Six‐month natural history of oral versus cervical human papillomavirus infection

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 sixmonth 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 5 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 HIVnegative (60% vs. 51%, p 5 0.70) and HIV-positive (55% vs. 63%, p 5 0.27) women. Factors that independently elevated odds for oral HPV persistence differed from cervical infection and included current smoking (OR 5 8, 95% CI 5 1.3-53), age above 44 years (OR 5 20, 95% CI 5 4.1-83), CD4 < 500 (OR 5 6, 95% CI 5 1.1-26), use of HAART therapy (OR 5 12, 95% CI 5 1.0-156), and time on HAART therapy (trend p 5 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. ' 2007 Wiley-Liss, Inc.Key words: oral; HPV; natural history; comparison; cervical; human papillomavirus; infectionThe majority of oral cancers are attributable to alcohol and tobacco use, however a subset are etiologically associated with human papillomavirus (HPV) infection.1 Case-control studies have shown that oral HPV infection elevates risk of oral cancer, 2,3 and therefore is likely a prerequisite for cancer development. Although natural history studies of oral infection are yet to be performed, seropositivity to HPV16 increases risk for incident oral cancer, supporting a temporal association between infection and cancer risk. While the natural history of cervical HPV infection is well studied, it is unclear whether it is appropriate to extrapolate data from the cervical literature to oral HPV infection. Unfortunately, 2 studies with consecutive measures of oral HPV infection provide limited insight into its natural history. One study evaluated persistence of oral HPV infection at baseline and a subsequent two and a half year time-point among only 4 subjects. 5 In a study of husband-wife pairs, only overall HPV infection status was considered.6 Because analysis of type-specific HPV infection was not performed, meaningful estimates of incidence and clearance could not be obtained. Our study was designed ...

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