousseau
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Canada.,Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Canada
| | - Nicolas Schlecht
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Canada.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, USA
| | - Geneviève Castonguay
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Canada
| | - Paul Allison
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Canada.,Department of Oncology, Division of Cancer Epidemiology, McGill University, Canada
| | - Phuc Félix Nguyen-Tan
- Department of Radiation Oncology, Hôpital Notre-Dame du Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Denis Souliéres
- Department of Hemato-Oncology, Hôpital Notre-Dame du Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Francois Coutlée
- Department of Oncology, Division of Cancer Epidemiology, McGill University, Canada.,Department of Microbiology and Infectious Diseases, Hôpital Notre-Dame du Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Michael Hier
- Faculty of Medicine, McGill University, Department of Otolaryngology-Head and Neck Surgery, Canada
| | - Sreenath Madathil
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Canada.,Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Canada
| | - Eduardo L Franco
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Canada.,Department of Oncology, Division of Cancer Epidemiology, McGill University, Canada
| | - Belinda Nicolau
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Canada.,Department of Oncology, Division of Cancer Epidemiology, McGill University, Canada
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9
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Chew EY, Hartman CM, Richardson PA, Zevallos JP, Sikora AG, Kramer JR, Chiao EY. Risk factors for oropharynx cancer in a cohort of HIV-infected veterans. Oral Oncol 2017; 68:60-66. [PMID: 28438295 DOI: 10.1016/j.oraloncology.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/11/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate HIV-related and other clinical risk factors associated with oropharynx cancer (OPSCC) in HIV-infected U.S. Veterans. METHODS Retrospective cohort study utilizing Veterans Affairs HIV Clinical Case Registry (CCR) data from 1985 to 2010. Outcome was incident OPSCC as indicated by 1 inpatient or 2 outpatient ICD-9 codes. Cox proportional hazard models were used to determine hazard ratios (HR) and 95% confidence intervals (CI) for each risk factor on the time to OPSCC diagnosis. RESULTS A total of 40,996 HIV-infected male veterans were included in the cohort with 97 cases of OPSCC. The age adjusted incidence rate was 23.2/100,000 [95% CI 17.8-29.2]. Age>50 (aHR=3.8, 95% CI 1.9-7.8), recent CD4<200 (aHR=3.8, 95% CI 2.0-7.3), and undetectable HIV viral loads 40-79% of the time (aHR=1.8, 95% CI 1.1-3.0) were associated with an increased risk of OPSCC. Era of HIV diagnosis, utilization of cART, nadir CD4 count, race, smoking history, and previous risk of HPV disease, including condyloma or invasive squamous cell carcinoma of the anus (SCCA) were not associated with increased risk of OPSCC. CONCLUSION Patients who were older at beginning of follow up, had lower CD4 counts around the time of OPSCC diagnosis, and moderate HIV viral control during follow-up had an increased risk of OPSCC. Other HPV-related diseases such as SCCA and condyloma did not increase the risk for OPSCC.
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Affiliation(s)
- Erin Y Chew
- One Baylor Plaza, Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA
| | - Christine M Hartman
- 2002 Holcombe Boulevard, Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Peter A Richardson
- 2002 Holcombe Boulevard, Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Jose P Zevallos
- 170 Manning Drive, CB# 7070 Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; 170 Rosenau Hall CB, #7400 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Andrew G Sikora
- One Baylor Plaza, Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jennifer R Kramer
- 2002 Holcombe Boulevard, Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Elizabeth Y Chiao
- One Baylor Plaza, Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA; 2002 Holcombe Boulevard, Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
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Lupato V, Holzinger D, Höfler D, Menegaldo A, Giorgi Rossi P, Del Mistro A, Da Mosto MC, Pawlita M, Boscolo-Rizzo P. Prevalence and Determinants of Oral Human Papillomavirus Infection in 500 Young Adults from Italy. PLoS One 2017; 12:e0170091. [PMID: 28103272 PMCID: PMC5245874 DOI: 10.1371/journal.pone.0170091] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/28/2016] [Indexed: 01/05/2023] Open
Abstract
Although the prevalence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is increasing in developed countries and becoming a relevant health issue, the natural history of oral HPV infection is still unclear. Estimating the infection's prevalence in specific populations and identifying risk factors can widen our understanding of its natural history and help to delineate appropriate prevention strategies. This study sought to (i) determine oral HPV prevalence and genotype distribution in a large series of young Italian adults, (ii) validate an oral rinse sampling/storage protocol, and (iii) pinpoint factors associated with oral HPV infection. Five hundred students, nurses, and technicians (19-35 years-old) studying and working at/for the University of Padua were recruited. Each participant was provided with an oral rinse sampling kit and instructions for use. They were also asked to complete an anonymous questionnaire concerning their demographic characteristics and behaviors. The questionnaires and oral rinse containers were labeled with the same identification code number. The oral rinse samples were tested using a bead-based multiplex BSGP5+/6+-MPG genotyping assay which amplifies the L1 region of 51 mucosal HPV types. The prevalence of oral HPV infection was 4.0% (95% confidence interval (CI), 2.5%-6.1%); those of 14 high-risk HPV types and of HPV-type 16 (HPV16) infection were 2.2% (95% CI, 1.1%-3.9%) and 1.6% (95% CI, 0.6%-3.1%), respectively. HPV16 was the most frequent genotype (40.0% of oral HPV infections). No association was found between oral infection and the co-variables studied (gender, tobacco, alcohol and illegal drug use, number of sex and oral sex partners, HPV vaccination status, history of HPV and sexually transmitted infections, abnormal pap smears, recurrent tonsillitis and tonsillectomy). The oral rinse sampling protocol outlined here proved to be simple, efficient and well tolerated, and the prevalence rate can be considered reliable and thus useful to guide future research. Determinants of oral HPV infection are still unclear and further studies are certainly warranted.
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Affiliation(s)
- Valentina Lupato
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padua, Treviso, Italy
- Unit of Otolaryngology, Azienda Ospedaliera “S. Maria degli Angeli”, Pordenone, Italy
| | - Dana Holzinger
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Höfler
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna Menegaldo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padua, Treviso, Italy
| | - Paolo Giorgi Rossi
- Interinstitutional Epidemiology Unit, Local Health Authority, Reggio Emilia, Italy
- Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Annarosa Del Mistro
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto—IRCCS, Padova, Italy
| | - Maria Cristina Da Mosto
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padua, Treviso, Italy
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Regional Center for Head and Neck Cancer, University of Padua, Treviso, Italy
- * E-mail:
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King EM, Oomeer S, Gilson R, Copas A, Beddows S, Soldan K, Jit M, Edmunds WJ, Sonnenberg P. Oral Human Papillomavirus Infection in Men Who Have Sex with Men: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0157976. [PMID: 27384050 PMCID: PMC4934925 DOI: 10.1371/journal.pone.0157976] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The epidemiology of oral human papillomavirus (HPV) infection in men who have sex with men (MSM) differs from anogenital HPV infection. The impact of HPV vaccination has, to date, largely focussed on anogenital outcomes. Vaccination of MSM in the UK has been recommended and, if implemented, baseline estimates of oral HPV prevalence will be useful. METHODS We searched Medline, Embase and psycINFO databases for studies reporting prevalence, incidence, and clearance of oral HPV infection in MSM. We performed a random-effects meta-analysis and meta-regression on prevalence estimates and summarised within-study risk factors for oral HPV DNA detection and incidence/clearance rates. We also performed a meta-analysis of the effect of MSM on oral HPV prevalence compared to heterosexual men. RESULTS 26 publications were identified. The pooled prevalence of oral HPV16 from twelve estimates was 3.0% (95%CI 0.5-5.5) in HIV-negative and 4.7% (95%CI 2.1-7.3) in HIV-positive MSM. Median age of study participants explained 38% of heterogeneity (p<0.01) in HPV prevalence estimates (pooled = 17% and 29% in HIV-negative and HIV-positive, respectively; 22 estimates). Nine studies compared MSM to heterosexual men and found no difference in oral HPV prevalence (pooled OR 1.07 (95%CI 0.65-1.74)). The clearance rate was higher than incidence within studies. Type-specific concordance between oral and anogenital sites was rare. CONCLUSION There was substantial heterogeneity between estimates of oral HPV prevalence in MSM populations that was partly explained by HIV status and median age.
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Affiliation(s)
- Eleanor M. King
- Research Department of Infection and Population Health, University College London, WC1E 6JB, London, United Kingdom
| | - Soonita Oomeer
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, WC1E 6JB, London, United Kingdom
| | - Richard Gilson
- Research Department of Infection and Population Health, University College London, WC1E 6JB, London, United Kingdom
- The Mortimer Market Centre, Central and North West London NHS Foundation Trust, WC1E 6JB, London, United Kingdom
| | - Andrew Copas
- Research Department of Infection and Population Health, University College London, WC1E 6JB, London, United Kingdom
| | - Simon Beddows
- Virus Reference Department, Public Health England, 61 Colindale Avenue, NW9 5EQ, London, United Kingdom
| | - Kate Soldan
- Centre for Communicable Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, NW9 5EQ, London, United Kingdom
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, 61 Colindale Avenue, NW9 5EQ, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom
| | - W. John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, WC1E 6JB, London, United Kingdom
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12
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Human papillomavirus infection in the oral cavity of HIV patients is not reduced by initiating antiretroviral therapy. AIDS 2016; 30:1573-82. [PMID: 26919735 PMCID: PMC4900420 DOI: 10.1097/qad.0000000000001072] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: The incidence of human papillomavirus (HPV)-related oral malignancies is increasing among HIV-infected populations, and the prevalence of oral warts has reportedly increased among HIV patients receiving antiretroviral therapy (ART). We explored whether ART initiation among treatment-naive HIV-positive adults is followed by a change in oral HPV infection or the occurrence of oral warts. Design: Prospective, observational study. Methods: HIV-1 infected, ART-naive adults initiating ART in a clinical trial were enrolled. End points included detection of HPV DNA in throat-washes, changes in CD4+ T-cell count and HIV RNA, and oral wart diagnosis. Results: Among 388 participants, 18% had at least one HPV genotype present before initiating ART, and 24% had at least one genotype present after 12–24 weeks of ART. Among those with undetectable oral HPV DNA before ART, median change in CD4+ count from study entry to 4 weeks after ART initiation was larger for those with detectable HPV DNA during follow-up than those without (P = 0.003). Both prevalence and incidence of oral warts were low (3% of participants having oral warts at study entry; 2.5% acquiring oral warts during 48 weeks of follow-up). Conclusion: These results suggest: effective immune control of HPV in the oral cavity of HIV-infected patients is not reconstituted by 24 weeks of ART; whereas ART initiation was not followed by an increase in oral warts, we observed an increase in oral HPV DNA detection after 12–24 weeks. The prevalence of HPV-associated oral malignancies may continue to increase in the modern ART era.
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13
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Khariwala SS, Moore MG, Malloy KM, Gosselin B, Smith RV. The "HPV Discussion": Effective Use of Data to Deliver Recommendations to Patients Impacted by HPV. Otolaryngol Head Neck Surg 2015. [PMID: 26220060 DOI: 10.1177/0194599815597200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The dramatic rise in oropharyngeal squamous cell carcinoma associated with the human papilloma virus (HPV) has brought significant change to the interaction between patients and head and neck oncologists. HPV-induced cancers are generally the result of elements from the patient's sexual history, and otolaryngologists are generally less experienced than primary care physicians in addressing patient questions relating to sexual history and practices. This article addresses questions commonly posed by patients relating to HPV-induced head and neck cancers, issues related to HPV vaccination, and surveillance of HPV-related lesions. Supporting data are provided such that physicians may be better equipped to sufficiently address patient queries on this topic. DATA SOURCES Available peer-reviewed literature and clinical practice guidelines. REVIEW METHODS Assessment and discussion of specific topics by authors selected from the Head and Neck Surgery Education Committee of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. RESULTS An educational "miniseminar" resulted in a notable increase in attendee knowledge and comfort regarding oropharyngeal squamous cell carcinoma counseling for patients in the setting of HPV-positive disease. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The dramatic increase in HPV-associated head and neck cancers has resulted in a changed paradigm of the physician-patient interaction. Care providers in today's environment must be prepared to counsel patients regarding sexually transmitted diseases and high-risk sexual behaviors. Examination of the existing data provides the foundation with which to construct a framework in which physicians can effectively communicate information and recommendations as they pertain to HPV-related carcinoma.
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Affiliation(s)
- Samir S Khariwala
- Department Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael G Moore
- Department Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Kelly M Malloy
- Department Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benoit Gosselin
- Department Otolaryngology-Head and Neck Surgery, Dartmouth Medical Center, Manchester, New Hampshire, USA
| | - Richard V Smith
- Department Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
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d’Huart MC, Chevaux JB, Bressenot AM, Froment N, Vuitton L, Degano SV, Latarche C, Bigard MA, Courrier A, Hudziak H, Koch S, Kull E, Peyrin-Biroulet L. Prevalence of esophageal squamous papilloma (ESP) and associated cancer in northeastern France. Endosc Int Open 2015; 3:E101-6. [PMID: 26135647 PMCID: PMC4477031 DOI: 10.1055/s-0034-1390976] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/26/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Esophageal squamous papilloma (ESP) is a rare lesion. The aims of this study were to assess the prevalence of ESP in northeastern France and the risk of associated squamous cell carcinoma (SCC). PATIENTS AND METHODS The charts of 78 patients who were diagnosed with ESP between January 2005 and February 2013 at three hospitals in northeastern France were reviewed. RESULTS A total of 55 305 endoscopies were performed and 78 ESP were diagnosed (0.01 %). Patients with ESP included 44 males (56.4 %), 34 females (43.6 %); median age 50, interquartile range (IQR) 19 - 86. Median follow-up was 21 months (IQR 0 - 91 mo) and median time between first and second endoscopy was 7 months (IQR 0.5 - 74 mo). Of the total number of patients, 35 (44.9 %) had a second endoscopy. Main endoscopy indication was dyspepsia (24.4 %). Most ESP were isolated (93.6 %) and located at distal esophagus (27 cm, IQR 16 - 40 cm). Median size was 3 mm (IQR 1 - 20 mm). ESP-associated endoscopic lesions were hiatal hernia in 12 patients and esophagitis in 11 patients. Endoscopic treatment was mainly excisional biopsies (60.3 %). Human papillomavirus (HPV) was not detected in the 6 patients with available data. Low dysplasia was found in 2 ESP. During follow-up endoscopies, 2 SCC were detected in 2 different patients; the first SCC was located at the previous resection site of the ESP and the second had a different location. Prevalence of associated cancer was 1.3 %. CONCLUSION Prevalence of ESP in northeastern France is similar to that previously reported. Endoscopic findings were also broadly the same as in previous reports. The occurrence of dysplasia and SCC should strongly encourage the endoscopist to totally remove the ESP and to start an endoscopic surveillance, given the potential risk of malignant transformation.
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Affiliation(s)
- Marie-Caroline d’Huart
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Jean Baptiste Chevaux
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | | | | | - Lucine Vuitton
- Department of Hepatogastroenterology, Besançon University Hospital, Besançon, France
| | | | - Clotide Latarche
- Inserm CIC-EC CIE6, Vandoeuvre-lès-Nancy, France and Department of Epidemiology and Clinical Evaluation, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Marc André Bigard
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Alain Courrier
- Department of Hepatogastroenterology, Metz Mercy Hospital, Metz, France
| | - Hervé Hudziak
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Stéphane Koch
- Department of Hepatogastroenterology, Besançon University Hospital, Besançon, France
| | - Eric Kull
- Department of Hepatogastroenterology, Metz Mercy Hospital, Metz, France
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France,Corresponding author Laurent Peyrin-Biroulet, MD, PhD Inserm U954 and Department of HepatogastroenterologyNancy University HospitalAllée du Morvan54511 Vandoeuvre-lès-NancyFrance
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15
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Videla S, Darwich L, Cañadas M, Clotet B, Sirera G. Incidence and clinical management of oral human papillomavirus infection in men: a series of key short messages. Expert Rev Anti Infect Ther 2014; 12:947-57. [PMID: 24865412 DOI: 10.1586/14787210.2014.922872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oral human papillomavirus (HPV) infections are less prevalent than genital and anal infections. However, the incidence of oropharyngeal squamous cell carcinomas has increased significantly over the last 2 decades in several countries. At least 90% of these cancers are associated with oncogenic type HPV16. Oral HPV infections are notably more frequent in men than in women, and the incidence of HPV-positive oropharyngeal squamous cell carcinomas has increased, predominantly among mid-adult men. Nevertheless, little is known about the progression of oral HPV infection to cancer, and it remains unclear which medical interventions should be applied to modify the natural history of the disease. This narrative review aimed at non-experts in HPV infection provides an update on oral HPV infection and its clinical management in men. Furthermore, using the cervix as a reference anatomical site, the lessons learned from investigations on cervical HPV infection are also addressed.
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Affiliation(s)
- Sebastián Videla
- Lluita Contra La SIDA Foundation, Hospital Universitari Germans Trias i Pujol, 08916 Badalona (Barcelona), Spain
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16
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Prevalence, clearance, and incidence of human papillomavirus type-specific infection at the anal and penile site of HIV-infected men. Sex Transm Dis 2014; 40:611-8. [PMID: 23859907 DOI: 10.1097/01.olq.0000430798.61475.08] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We studied the type-specific infection of human papillomavirus (HPV) at the anal canal and penile site in a cohort of HIV-infected men. METHODS Prevalence, clearance, and incidence of specific HPV types in the anal canal and penis were determined in 733 HIV-infected men from the Spanish CAn Ruti HIV+ Men ([CARH•MEN]) cohort (538 men who have sex with men [MSM] and 195 heterosexual men). RESULTS In both groups, the most prevalent high-risk type was HPV-16 (anal canal [31.6% MSM; 6.8% heterosexual] and penis [4.8% MSM; 6.8% heterosexual]). The most prevalent low-risk type was HPV-6 (anal canal [23.2% MSM; 12.8% heterosexual], penis [8.1% MSM; 8.9% heterosexual]). Anal prevalence was significantly higher in MSM, as was incidence, except for HPV-16, which was similar between male groups (5.9 new cases per 1000 person-months [95% confidence interval, 4.3-7.9] in MSM; 4.4 [95% confidence interval, 2.5-7.2] in heterosexual men; P > 0.05). The anal clearance rate of the different HPV types and retention time of infection were similar in both groups, as well as the HPV infection of the penis. CONCLUSIONS HIV-infected MSM had a high prevalence of HPV infection at the anal canal; however, heterosexual HIV-infected men were also at risk for acquiring and sustaining persistent high-risk HPV types at the anal and penile site and are at risk for developing dysplasia in the future. All HIV-infected men should be recommended for routinely anal HPV screening.
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Erkhembaatar A, Kawai R, Kato S, Yoshida W, Kamiya K, Nagaya Y, Hattori T, Sugita Y, Kubo K, Maeda H. Hyperplastic Epithelium of Oral Mucosal Lesions Associated with Denture Wearing as a Potential Reservoir of Human Papillomavirus. J HARD TISSUE BIOL 2014. [DOI: 10.2485/jhtb.23.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Beachler DC, D'Souza G. Oral human papillomavirus infection and head and neck cancers in HIV-infected individuals. Curr Opin Oncol 2013; 25:503-10. [PMID: 23852381 PMCID: PMC3896303 DOI: 10.1097/cco.0b013e32836242b4] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW HIV-infected individuals are living longer due to effective antiretroviral therapy and may therefore have a greater opportunity to develop human papillomavirus (HPV)-associated malignancies. This review describes the risk factors and burden of oral HPV infection and HPV-associated head and neck cancer (HNC) among HIV-infected individuals. RECENT FINDINGS Oral HPV infection is commonly detected in HIV-infected individuals and is elevated among those with a higher number of lifetime oral sexual partners, current tobacco use and immunosuppression. There are limited data on the natural history of oral HPV, but initial studies suggest that the majority of infections clear within 2 years. Although HIV-infected individuals are at a much higher risk of most HPV-associated cancers than the general population, studies suggest HIV-infected individuals have a more modest 1.5-4-fold greater risk for HPV-associated HNC. SUMMARY HIV-infected individuals are living longer, have a high prevalence of oral HPV infection and have many of the currently determined risk factors for HPV-associated HNC.
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Affiliation(s)
- Daniel C. Beachler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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19
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Fakhry C, D'Souza G. Discussing the diagnosis of HPV-OSCC: common questions and answers. Oral Oncol 2013; 49:863-871. [PMID: 23876627 PMCID: PMC4264664 DOI: 10.1016/j.oraloncology.2013.06.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 12/14/2022]
Abstract
Human papillomavirus (HPV) is responsible for a rising proportion of oropharyngeal squamous cell cancers (OSCCs). HPV-positive OSCCs (HPV-OSCCs) are associated with oral HPV infection and sexual behavior. Patient questions regarding risk factors, prognosis and implications for past, present and future relationships often arise. This manuscript addresses frequently asked questions by patients with HPV-OSCC and their families. A framework for clinicians to address these conversations and the limitations of our present knowledge base is also presented.
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Affiliation(s)
- Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Gypsyamber D'Souza
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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20
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Abstract
OBJECTIVE Oral infection with human papillomavirus (HPV) is associated with a subset of head and neck cancers. We compared prevalence of, and risk factors for, oral HPV infection among HIV-negative and HIV-infected MSM. DESIGN Analysis of baseline data from a prospective cohort study. METHODS MSM aged 18 years or older were recruited from three study sites in Amsterdam, the Netherlands. Participants completed a self-administered risk-factor questionnaire. Oral-rinse and gargle specimens were analyzed for HPV DNA and genotyped using a highly sensitive PCR and reverse line blot assay [short PCR fragment (SPF)10-PCR-DNA Enzyme Immuno Assay (DEIA)/LiPA25 system]. RESULTS In 2010-2011, 794 MSM were included, of whom 767 participants had sufficient data for analysis. Median age was 40.1 years [interquartile range (IQR) 34.8-47.5] and 314 men were HIV-infected (40.9%). Any of 25 typable HPV types was present in 24.4% of all oral samples. Oncogenic HPV types were detected in 24.8 and 8.8% of oral samples from HIV-infected and HIV-negative MSM, respectively (P < 0.001). Of these high-risk types, HPV-16 was the most common (overall 3.4%). Oral infection with high-risk HPV was associated with HIV infection in multivariable analysis (P < 0.001). Increasing age was significantly associated with oral HPV infection in HIV-negative, but not in HIV-infected MSM. CONCLUSION Oral HPV infection is very common among MSM. HIV infection was independently associated with high-risk oral HPV infection, suggesting an important role of HIV in oral HPV infection.
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21
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Forslund O, Johansson H, Madsen KG, Kofoed K. The nasal mucosa contains a large spectrum of human papillomavirus types from the Betapapillomavirus and Gammapapillomavirus genera. J Infect Dis 2013; 208:1335-41. [PMID: 23878325 DOI: 10.1093/infdis/jit326] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) types from the Betapapillomavirus and Gammapapillomavirus genera are common at cutaneous sites. The aim of this study was to analyze the prevalence of these HPV types in oral and nasal samples. METHODS Nasal samples and oral samples were obtained from 312 volunteer Danish healthcare staff (240 women and 72 men), among whom the mean age was 42 years. A total of 311 oral samples and 304 nasal samples were eligible for HPV DNA analysis. HPV types were detected by use of polymerase chain reactions with modified general primers (MGP) and Forslund-Antonsson primers (FAP) and identified by Luminex (for types detected by MGP PCR) or direct sequencing or cloning before sequencing (for types detected by FAP PCR). RESULTS HPV DNA was detected in 6% of the oral samples and 50% of the nasal samples. Seventy-five diverse HPV types or putative HPV types were identified. HPV types within the Alphapapillomavirus, Betapapillomavirus, and Gammapapillomavirus genera were detected in 3%, 31%, and 23% of the nasal samples, respectively. A putative subtype of HPV76, originally isolated from a feline oral squamous cell carcinoma, was detected in 7 nasal samples. CONCLUSION A large spectrum of HPV types from Betapapillomavirus and Gammapapillomavirus have tropism for the nasal mucosa. The implication of the relatively high prevalence of these viruses in the nasal mucosa is unknown.
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Affiliation(s)
- Ola Forslund
- Department of Laboratory Medicine, Division of Medical Microbiology, Lund University, Malmö, Sweden
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22
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Oral and genital HPV genotypic concordance between sexual partners. Clin Oral Investig 2013; 18:261-8. [PMID: 23483257 DOI: 10.1007/s00784-013-0959-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 02/22/2013] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim of this study was to verify human papillomavirus (HPV) transmission and genotype concordance among heterosexual couples. MATERIALS AND METHODS Thirty-one married couples were evaluated. All male subjects presented with clinically diagnosed HPV-related malignant or potentially malignant lesions and underwent peniscopy and penile swab. Their female counterparts underwent swabs of the uterine cervix and oral mucosa. HPV-DNA detection was performed by polymerase chain reaction and restriction fragment length polymorphism. RESULTS HPV-DNA was detected in the penis, vagina/cervix, and oral cavity of 16 couples (51.61%). Of these, HPV-DNA concordance was observed in 14 couples (87.5%). HPV-DNA was amplified in penile and oral sites of 14 couples. Of these, 13 couples reported fellatio (92.85%), most of them (10 couples, 76.9%) without condom use. HPV-DNA concordance was observed in 7/10 of these couples (70%). The three couples (100%) who reported use of condom during fellatio were HPV-DNA discordant (p = 0.025). CONCLUSIONS Lifetime number of female sexual partners and detection of HPV-DNA in the penile mucosa are surrogate markers of exposure to HPV during marriage. Consistent use of condoms may reduce the risk of HPV transmission. CLINICAL RELEVANCE Oral acquisition of HPV from oro-genital contact is influenced by lack of condom use and previous sexual behavior of the male partner. In addition, oral transmission of the virus due to fellatio is as common as genital transmission.
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Abstract
BACKGROUND Little is known about the rates and determinants of oral human papillomavirus (HPV) infection, an infection that is etiologically linked with oropharyngeal cancers. METHODS A cohort of male university students (18-24 years) was examined every 4 months (212 men, 704 visits). Oral specimens were collected via gargle/rinse and swabbing of the oropharynx. Genotyping for HPV-16 and 36 other α-genus types was performed by polymerase chain reaction-based assay. Data on potential determinants were gathered via clinical examination, in-person questionnaire, and biweekly online diary. Hazards ratios (HR) were used to measure associations with incident infection. RESULTS Prevalence of oral HPV infection at enrollment was 7.5%, and 12-month cumulative incidence was 12.3% (95% confidence interval [CI], 7.0, 21.3). Prevalence of oral HPV-16 was 2.8% and 12-month cumulative incidence was 0.8% (95% CI, 0.1%-5.7%). None of the incident oral HPV infections and 28.6% of the prevalent oral HPV infections were detected more than once. In a multivariate model, incident oral HPV infection was associated with recent frequency of performing oral sex (≥1 per week: HR, 3.7; 95% CI, 1.4-9.8), recent anal sex with men (HR, 42.9; 95% CI, 8.8-205.5), current infection with the same HPV type in the genitals (HR, 6.2; 95% CI, 2.4-16.4), and hyponychium (HR, 11.8, 95% CI, 4.1-34.2). CONCLUSIONS Although nearly 20% of sexually active male university students had evidence of oral HPV infection within 12 months, most infections were transient. Human papillomavirus type 16 was not common. Sexual contact and autoinoculation appeared to play independent roles in the transmission of α-genus HPV to the oral cavity of young men.
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Oral human papillomavirus detection in older adults who have human immunodeficiency virus infection. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:505-14. [PMID: 23375488 DOI: 10.1016/j.oooo.2012.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/03/2012] [Accepted: 11/08/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate reproducibility of oral rinse self-collection for human papillomavirus (HPV) detection and investigate associations between oral HPV, oral lesions, immune and sociodemographic factors, we performed a cross-sectional study of older adults with human immunodeficiency virus (HIV) infection. STUDY DESIGN We collected oral rinse samples from 52 subjects at 2 different times of day, followed by an oral examination and interview. We identified HPV with the use of polymerase chain reaction platforms optimized for detection of mucosal and cutaneous types. RESULTS Eighty-seven percent of individuals had oral HPV, of which 23% had oncogenic alpha, 40% had nononcogenic alpha, and 46% had beta or gamma HPV. Paired oral specimens were concordant in all parameters tested. Significant associations observed for oral HPV with increased HIV viral load, hepatitis C seropositivity, history of sexually transmitted diseases, and lifetime number of sexual partners. CONCLUSIONS Oral cavity may be a reservoir of subclinical HPV in older adults who have HIV infection. Understanding natural history, transmission, and potential implications of oral HPV warrants further investigations.
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Anaya-Saavedra G, Flores-Moreno B, García-Carrancá A, Irigoyen-Camacho E, Guido-Jiménez M, Ramírez-Amador V. HPV oral lesions in HIV-infected patients: the impact of long-term HAART. J Oral Pathol Med 2012; 42:443-9. [PMID: 23278731 DOI: 10.1111/jop.12032] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since the introduction of highly active antiretroviral therapy (HAART), an increase in the frequency of human papillomavirus-associated oral lesions (HPV-OL) has been observed. Thus, the aim of this study was to determine the prevalence and factors associated with HPV-OL in Mexican HIV-infected patients, as well as its genotyping, in the HAART era. METHODS In a cross-sectional study developed at an HIV/AIDS referral center in Mexico City, HIV-infected patients were consecutively included from 2004 to 2011. An oral exam was performed; lymphocyte CD4(+) count, HIV-viral load, CDC-stage, and HAART use were recorded. HPV-OL samples were taken for routine histopathological analysis (H-E) and HPV-DNA amplification/sequencing. Logistic regression models were performed and the interactions tested using the STATA software. RESULTS Among 787 HIV patients, 55 (6.9%) showed HPV-OL. HPV-OLs were independently associated with age (≥40 years) and with a longer time of HAART use (≥12 months). The most frequent lesion was squamous cell papilloma in 22 (40%) cases, followed by multifocal epithelial hyperplasia in 15 (27.3%) cases. Labial mucosa was the most common site involved (56.4%). Of the sequences obtained, 65.4% corresponded to low risk and 11.5% to high risk. Mixed high- and low-risk infection were identified in 7.7% of the cases. CONCLUSIONS Human papillomavirus-associated oral lesions were associated with older age and longer HAART use. All lesions were benign in nature and most of the HPV sequences corresponded to low-risk types. The rise of HPV-OLs in HIV patients on HAART may be related with the longer life expectancy of individuals with an impaired immune system rather than a direct effect of HAART.
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Cole L, Polfus L, Peters ES. Examining the incidence of human papillomavirus-associated head and neck cancers by race and ethnicity in the U.S., 1995-2005. PLoS One 2012; 7:e32657. [PMID: 22448226 PMCID: PMC3308956 DOI: 10.1371/journal.pone.0032657] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 01/30/2012] [Indexed: 11/18/2022] Open
Abstract
Background Head and neck cancer (HNC) incidence, mortality and survival rates vary by sex and race, with men and African Americans disproportionately affected. Risk factors for HNC include tobacco and alcohol exposure, with a recent implication of human papillomavirus (HPV) in the pathogenesis of HNC. This study describes the epidemiology of HNC in the United States, examining variation of rates by age, sex, race/ethnicity and potential HPV-association. Methods We used the North American Association of Central Cancer Registries (NAACCR) Cancer in North America (CINA) Deluxe Analytic Data to analyze HNC incidence for 1995–2005 from forty population-based cancer registries. We calculated age-adjusted incidence rates and incidence trends using annual percent change by age, sex, race/ethnicity and HPV-association. Results Males and Non-Hispanic Blacks experienced greater HNC incidence compared to women and other race/ethnicity groupings. A significant overall increase in HNC incidence was observed among HPV-associated sites during 1995–2005, while non HPV-associated sites experienced a significant decline in HNC incidence. Overall, younger age groups, Non-Hispanic Whites and Hispanics experienced greater increases in incidence for HPV-associated sites, while HNC incidence declined for Non-Hispanic Blacks independent of HPV-association. In particular, for HPV-associated sites, HNC incidence for Non-Hispanic White males aged 45–54 increased at the greatest rate, with an APC of 6.28% (p<0.05). Among non HPV-associated sites, Non-Hispanic Black males aged 0–44 years experienced the greatest reduction in incidence (APC, −8.17%, p<0.05), while a greater decline among the older, 55–64 year age group (APC, −5.44%, p<0.05) occurred in females. Conclusions This study provides evidence that HPV-associated tumors are disproportionately affecting certain age, sex and race/ethnicity groups, representing a different disease process for HPV-associated tumors compared to non HPV-associated tumors. Our study suggests that HPV tumor status should be incorporated into treatment decisions for HNC patients to improve prognosis and survival.
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Affiliation(s)
- Lauren Cole
- Louisiana State University Health Sciences Center, School of Public Health, Epidemiology, New Orleans, Louisiana, United States of America.
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Mishra A, Verma V. Oral Sex and HPV: Population Based Indications. Indian J Otolaryngol Head Neck Surg 2012; 67:1-7. [PMID: 25621245 DOI: 10.1007/s12070-012-0521-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 02/09/2012] [Indexed: 11/28/2022] Open
Abstract
Human pappilloma virus (HPV) is well established in etiology of uterine cervical cancers, but its role in head and neck cancer is strongly suggested through many epidemiological and laboratory studies. Although HPV-16 induced oropharyngeal cancer is a distinct molecular entity, its role at other sub-sites (oral cavity, larynx, nasopharynx, hypopharynx) is less well established. Oral sex is supposedly the most commonly practiced unnatural sex across the globe and may prove to be a potential transmitting link between cancers of the uterine cervix and the oropharynx in males particularly in those 10-15% non-smokers. In India with the second largest population (higher population density than China) the oral sex is likely to be a common 'recreation-tool' amongst the majority (poor) and with the concurrent highly prevalent bad cervical/oral hygiene the HPV is likely to synergize other carcinogens. Hence in accordance (or coincidently), in India the cervical cancer happens to be the commonest cancer amongst females while oral/oropharyngeal cancer amongst males. Oral sex as a link between these two cancer types, can largely be argued considering a poor level of evidence in the existing literature. The modern world has even commercialized oral sex in the form of flavored condoms. The inadequate world literature currently is of a low level of evidence to conclude such a relationship because no such specific prospective study has been carried out and also due to wide (and unpredictable) variety of sexual practices, such a relationship can only be speculated. This article briefly reviews the existing literature on various modes and population based indications for HPV to be implicated in head and neck cancer with reference to oral sexual practice.
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Affiliation(s)
- Anupam Mishra
- Department of Otolaryngology, King George's Medical College (CSMMU), Lucknow, UP India
| | - Veerendra Verma
- Department of Otolaryngology, King George's Medical College (CSMMU), Lucknow, UP India
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Beachler DC, Weber KM, Margolick JB, Strickler HD, Cranston RD, Burk RD, Wiley DJ, Minkoff H, Reddy S, Stammer EE, Gillison ML, D’Souza G. Risk factors for oral HPV infection among a high prevalence population of HIV-positive and at-risk HIV-negative adults. Cancer Epidemiol Biomarkers Prev 2012; 21:122-33. [PMID: 22045700 PMCID: PMC3280125 DOI: 10.1158/1055-9965.epi-11-0734] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is an important risk factor for oropharyngeal cancer. Individuals with human immunodeficiency virus (HIV) have higher oral HPV prevalence but the risk factors for oral HPV infection are not well understood for either HIV-positive or HIV-negative individuals. METHODS This study was nested within the Multicenter AIDS Cohort Study (MACS; men) and Women Interagency HIV Study (WIHS; women) cohorts. Exfoliated oral epithelial cells were collected from 379 HIV-positive and 266 at-risk HIV-negative individuals using a rinse and gargle with Scope mouthwash. Samples were tested for 36 types of HPV DNA using PGMY09/11 consensus primers and reverse line blot hybridization. Risk factors for oral HPV infection were explored using logistic regression with generalized estimating equations in this cross-sectional analysis. RESULTS Prevalent oral HPV infection was common (34%), including HPV16 infection in 5.7% of participants. HIV-positive individuals had increased odds of prevalent oral HPV infection compared with HIV-negative individuals [adjusted OR = 2.1; 95% confidence interval (CI), 1.6-2.8]. Risk factors for prevalent oral HPV differed in HIV-positive and HIV-negative participants. Among HIV-negative individuals, higher number of recent oral sex or rimming partners were strong risk factors for prevalent oral HPV infection (each P(trend) < 0.01). In contrast, among HIV-positive individuals, lower CD4 T-cell count (P(trend) < 0.001) and higher number of lifetime sexual partners (P(trend) = 0.03) were strong risk factors. CONCLUSIONS Oral HPV prevalence was elevated in HIV-positive individuals after controlling for differences in cigarette smoking and sexual behavior, supporting the possibility that HIV may affect the natural history of oral HPV. IMPACT Immunosuppression may contribute to increased persistence or progression of oral HPV infection.
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Affiliation(s)
- Daniel C. Beachler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kathleen M. Weber
- Hektoen Institute of Medicine, The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Howard D. Strickler
- Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Ross D. Cranston
- Department of Medicine, University of Pittsburgh. Pittsburgh, PA
| | - Robert D. Burk
- Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- Department of Pediatrics, Microbiology & Immunology and Obstetrics, Gynecology & Women’s Health, Albert Einstein College of Medicine, Bronx, NY
| | - Dorothy J. Wiley
- School of Nursing, University of California-Los Angeles, Los Angeles, CA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY
| | - Susheel Reddy
- Department of Infectious Disease, Northwestern University, Chicago, IL
| | - Emily E. Stammer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Maura L. Gillison
- Viral Oncology Program, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Amornthatree K, Sriplung H, Mitarnun W, Nittayananta W. Impacts of HIV infection and long-term use of antiretroviral therapy on the prevalence of oral human papilloma virus type 16. J Oral Pathol Med 2011; 41:309-14. [PMID: 22098553 DOI: 10.1111/j.1600-0714.2011.01117.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objectives of this study were to determine (i) the prevalence and the copy numbers of oral human papilloma virus type 16 (HPV-16) in HIV-infected patients compared with non-HIV controls, and (ii) the effects of antiretroviral therapy (ART) and its duration on the virus. METHODS A cross-sectional study was carried out in HIV-infected patients with and without ART and in non-HIV controls. Saliva samples were collected, and the DNA extracted from those samples was used as a template to detect HPV-16 E6 and E7 by quantitative polymerase chain reaction. Student's t-test and ANOVA test were performed to determine the prevalence rates among groups. RESULTS Forty-nine HIV-infected patients: 37 on ART (age range, 23-54 years; mean, 37 years), 12 not on ART (age range, 20-40 years; mean, 31 years), and 20 non-HIV controls (age range, 19-53 years; mean, 31 years) were enrolled. The prevalence of oral HPV-16 infection and the copy numbers of the virus were significantly higher in HIV-infected patients than in non-HIV controls when using E6 assay (geometric mean = 10696 vs. 563 copies/10(5) cells, P < 0.001), but not E7 assay. No significant difference was observed between those who were and were not on ART. Long-term use of ART did not significantly change the prevalence of oral HPV-16 infection and the copy numbers of the virus (P = 0.567). CONCLUSION We conclude that the prevalence of oral HPV-16 infection and the copy numbers of the virus are increased by HIV infection. Neither the use of ART nor its duration significantly affected the virus.
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Affiliation(s)
- Korntip Amornthatree
- Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Bottalico D, Chen Z, Dunne A, Ostoloza J, McKinney S, Sun C, Schlecht NF, Fatahzadeh M, Herrero R, Schiffman M, Burk RD. The oral cavity contains abundant known and novel human papillomaviruses from the Betapapillomavirus and Gammapapillomavirus genera. J Infect Dis 2011; 204:787-92. [PMID: 21844305 DOI: 10.1093/infdis/jir383] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Human papillomaviruses (HPVs) primarily sort into 3 genera: Alphapapillomavirus (α-HPV), predominantly isolated from mucosa, and Betapapillomavirus (β-HPV) and Gammapapillomavirus (γ-HPV), predominantly isolated from skin. HPV types might infect body sites that are different from those from which they were originally isolated. METHODS We investigated the spectrum of HPV type distribution in oral rinse samples from 2 populations: 52 human immunodeficiency virus (HIV)-positive men and women and 317 men who provided a sample for genomic DNA for a prostate cancer study. HPV types were detected with the MY09/MY11 and FAP59/64 primer systems and identified by dot blot hybridization and/or direct sequencing. RESULTS Oral rinse specimens from 35 (67%) of 52 HIV-positive individuals and 117 (37%) of 317 older male participants tested positive for HPV DNA. We found 117 type-specific HPV infections from the HIV-positive individuals, including 73 α-HPV, 33 β-HPV, and 11 γ-HPV infections; whereas, the distribution was 46 α-HPV, 108 β-HPV, and 14 γ-HPV infections from 168 type-specific infections from the 317 male participants. CONCLUSIONS The oral cavity contains a wide spectrum of HPV types predominantly from the β-HPV and γ-HPV genera, which were previously considered to be cutaneous types. These results could have significant implications for understanding the biology of HPV and the epidemiological associations of HPV with oral and skin neoplasia.
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Affiliation(s)
- Danielle Bottalico
- Department of Pediatrics, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
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Pinheiro RS, de França TR, Rocha B, Ferreira DC, Ribeiro CMB, Cavalcanti SMB, de Souza IPR, Leão JC, Castro GFB. Human papillomavirus coinfection in the oral cavity of HIV-infected children. J Clin Pathol 2011; 64:1083-7. [DOI: 10.1136/jclinpath-2011-200187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AimTo identify the early presence of human papillomavirus (HPV) DNA in the oral cavity of HIV-infected children.MethodsThe study group comprised 50 HIV-infected children and 50 healthy aged paired controls. Oral mucosa samples were collected by swab, and a 450 bp HPV DNA fragment was amplified by PCR, using degenerate consensus primers directed to the L1 gene. HPV typing was performed using specifics primers for types 6/16 and 11/18.ResultsAll HPV co-infected children had vertical transmission of HIV. HPV DNA was detected in 6/50 (12.0%) of HIV children and three control group individuals 3/50 (6.0%) (p>0.01). In the HIV group, one had type 11, in the control group one had co-infection of types 11/16, and the others had type 16 and 18.ConclusionsBased upon the results, it is concluded that HPV DNA may be present in HIV disease, but no association with immunosuppression, delivery, or medical records (CD4 cell count, viral load and use of highly active antiretroviral therapy) was observed, and no differences could be observed between the groups either.
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Mor Z, Gefen D, Linhart Y, Amitai ZS, Dan M, Shohat T. The contribution of oral sex to male urethral Neisseria gonorrhoeae infections in Tel-Aviv district, Israel. Int J STD AIDS 2011; 22:251-5. [PMID: 21571972 DOI: 10.1258/ijsa.2009.009202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The incidence of Neisseria gonorrhoeae (NG) in Tel-Aviv district, Israel has increased since the mid-1990s. This study aimed to address behavioural attributes and identify the sources of NG infection. Of 1234 NG cases in men reported between 2000 and 2004, 379 (31%) were interviewed. Most were single, heterosexual and Israeli-born. Insertive oral sex (OS) was reported by 77% patients and vaginal intercourse by 69%, where condoms were used by 4% and 40% for these practices, respectively. Unprotected OS was performed by 95% of the 151 men involved in protected vaginal sex. OS was the most common practice among the younger age group, and in sexual contacts with casual partners or commercial sex workers (CSWs): behaviours that were reported by 37% and 36% of patients, respectively. Unprotected OS is a common route for NG transmission, and it is suggested that the rise in NG may be attributed to unprotected OS with casual partners or CSWs.
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Affiliation(s)
- Z Mor
- Tel-Aviv Department of Health, Ministry of Health, E Wolfson Medical Centre, Holon, Israel.
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Parisi SG, Cruciani M, Scaggiante R, Boldrin C, Andreis S, Dal Bello F, Pagni S, Barelli A, Sattin A, Mengoli C, Palù G. Anal and oral human papillomavirus (HPV) infection in HIV-infected subjects in northern Italy: a longitudinal cohort study among men who have sex with men. BMC Infect Dis 2011; 11:150. [PMID: 21612634 PMCID: PMC3119070 DOI: 10.1186/1471-2334-11-150] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 05/25/2011] [Indexed: 01/05/2023] Open
Abstract
Background A study including 166 subjects was performed to investigate the frequency and persistence over a 6-month interval of concurrent oral and anal Human Papillomavirus (HPV) infections in Human Immunodeficiency Virus (HIV)-infected men who have sex with men (MSM). Methods Patients with no previously documented HPV-related anogenital lesion/disease were recruited to participate in a longitudinal study. Polymerase chain reaction (PCR) was performed to detect HPV from oral and anal swabs and to detect Human Herpes Virus 8 (HHV-8) DNA in saliva on 2 separate specimen series, one collected at baseline and the other collected 6 months later. A multivariate logistic analysis was performed using anal HPV infection as the dependent variable versus a set of covariates: age, HIV plasma viral load, CD4+ count, hepatitis B virus (HBV) serology, hepatitis C virus (HCV) serology, syphilis serology and HHV-8 viral shedding. A stepwise elimination of covariates with a p-value > 0.1 was performed. Results The overall prevalence of HPV did not vary significantly between the baseline and the follow-up, either in the oral (20.1 and 21.3%, respectively) or the anal specimens (88.6 and 86.3%). The prevalence of high-risk (HR) genotypes among the HPV-positive specimens was similar in the oral and anal infections (mean values 24.3% and 20.9%). Among 68 patients with either a HR, low-risk (LR) or undetermined genotype at baseline, 75% had persistent HPV and the persistence rates were 71.4% in HR infections and 76.7% in LR infections. There was a lack of genotype concordance between oral and anal HPV samples. The prevalence of HR HPV in anus appeared to be higher in the younger patients, peaking (> 25%) in the 43-50 years age group. A decrease of the high level of anal prevalence of all genotypes of HPV in the patients > 50 years was evident. HHV-8 oral shedding was positively related to HPV anal infection (p = 0.0046). A significant correlation was found between the persistence of HHV-8 shedding and HIV viral load by logistic bivariate analysis (Odds Ratio of HHV-8 persistence for 1-log increase of HIV viral load = 1.725 ± 0.397, p = 0.018). Conclusions A high prevalence of HPV infection was found in our cohort of HIV-infected MSM, with a negative correlation between anal HPV infection and CD4 cell count.
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Affiliation(s)
- Saverio G Parisi
- Department of Histology, Microbiology and Medical Biotechnology, Padua University, Via Gabelli 63, 35100 Padova, Italy.
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Challacombe S, Chidzonga M, Glick M, Hodgson T, Magalhães M, Shiboski C, Owotade F, Ranganathan R, Naidoo S. Global Oral Health Inequalities. Adv Dent Res 2011; 23:227-36. [DOI: 10.1177/0022034511402081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Four oral mucosal infections were identified as Global Oral Health Priorities: (a) HIV and associated viral, bacterial, and fungal infections; (b) tuberculosis; (c) NOMA; and (d) sexually transmitted diseases. Huge global inequalities exist in all four. HIV-associated infections constitute the major challenge. Oral manifestations of AIDS can be specifically diagnostic, indicating a significant role for dentists within health teams. The World Workshops in Oral Health & Disease in AIDS have identified a research program, elements of which are being implemented. Data on oral mucosal involvement in tuberculosis, syphilis, and gonorrhea are incomplete in developed countries and virtually non-existent in low- and middle-income countries, indicating the need for further epidemiological studies. Oral manifestations of tuberculosis and sexually transmitted diseases are largely associated with general health, so action programs should be integrated with agencies treating the systemic diseases. NOMA is very much in the oral health domain. It is a preventable disease associated with malnutrition and unidentified bacterial factors. Prevalence is probably grossly overestimated at present; but nevertheless it constitutes a challenge to the profession, especially in the NOMA belt. Current treatment is surgical, but plans for its eradication should be achievable. The global oral health community, especially the IADR, has a major role to play.
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Affiliation(s)
- S. Challacombe
- Oral Medicine, King’s College London Dental Institute, Central Office, Floor 18, Guys Tower, Guys Hospital, London SE1 9RT, UK
| | - M. Chidzonga
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - M. Glick
- University of Buffalo, Buffalo; NY, USA
| | - T. Hodgson
- Eastman Dental Hospital UCLH NHS Foundation Trust and UCL Eastman Dental Institute, UK
| | | | - C. Shiboski
- University of California at San Francisco, USA
| | - F. Owotade
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - S. Naidoo
- University of the Western Cape, Cape Town, South Africa
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Lu B, Viscidi RP, Lee JH, Wu Y, Villa LL, Lazcano-Ponce E, da Silva RJC, Baggio ML, Quiterio M, Salmerón J, Smith DC, Abrahamsen M, Papenfuss M, Stockwell HG, Giuliano AR. Human papillomavirus (HPV) 6, 11, 16, and 18 seroprevalence is associated with sexual practice and age: results from the multinational HPV Infection in Men Study (HIM Study). Cancer Epidemiol Biomarkers Prev 2011; 20:990-1002. [PMID: 21378268 DOI: 10.1158/1055-9965.epi-10-1160] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few human papillomavirus (HPV) serology studies have evaluated type-specific seroprevalence of vaccine HPV types in men. This study investigates seroprevalence of HPV 6, 11, 16, and 18, and associated risk factors in men residing in three countries (United States, Mexico, and Brazil). METHODS Data from 1,477 men aged 18 to 70 enrolled in the HPV Infection in Men Study (HIM Study) were analyzed. Serum antibody testing was performed with virus-like particle-based ELISA. Potential risk factors were assessed for individual HPV types by the use of logistic regression. RESULTS Overall, HPV-6, 11, 16, and 18 seroprevalence was 14.8%, 17.3%, 11.2%, and 5.8%, respectively. Thirty-four percent of men were seropositive to one or more HPV types. When examined by sexual practice, 31.2% of men who had sex with women, 65.6% of men who had sex with men (MSM), and 59.4% of men who had sex with both men and women (MSMW) were seropositive to one or more HPV types. Seroprevalence increased with age among young-to-middle-aged men with significant upward age trends observed for HPV 11, 16, and 18. Men with multiple lifetime male anal sex partners were 2 to 4 times more likely to be HPV 6 or 11 seropositive and 3 to 11 times more likely to be HPV 16 or 18 seropositive. CONCLUSION Our data indicate that exposures to vaccine HPV types were common in men and highly prevalent among MSM and MSMW. IMPACT Our study provides strong evidence that the practice of same-sex anal intercourse is an independent risk factor for seroprevalence of individual vaccine HPV types. Examination of antibody responses to HPV infections at various anatomic sites in future studies is needed to elaborate on the mechanism.
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Affiliation(s)
- Beibei Lu
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL 33612-9416, USA
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Sánchez-Vargas LO, Díaz-Hernández C, Martinez-Martinez A. Detection of Human Papilloma Virus (HPV) in oral mucosa of women with cervical lesions and their relation to oral sex practices. Infect Agent Cancer 2010; 5:25. [PMID: 21129222 PMCID: PMC3014881 DOI: 10.1186/1750-9378-5-25] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 12/04/2010] [Indexed: 12/01/2022] Open
Abstract
Background Previous studies have either investigated the relationship of HPV with oral cancer or the prevalence of HPV on the oral cavity. The purpose of this investigation was to study the prevalence of HPV in oral cavity of women with oral sex practices and cervical lesions. Methods Forty six (46) non-smokers and non-alcoholic patients attended the "Clínica de Displasias" of "Ciudad Juarez" were sampled. This population had a CIN diagnosis sometime between the previous six months. On previous consent they filled out a questionnaire related to their oral sex practices. Afterwards one swab from cheeks and another from palate/gum were taken; PCR was used to determine generic HPV, HPV16 and HPV18. Results Seventy two percent (72%) of the patients stated to have oral sex practices regularly which all of them were positive to HPV either in oral mucus, palate/gum or both. The total of the given results showed that 35% had HPV16; among those distributed in 26% with regular oral sex practices and 9% stated as never practiced oral sex. An association was found between oral HPV16 positivity and progression to cervical CIN advanced lesions. On the other hand HPV18 was not detected. The frequency of HPV16 was higher in buccal mucosa (23%) versus palate/gum (16%). Conclusions This study suggests that buccal HPV16 infection is associated with CIN progression.
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Affiliation(s)
- Luis O Sánchez-Vargas
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Chihuahua, México.
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Abstract
BACKGROUND Human papillomavirus type 16 (HPV16) is a common infection in the anogenital tract. HPV16 DNA detected in oral specimens has recently been identified as a risk factor for some oropharyngeal cancers. The reported prevalence of oral HPV infection from individual studies is highly variable. METHODS We systematically reviewed and abstracted data from published studies (n = 18) that detected oral HPV DNA in 4581 cancer-free subjects to determine the pooled prevalence (and 95% confidence intervals [CI]) of HPV16, carcinogenic HPV, and any HPV. RESULTS 1.3% (95% CI: 1.0-1.7%) of 3977 healthy subjects had oral HPV16, 3.5% (95% CI: 3.0-4.1) of 4441 subjects had carcinogenic HPV, and 4.5% (95% CI: 3.9-5.1) of 4070 subjects were positive for any HPV. Oral HPV16 accounted for 28% of all HPV detected in the oral region. Men (47 of 1017) and women (117 of 3690) had nearly exactly the same prevalence of any oral HPV detected (4.6% vs. 4.4%, respectively). CONCLUSIONS HPV-16, a common anogenital infection, was rarely detected in oral specimens. However, a small but noteworthy proportion of healthy individuals have oral HPV infections with types known to cause cancer in the oral region.
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Abstract
PURPOSE OF REVIEW Oral human papillomavirus (HPV) infection is the principal cause of a distinct form of oropharyngeal cancer (OPCA) that has been rising in incidence in the United States since 1973, particularly among young men. The possible contribution of the HIV-epidemic to this increase is unclear. RECENT FINDINGS Incidence rates for HPV-related OPCA increased with age and were strongly influenced by year of birth in the United States (cohort effect). Persons with HIV/AIDS are at increased risk ( approximately two to six-fold) for OPCA relative to the general population. However, this excess risk may be attributable to tobacco smoking rather than the three-fold higher prevalence of oral HPV infection in this population. Consistent with a viral attribution, however, is the apparent increase in risk of OPCA with severity of AIDS-related immunosuppression. Analogous to other HPV-related cancers (e.g. cervical and anal cancer), trends over time do not appear to be influenced by highly active antiretroviral (HAART) therapy. SUMMARY Healthcare providers may encounter HPV-related OPCA more frequently among individuals with HIV/AIDS as this population ages and due to the strong birth cohort effects observed in the general population. However, there is no evidence in support of different incidence trends over time among persons with and without HIV/AIDS.
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Feller L, Khammissa RA, Wood NH, Lemmer J. Epithelial maturation and molecular biology of oral HPV. Infect Agent Cancer 2009; 4:16. [PMID: 19930727 PMCID: PMC2788520 DOI: 10.1186/1750-9378-4-16] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 11/25/2009] [Indexed: 12/12/2022] Open
Abstract
Human papillomavirus (HPV) is widespread and can cause latent infection in basal cells, with low HPV DNA copy-number insufficient for transmission of infection; can cause subclinical infection that is active but without clinical signs; or can cause clinical infection leading to benign, potentially malignant or malignant lesions. The HPV cycle is influenced by the stage of maturation of the infected keratinocytes, and the production of virions is restricted to the post-mitotic suprabasal epithelial cells where all the virus genes are expressed.Low-risk HPV genotypes are associated with the development of benign oral lesions, whereas high-risk HPV genotypes are implicated in the development of malignant epithelial neoplasms. The rôle of high-risk HPV as a causative agent in epithelial malignancy is different at different anatomical sites: it is almost invariably implicated in squamous cell carcinoma of the uterine cervix, fairly frequently implicated in squamous cell carcinoma of the oropharynx, and it is seldom implicated in squamous cell carcinoma of the mouth.
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Affiliation(s)
- Liviu Feller
- Department of Periodontology and Oral Medicine, School of Dentistry, University of Limpopo, Medunsa Campus, South Africa.
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Leao JC, Ribeiro CMB, Carvalho AAT, Frezzini C, Porter S. Oral complications of HIV disease. Clinics (Sao Paulo) 2009; 64:459-70. [PMID: 19488613 PMCID: PMC2694251 DOI: 10.1590/s1807-59322009000500014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 02/18/2009] [Indexed: 12/13/2022] Open
Abstract
Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS.
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Affiliation(s)
- Jair C Leao
- Departamento de Clinica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, PE, Brazil.
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Agrawal Y, Koch WM, Xiao W, Westra WH, Trivett AL, Symer DE, Gillison ML. Oral human papillomavirus infection before and after treatment for human papillomavirus 16-positive and human papillomavirus 16-negative head and neck squamous cell carcinoma. Clin Cancer Res 2008; 14:7143-50. [PMID: 18981014 DOI: 10.1158/1078-0432.ccr-08-0498] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Oral human papillomavirus (HPV) infection is a risk factor for head and neck squamous cell carcinoma (HNSCC), and is a concern for patients with HPV-positive HNSCC and their partners. The prevalence of oral HPV infection before and after cancer therapy was investigated among patients with HPV16-positive and HPV16-negative HNSCC. EXPERIMENTAL DESIGN Serial oral rinse samples (ORS) were collected from a cohort of 135 HNSCC cases as frequently as every 3 months for up to 3 years. Tumor HPV status was determined by HPV16 in situ hybridization. HPV was detected in ORS by consensus PCR and line blot hybridization. The HPV16 variants in positive oral rinse-tumor pairs were determined by sequencing. The odds of oral HPV infection among HPV16-positive and HPV16-negative cases were compared by use of generalized estimating equations. RESULTS Patients were followed for a median of 21 months and provided a median of 4 samples. Forty-four of 135 patients had HPV16-positive tumors. HPV16-positive cases were more likely than HPV16-negative cases to have an oral HPV infection detected before (odds ratio, 8.6; 95% confidence interval, 3.5-21) and after therapy (OR, 2.9; 95% confidence interval, 1.1-7.4). Oral infections by HPV16 and other high-risk, but not low-risk, types were more common among HPV16-positive cases both before and after therapy. Most HPV16 variants in ORS were European, unique, and identical to that in the tumor. Persistence of a type-specific oral infection was demonstrable for as long as 5 years. CONCLUSION Oral high-risk HPV infections are more frequent among patients with HPV16-positive than HPV16-negative HNSCC, consistent with a behavioral and/or biological disposition to infection.
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Affiliation(s)
- Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21231, USA
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Gillison ML. Human papillomavirus-related diseases: oropharynx cancers and potential implications for adolescent HPV vaccination. J Adolesc Health 2008; 43:S52-60. [PMID: 18809146 PMCID: PMC3037092 DOI: 10.1016/j.jadohealth.2008.07.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 07/01/2008] [Accepted: 07/03/2008] [Indexed: 02/03/2023]
Abstract
Molecular and epidemiological data now support an etiologic role for oncogenic human papillomavirus (HPV) in oral cancers in women and men. Recent studies have demonstrated an increase in the incidence of HPV-associated oral cancers in the United States. Moreover, the incidence rates for these cancers are higher in men than women. Oral HPV infections acquired through oral sex appear to be the principal risk factor for HPV-associated oral cancers. Despite reports in the popular press that the prevalence of oral sexual behaviors is increasing in the adolescent population, trends in these behaviors over time are largely unavailable. However, data indicate that oral-genital contact is frequently practiced among adolescents; adolescents do not typically consider this a risky behavior. The majority of oral cancers (approximately 90%) caused by HPV are identified as HPV 16 positive. Therefore, HPV-associated oral cancers could be prevented by a prophylactic vaccine if the vaccine were demonstrated to be capable of preventing oral HPV 16 infection. These findings have created new potential opportunities for the primary prevention of oral cancers.
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Affiliation(s)
- Maura L Gillison
- The Johns Hopkins Medical Institutions, Baltimore, Maryland 21231, USA.
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D'Souza G, Fakhry C, Sugar EA, Seaberg EC, Weber K, Minkoff HL, Anastos K, Palefsky JM, Gillison ML. Six-month natural history of oral versus cervical human papillomavirus infection. Int J Cancer 2007; 121:143-50. [PMID: 17354235 DOI: 10.1002/ijc.22667] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Human papillomavirus (HPV) infection is etiologically associated with a subset of oral cancers, and yet, the natural history of oral HPV infection remains unexplored. The feasibility of studying oral HPV natural history was evaluated by collecting oral rinse samples on 2 occasions at a 6-month interval from 136 HIV-positive and 63 HIV-negative participants. Cervical vaginal lavage samples were concurrently collected for comparison. HPV genomic DNA was detected in oral and cervical samples by consensus primer PCR and type-specified for 37 HPV types. The six-month cumulative prevalence of oral HPV infection was significantly less than for cervical infection (p < 0.0001). HIV-positive women were more likely than HIV-negative women to have an oral (33 vs. 15%, p = 0.016) or cervical (78 vs. 51%, p < 0.001) infection detected. Oral HPV infections detected at baseline were as likely as cervical infections to persist to 6 months among HIV-negative (60% vs. 51%, p = 0.70) and HIV-positive (55% vs. 63%, p = 0.27) women. Factors that independently elevated odds for oral HPV persistence differed from cervical infection and included current smoking (OR = 8, 95% CI = 1.3-53), age above 44 years (OR = 20, 95% CI = 4.1-83), CD4 < 500 (OR = 6, 95% CI = 1.1-26), use of HAART therapy (OR = 12, 95% CI = 1.0-156), and time on HAART therapy (trend p = 0.04). The rate of oral HPV infections newly detected at follow-up was significantly lower than cervical infection among HIV-positive (p < 0.001) and HIV-negative women (p < 0.001). Our study not only demonstrates that it is feasible to study the natural history of oral HPV infection with oral rinse sampling, but also indicates that oral and cervical HPV natural history may differ.
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Affiliation(s)
- Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
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Abstract
HPV infection of both the genital tract and oral cavity of HIV+ men and women is increased. HPV-related pathology is also increased in the HIV+ individuals, usually with further increases seen for those HIV+ individuals with lower CD4 cell counts. Fortunately, the rates of cervical cancer and anal cancer are relatively low and not related to CD4 cell count. Treatment of the HIV+ individual with HPV-related disease is challenging and requires close long-term follow-up to prevent recurrent disease. The mechanism of how HPV and HIV interact is still not known but is more likely to be linked to immune suppression rather than a direct interaction between viruses. The newly developed HPV vaccines will likely have a significant impact on HPV-related disease in immunocompetent individuals. It remains to be seen what impact these vaccine will have on the immune depressed.
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Affiliation(s)
- Jennifer E Cameron
- Tulane Health Sciences Center, Tulane Medical School, New Orleans, LA, USA
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Fakhry C, D'souza G, Sugar E, Weber K, Goshu E, Minkoff H, Wright R, Seaberg E, Gillison M. Relationship between prevalent oral and cervical human papillomavirus infections in human immunodeficiency virus-positive and -negative women. J Clin Microbiol 2006; 44:4479-85. [PMID: 17021055 PMCID: PMC1698387 DOI: 10.1128/jcm.01321-06] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Human papillomavirus (HPV) is an etiologic agent for both oropharyngeal and cervical cancers, yet little is known about the interrelationship between oral and cervical HPV infections. Therefore, we compared the prevalences and type distributions of oral and cervical HPV infections and evaluated infection concordance in a cross-sectional study within the Women's Interagency HIV Study cohort. Oral rinse and cervical-vaginal lavage samples were concurrently collected from a convenience sample of 172 human immunodeficiency virus (HIV)-positive and 86 HIV-negative women. HPV genomic DNA was detected by PGMY09/11 L1 consensus primer PCR and type specified by reverse line blot hybridization for 37 HPV types and beta-globin. Only 26 of the 35 HPV types found to infect the cervix were also found within the oral cavity, and the type distribution for oral HPV infections appeared distinct from that for cervical infections (P<0.001). Oral HPV infections were less common than cervical infections for both HIV-positive (25.2% versus 76.9%, P<0.001) and HIV-negative (9.0% versus 44.9%, P<0.001) women. Oral HPV infections were more common among women with a cervical HPV infection than those without a cervical HPV infection (25.5% versus 7.9%, P=0.002). The majority of women (207; 93.7%) did not have simultaneous oral and cervical infections by the same HPV type; however, the number of women who did (14; 6.3%) was significantly greater than would be expected by chance (P=0.0002). Therefore, the oral and cervical reservoirs for HPV infection are likely not entirely independent of one another.
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Affiliation(s)
- Carole Fakhry
- Johns Hopkins Medicine and Johns Hopkins Bloomberg School of Public Health, Cancer Research Building I, 1650 Orleans Street G91, Baltimore, MD 21231-1000, and The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
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Abstract
Human papillomavirus (HPV) is now recognized to play a role in the pathogenesis of a subset of head and neck squamous cell carcinomas (HNSCCs), particularly those that arise from the lingual and palatine tonsils within the oropharynx. High-risk HPV16 is identified in the overwhelming majority of HPV-positive tumors, which have molecular-genetic alterations indicative of viral oncogene function. Measures of HPV exposure, including sexual behaviors, seropositivity to HPV16, and oral, high-risk HPV infection, are associated with increased risk for oropharyngeal cancer. HPV infection may be altering the demographics of HNSCC patients, as these patients tend to be younger, nonsmokers, and nondrinkers. There is sufficient evidence to conclude that a diagnosis of HPV-positive HNSCC has significant prognostic implications; these patients have at least half the risk of death from HNSCC when compared with the HPV-negative patient. The HPV etiology of these tumors may have future clinical implications for the diagnosis, therapy, screening, and prevention of HNSCC.
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Affiliation(s)
- Carole Fakhry
- Department of Viral Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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Burchell AN, Winer RL, de Sanjosé S, Franco EL. Chapter 6: Epidemiology and transmission dynamics of genital HPV infection. Vaccine 2006; 24 Suppl 3:S3/52-61. [PMID: 16950018 DOI: 10.1016/j.vaccine.2006.05.031] [Citation(s) in RCA: 258] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 05/15/2006] [Indexed: 11/17/2022]
Abstract
This chapter provides an overview of the epidemiology of human papillomavirus (HPV) infection, with a focus on the dynamics of sexual transmission. We explore concepts related to the spread of sexually transmitted infections, including population prevalence, duration of infectivity, patterns of sexual contacts, and transmissibility, including modifiers of susceptibility and infectivity. HPV prevalence and incidence are high in most studies, particularly amongst young women. There is strong evidence that transmission occurs primarily via sexual activity, most commonly vaginal and anal intercourse. Although the duration of infectivity may be short, current evidence suggests that HPV is highly transmissible. The implications of transmission dynamics for the success of future HPV vaccines are discussed.
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Affiliation(s)
- Ann N Burchell
- Division of Cancer Epidemiology, Departments of Oncology and Epidemiology and Biostatistics, McGill University, 546 Pine Avenue West, Montreal, Quebec, Canada.
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Ompad DC, Strathdee SA, Celentano DD, Latkin C, Poduska JM, Kellam SG, Ialongo NS. Predictors of early initiation of vaginal and oral sex among urban young adults in Baltimore, Maryland. ARCHIVES OF SEXUAL BEHAVIOR 2006; 35:53-65. [PMID: 16502153 DOI: 10.1007/s10508-006-8994-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2004] [Revised: 12/17/2004] [Accepted: 02/20/2005] [Indexed: 05/06/2023]
Abstract
Over the past three decades, most research on adolescent sexual behavior has focused on vaginal intercourse and related behaviors, including contraception and unintended pregnancy. In this study, we describe the prevalence and correlates of vaginal, oral, and anal sex in an epidemiologically defined population in Baltimore, Maryland. Young adults (ages 18-24), who had been enrolled in a behavioral intervention trial during elementary school, were interviewed by telephone between 1998 and 2002 to assess their sexual behavior. Of 1679 respondents interviewed, 70.8% were Black and 55% were women. Overall, 93% of the young adults reported vaginal intercourse, 78% reported receiving oral sex, 57% reported performing oral sex, and 10% reported receptive anal intercourse. Among men, 27% reported insertive anal intercourse. Blacks initiated vaginal intercourse at an earlier age than Whites; White women performed oral sex earlier than Black women. Significant interactions were observed between age of first vaginal partner and both gender and race/ethnicity. Blacks with older partners initiated sex at an earlier age than both Blacks with a partner the same age or younger and Whites. We also observed a relationship between older female sex partners and earlier vaginal sex initiation among men. We conclude that older sex partners play an important role in sexual initiation among young adults. In light of the rates of oral and anal sex, sexual education and intervention programs should address the risk for unintended consequences of these behaviors.
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Affiliation(s)
- Danielle C Ompad
- Center for Urban Epidemiological Studies, New York Academy of Medicine, New York 10029, USA
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Cameron JE, Mercante D, O'Brien M, Gaffga AM, Leigh JE, Fidel PL, Hagensee ME. The impact of highly active antiretroviral therapy and immunodeficiency on human papillomavirus infection of the oral cavity of human immunodeficiency virus-seropositive adults. Sex Transm Dis 2006; 32:703-9. [PMID: 16254546 DOI: 10.1097/01.olq.0000175398.34610.2e] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prevalence of human papillomavirus (HPV)-associated oral condylomas has reportedly increased in HIV-infected individuals since the introduction of highly active antiretroviral therapy (HAART). The relationships between HIV therapy regimen, overall health, and subclinical oral HPV have not been examined. GOAL To determine oral HPV genotype prevalence and the impact of HAART and health in the HIV+ population. STUDY An L1 consensus-primer polymerase chain reaction and linear array assay were used to examine the prevalence of 27 HPV genotypes in saliva of 98 HIV+ individuals. Risk assessment variables were compared to oral HPV status. RESULTS Oral HPV was detected in 37% of HIV+ African American individuals. Caucasians were at greater risk of oral HPV infection than African Americans. Markers of advanced HIV disease did not predict HPV status. Therapy status was associated with HPV detection. CONCLUSIONS Treatment of HIV, rather than HIV immunosuppression, appears to play a role in oral HPV infections in HIV+ individuals.
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Affiliation(s)
- Jennifer E Cameron
- Department of Microbiology, Immunology, and Parasitology, New Orleans, LA, USA
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