Objective We aimed to assess incidence and clearance of oral human papillomavirus (HPV) infection and the respective risk factors in HIV-infected and uninfected men who have sex with men (MSM).
Methods Oral rinse and gargles were collected semiannually from 244 MSM (103, 42.2% HIV-infected). HPV-DNA testing was performed with the Linear Array HPV Genotyping test. A Markov model was used for estimation of incidence, clearance and risk factor analysis.
Results Incidence rates for any HPV were 21.2 and 15.0×1000 person-months in HIV-infected and uninfected MSM, respectively. The respective figures for high-risk HPVs were 10.7 and 6.5×1000 person-months. The clearance rate was 4–12 times higher than the respective incidence rate. HIV-infected MSM with >95 lifetime oral sex partners showed increased incidence of any HPV (adjusted HR, aHR: 8.46, 95% CI 1.89 to 37.92). Condomless oral sex appeared the strongest predictor for incident infection by high-risk HPVs in this group (aHR: 13.40, 95% CI 2.55 to 70.53). Those aged >46 years (aHR: 0.30, 95% CI 0.12 to 0.74) and those with nadir CD4+ T count of <200 cells/mm3 (aHR: 0.14, 95% CI 0.03 to 0.75) displayed a significantly reduced clearance of any and high-risk HPVs, respectively. HIV-uninfected MSM aged >46 years had increased risk of acquiring any HPV (aHR: 3.70, 95% CI 1.30 to 10.52) and high-risk HPV (aHR: 5.33, 95% CI 1.06 to 26.68). Any HPV clearance declined in those with more than six recent oral sex partners (aHR: 0.18, 95% CI 0.05 to 0.65).
Conclusions Acquisition of oral HPV infection in MSM seems to occur rarely, whereas clearance seems to be a frequent event. Oral HPV natural history in these at-risk subjects is differently influenced by age and sex behaviour, depending on HIV status.
- oral cavity
- gay men
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Handling editor Jason J Ong
AC and MGD' contributed equally.
Contributors Study conception and design: MGD, MG and AC; data acquisition and interpretation: MG, FR, BP, AL, MB, RP and MGD; data analysis: MG, MFV and MGD; manuscript drafting: MGD, MG and MFV; critical revision and final approval of the manuscript: FR, BP, AL, MB, RP and AC.
Funding This work was supported by the Italian Ministry of Health (grant number GR-2011-02349732) (to MGD).
Competing interests MB received non-financial support from Roche Diagnostics and Hologic outside the submitted work.
Patient consent for publication Not required.
Ethics approval Written informed consent was obtained from the participants. All procedures were performed in accordance with the Helsinki Declaration. The study was cleared by the institutional Ethics Committee (CE/417/14).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Database of this study includes results of molecular tests and deidentified, mostly sensitive, participant data.
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