RESUMEN
Oral infection with human papillomavirus (HPV) is likely to underpin the rapidly rising incidence of oropharyngeal squamous cell carcinoma; however, there are few data describing the natural history of oral HPV infection. We recruited 704 participants aged 20 to 70 years from worksites, universities and primary care practices in Brisbane, Australia. Participants completed questionnaires at baseline, 12 and 24 months and donate four saliva samples at baseline, 6, 12 and 24 months for HPV polymerase chain reaction testing and typing. We estimated the prevalence of oral HPV infection at baseline, incidence of new infections among those HPV-negative at baseline, clearance rate and persistent infections. At baseline, 10.7% of participants had oral HPV infections from 26 different HPV types. Sexual behaviours were associated with oral HPV infection, including more partners for passionate kissing (29 or more; odds ratio [OR] 3.4, 95% confidence interval [CI] 1.5-8.0), and giving and receiving oral sex (16 or more; OR 5.4, 95% CI 1.6-17.7 and OR 5.6, 95% CI 1.6-18.7, respectively). Of 343 participants, HPV-free at baseline and with subsequent saliva samples, 87 (25%) acquired new infections over the 24 months. Sixty-eight of 87 people included in the clearance analysis (78%) cleared their oral HPV infections. Clearance was associated with being a nonsmoker (OR 12.7, 95% CI 1.3-122.8), and no previous diagnosis of a sexually transmitted infection (OR 6.2, 95% CI 2.0-19.9). New oral infections with HPV in this sample were not rare. Although most infections were cleared, clearance was not universal suggesting a reservoir of infection exists that might predispose to oropharyngeal carcinogenesis.
Asunto(s)
Carcinoma de Células Escamosas/diagnóstico , Enfermedades de la Boca/diagnóstico , Neoplasias Orofaríngeas/diagnóstico , Infecciones por Papillomavirus/diagnóstico , Encuestas y Cuestionarios , Adulto , Anciano , Alphapapillomavirus/clasificación , Alphapapillomavirus/fisiología , Australia/epidemiología , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/virología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Enfermedades de la Boca/epidemiología , Enfermedades de la Boca/virología , Neoplasias Orofaríngeas/epidemiología , Neoplasias Orofaríngeas/virología , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/virología , Prevalencia , Estudios Prospectivos , Saliva/virología , Conducta Sexual/estadística & datos numéricos , Factores de Tiempo , Adulto JovenRESUMEN
Subclinical oral human papillomavirus (HPV) infection that persists for decades is likely to precede an HPV-driven squamous cell carcinoma of the head and neck, but little is known about the natural history of oral HPV. We systematically reviewed and abstracted data from nine manuscripts that examined human immunodeficiency virus-negative and cancer-free subjects for oral HPV DNA to determine the pooled baseline prevalence and incidence of newly acquired oral HPV infections, and specifically for HPV-16. We also documented the clearance rate and the median time to clearance, where data existed. Of 3762 individuals, 7.5â% had an oral infection with any HPV type (1.6â% for HPV-16). Meta-regression analysis estimated the 12-month cumulative incidence to be 4.8â% (95â% confidence interval 3.2-7.3â%). The overall oral HPV clearance was reported to be 0-80â% between studies, and the median time to clearance from 6.5 to 18 months. Oral HPV-16 clearance was 43-83â%, and median time to clearance for HPV-16 was 7-22 months. Oral HPV prevalence, incidence and clearance vary considerably between published studies from different geographical regions. Further research is required to identify predictors of persistent oral HPV infection. Measurable baseline prevalence was observed in all studies, as well as non-trivial incidence of newly acquired oral HPV infections and incomplete clearance.