Oral human Papillomavirus DNA detection in HIV-positive men: prevalence, predictors, and co-occurrence at anal site

Abstract

BackgroundHIV-positive patients carry an increased risk of HPV infection and associated cancers. Therefore, prevalence and patterns of HPV infection at different anatomical sites, as well as theoretical protection of nonavalent vaccine should be investigated. Aim was to describe prevalence and predictors of oral HPV detection in HIV-positive men, with attention to nonavalent vaccine-targeted HPV types. Further, co-occurrence of HPV DNA at oral cavity and at anal site was assessed.MethodsThis cross-sectional, clinic-based study included 305 HIV-positive males (85.9% MSM; median age 44.7 years; IQR: 37.4–51.0), consecutively observed within an anal cancer screening program, after written informed consent. Indication for anal screening was given by the HIV physician during routine clinic visit. Paired oral rinse and anal samples were processed for the all HPV genotypes with QIASYMPHONY and a PCR with MY09/MY11 primers for the L1 region.ResultsAt the oral cavity, HPV DNA was detected in 64 patients (20.9%), and in 28.1% of these cases multiple HPV infections were found. Prevalence of oral HPV was significantly lower than that observed at the anal site (p < 0.001), where HPV DNA was found in 199 cases (85.2%). Oral HPV tended to be more frequent in patients with detectable anal HPV than in those without (p = 0.08). Out of 265 HPV DNA-positive men regardless anatomic site, 59 cases (19.3%) had detectable HPV at both sites, and 51 of these showed completely different HPV types. At least one nonavalent vaccine-targeted HPV type was found in 17/64 (26.6%) of patients with oral and 199/260 (76.5%) with anal infection. At multivariable analysis, factors associated with positive oral HPV were: CD4 cells <200/μL (versus CD4 cells >200/μL, p = 0.005) and >5 sexual partners in the previous 12 months (versus 0–1 partner, p = 0.008).ConclusionsIn this study on Italian HIV-positive men (predominantly MSM), oral HPV DNA was detected in approximately one fifth of tested subjects, but prevalence was significantly lower than that observed at anal site. Low CD4 cell count and increasing number of recent sexual partners significantly increased the odds of positive oral HPV. The absence of co-occurrence at the two anatomical sites may suggest different routes or timing of infection.

Merkel Cell Polyomavirus Is Associated with Anal Infections in Men Who Have Sex with Men

“…In our study, HPV prevalence was very low compared to all the analogous published studies [20,21,22]. However, rates of anal HPV have been consistently observed to be higher in HIV-positive men compared to HIV-negative men, while our population consists only of HIV-negative subjects [23,24,25,26].…”

“…In this regard, Vergori and colleagues speculated that because of differences in local mucosal immunity, nongenital site infections are less likely to reactivate from latency when compared to genital infections, where microtraumatisms and the occurrence of sexually transmitted diseases may decrease the ability of the host to clear viruses [20].…”

Investigation of human papillomavirus prevalence in married women and molecular characterization and phylogenetic analysis of the virus

“…We want to draw attention to the fact that this type of HPV has been reported for the first time in Turkey. HPV 81, 54 and 72 genotypes isolated in our study were also isolated in another study from Italy by Vergori et al [28], from anal swab specimens of HIV-positive men. HPV114 was isolated from a low-grade cervical lesion by Ekström et al [29] in Sweden.…”

Oral testing for high‐risk human papillomavirus DNA and E6/E7 messenger RNA in healthy individuals at risk for oral infection

“…7 Importantly, an HPV mRNA evaluation represents the gold standard for identifying HPV-driven HNC because HPV DNA alone does not prove an HPVassociated etiology of the tumor. 3,8 Because of the simple and noninvasive nature of their collection, oral rinses and gargles (hereafter called oral rinses) have been used to search for a variety of HPVassociated biomarkers, such as HPV DNA [9][10][11][12][13][14] and HPVspecific antibodies, 15,16 in both healthy subjects and patients with HNC. In contrast, HPV mRNA detection in oral specimens is very challenging because mRNA is highly susceptible to degradation by the enzymes present in oral fluids.…”