Incidence and risk factors of HPV-related and HPV-unrelated Head and Neck Squamous Cell Carcinoma in HIV-infected individuals

Abstract

Objectives To examine the risk and trends of HPV-related and HPV-unrelated Head and Neck Squamous Cell Carcinoma (HNSCC) in HIV-infected individuals and assess whether immunosuppression (measured through CD4 cell count) and other risk factors impact HNSCC risk. Materials and methods Incident HNSCCs at HPV-related and HPV-unrelated anatomic sites were detected in HIV-infected participants from pooled data from 17 prospective studies in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) between 1996 and 2009. HNSCC cases were validated using chart review or cancer registry matching. Risk factors for incident HPV-related and HPV-unrelated HNSCC were explored using mixed effects Poisson regression in a full prospective analysis, and the effect of CD4 prior to cancer diagnosis was examined in a nested case control analysis. Results 66 HPV-related and 182 HPV-unrelated incident HNSCCs were detected among 82,375 HIV-infected participants. Standardized incidence ratios (SIRs) for both HPV-related (SIR = 3.2, 95%CI = 2.5–3.4) and HPV-unrelated (SIR = 3.0, 95%CI = 2.5–4.1) HNSCC were significantly elevated in HIV-infected individuals compared with the US general population. Between 1996 and 2009, the age-standardized HPV-related HNSCC incidence increased non-significantly from 6.8 to 11.4 per 100,000 person-years (p-trend = 0.31) while the age-standardized incidence of HPV-unrelated HNSCC decreased nonsignificantly from 41.9 to 29.3 per 100,000 person-years (p-trend = 0.16). Lower CD4 cell count prior to cancer diagnosis was significantly associated with increased HPV-related and HPV-unrelated HNSCC risk. Conclusion The standardized incidence of HPV-related and HPV-unrelated HNSCC are both elevated in HIV-infected individuals. Immunosuppression may have a role in the development of both HPV-related and HPV-unrelated HNSCC.

Oral Human Papillomavirus in Youth From the Pediatric HIV/AIDS Cohort Study

“…The rates of oral HPV were by far lower than HIV-infected adults or sexually active high risk adolescents where rates have ranged from 16% to 38.5% with the highest being found in HIV-infected men who have sex with men [2, 3, 5]. Despite our low rate of detection, we did find associations with low CD4 count and high VL similar to that reported in adults [2, 3, 5].…”

“…HPV 16 is the predominant genotype found in these cancers. Individuals with HPV-associated head and neck squamous cell carcinomas have similar risk factors as those with HPV associated anogenital cancers including a greater lifetime number of sex partners and HIV infection [2, 3]. Despite these similarities, oral HPV infections are much less common than genital infections.…”

HPV Infection and Cervical Abnormalities in HIV Positive Women in Different Regions of Brazil, a Middle-Income Country

“…In addition, recent data demonstrate that HR-HPV is also associated with a subset of head and neck cancers, including 50-75% of oropharyngeal cancers (Marur et al, 2010;Beachler et al, 2014). HPV infection is particularly burdensome for human immunodeficiency virus (HIV+)-infected women, as they are more susceptible to infection and less likely to clear the virus, which in turn increases their risk of developing all types of HPV-associated cancers compared to the general population.…”

Cancer prevention in HIV-infected populations

“…HIV-infected patients are at an approximately 2–4 fold increased risk of developing both HPV-associated and HPV-unassociated head and neck squamous cell carcinomas (HNSCC) 120 compared to the general population. Collectively, head and neck cancers are the fourth commonest NADMs.…”