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Lim YX, D'Silva NJ. HPV-associated oropharyngeal cancer: in search of surrogate biomarkers for early lesions. Oncogene 2024; 43:543-554. [PMID: 38191674 PMCID: PMC10873204 DOI: 10.1038/s41388-023-02927-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024]
Abstract
The incidence of oropharyngeal cancer (OPSCC) has escalated in the past few decades; this has largely been triggered by high-risk human papillomavirus (HPV). Early cancer screening is needed for timely clinical intervention and may reduce mortality and morbidity, but the lack of knowledge about premalignant lesions for OPSCC poses a significant challenge to early detection. Biomarkers that identify individuals at high risk for OPSCC may act as surrogate markers for precancer but these are limited as only a few studies decipher the multistep progression from HPV infection to OPSCC development. Here, we summarize the current literature describing the multistep progression from oral HPV infection, persistence, and tumor development in the oropharynx. We also examine key challenges that hinder the identification of premalignant lesions in the oropharynx and discuss potential biomarkers for oropharyngeal precancer. Finally, we evaluate novel strategies to improve investigations of the biological process that drives oral HPV persistence and OPSCC, highlighting new developments in the establishment of a genetic progression model for HPV + OPSCC and in vivo models that mimic HPV + OPSCC pathogenesis.
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Affiliation(s)
- Yvonne X Lim
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 N. University Ave, Ann Arbor, MI, USA
| | - Nisha J D'Silva
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 N. University Ave, Ann Arbor, MI, USA.
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, USA.
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2
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Wierzbicka M, San Giorgi MRM, Dikkers FG. Transmission and clearance of human papillomavirus infection in the oral cavity and its role in oropharyngeal carcinoma - A review. Rev Med Virol 2023; 33:e2337. [PMID: 35194874 PMCID: PMC10078185 DOI: 10.1002/rmv.2337] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 01/28/2023]
Abstract
The majority of sexually active individuals becomes infected with human papillomavirus (HPV) at least once in their lifetime. Pathways for HPV transmission vary across different mucosal sites per individual. They include autoinoculation within one host, direct transmission between individuals (including perinatal transmission and transmission during sexual activity), and indirect transmission through contact with hands. The authors aim to clarify the prevalence and route of transmission per anatomic site, inter- and intra-individually, using a narrative review of the literature. In conclusion, transmission of HPV to the oral cavity and oropharynx is hypothesised to occur mainly through sexual contact. Transmission of particles through saliva has not been proven and daily living activities are not a documented source of HPV infection. Oropharyngeal HPV related cancer survivors and their partners do not show increased risk of infection during sexual intercourse. Transmission of HPV to the oral cavity (autoinoculation with fingers or transmission through saliva in deep kissing) is probably of limited importance.
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Affiliation(s)
- Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, Poznan, Poland
| | - Michel R M San Giorgi
- Department of Otorhinolaryngology, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik G Dikkers
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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3
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Jordan KH, Beverly Hery CM, Zhang X, Paskett ED. Low Rates of Dual-Site and Concordant Oral-Cervical Human Papillomavirus Infections and Cancers: A Systematic Review. Front Oncol 2022; 12:848628. [PMID: 35425709 PMCID: PMC9004260 DOI: 10.3389/fonc.2022.848628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The oral-cervical human papillomavirus (HPV) infection/cancer relationship is not well established. Oral-cervical HPV studies were reviewed to assess dual-site occurrence, HPV type concordance, and study quality/deficiencies. Methods PubMed, EMBASE, Ovid Medline, and Web of Science were searched between 1/1/1990 and 8/10/2021 for studies investigating HPV infections/cancers and type concordance between the oral cavity/oropharynx and cervix. Dual-site and concordant HPV infection rates were summarized as percentages; cancer diagnoses studies were summarized using standardized incidence ratios (SIR). The Quality Assessment Tool for Quantitative Studies (QATQS) evaluated study methodology. Results One hundred fourteen papers were identified. Most were cross-sectional (n=79, 69%), involved synchronous dual-site HPV testing (n=80, 70%), did not report HPV type concordance (n=62, 54%), and achieved moderate methodological QATQS ratings (n=81, 71%). The overall dual-site infection rate averaged 16%; the HPV type concordance rate averaged 41%, among those dually-infected women. Most HPV-related cancer diagnoses studies reported increased secondary cancer risk, with SIRs generally ranging from 1.4 to 29.4 for secondary cervical cancer after primary oral cancer and from 1.4 to 6.3 for secondary oral cancer after primary cervical cancer. Conclusion/Impact Oral-cervical HPV infections/cancers remain understudied. Future research should use stronger methodologies and HPV concordance analyses to better understand oral-cervical HPV epidemiology.
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Affiliation(s)
- Kelsey H Jordan
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Chloe M Beverly Hery
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Xiaochen Zhang
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Electra D Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, United States.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
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4
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Hernandez AL, Karthik R, Sivasubramanian M, Raghavendran A, Lensing S, Lee JY, Abraham P, Mathai D, Palefsky JM. Prevalence of oral human papillomavirus infection among Indian HIV-positive men who have sex with men: a cross-sectional study. BMC Infect Dis 2021; 21:675. [PMID: 34247583 PMCID: PMC8274002 DOI: 10.1186/s12879-021-06301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Oral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. However, there is little information available on the prevalence of oral HPV in this population. METHODS We tested 302 HIV-positive Indian MSM for oral HPV infection using L1 HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load (VL) were measured. Participants completed an interviewer-administered questionnaire including a sexual history. RESULTS The prevalence of oral HPV was 23.7% (95% CI: 19-29%) and 2.4% of participants had oncogenic HPV types. No participants had oral HPV type 16 (HPV-16) and the prevalence of other anogenital HPV types was low. Participants with higher CD4+ levels had reduced odds of having any oral HPV infection (OR: 3.1 [1.4-6.9]) in multivariable analyses. CONCLUSIONS This is the first report of oral HPV among Indian HIV-positive MSM. Our results show a high prevalence of oral HPV infection consistent with studies from Western populations. However, oncogenic anogenital HPV types were relatively uncommon in our study population. It is unknown what the impact of this distribution of oral HPV will be on oropharyngeal cancers. HIV-positive MSM in India should be monitored closely for oral and oropharyngeal pre-cancer and cancer.
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Affiliation(s)
- Alexandra L Hernandez
- Division of Infectious Diseases, Department of Medicine, University of California, Box 0654, 513 Parnassus Ave, Room S420, San Francisco, CA, 94143, USA.
- Public Health Program, College of Education and Health Sciences, Touro University, Vallejo, CA, USA.
| | - Rajiv Karthik
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | | | | | - Shelly Lensing
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeannette Y Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Priya Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, India
| | - Dilip Mathai
- Apollo Institute of Medical Sciences and Research, Hyderabad, India
| | - Joel M Palefsky
- Division of Infectious Diseases, Department of Medicine, University of California, Box 0654, 513 Parnassus Ave, Room S420, San Francisco, CA, 94143, USA
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5
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Wierzbicka M, Klussmann JP, San Giorgi MR, Wuerdemann N, Dikkers FG. Oral and laryngeal HPV infection: Incidence, prevalence and risk factors, with special regard to concurrent infection in head, neck and genitals. Vaccine 2021; 39:2344-2350. [PMID: 33812740 DOI: 10.1016/j.vaccine.2021.03.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022]
Abstract
This review focuses on the importance of oral and laryngeal HPV infection which is present in majority of sexually active individuals at least once in their lifetime. Despite testing, still little is known about prevalence rates, determinants and, especially, the concurrent HPV infection in head and neck, and genitals. The purpose of this review is to clarify some issues of oral HPV incidence, prevalence, and to demonstrate the difficulties in identification of asymptomatic oral HPV carriers. The main premise to take up this topic is the high and still increasing risk for development of oropharyngeal cancer, and potential benefit from screening strategies, education programs and HPV vaccination. Transmission of HPV to the oral cavity and oropharynx is hypothesized to occur mainly through sexual contact. The exposure of oropharyngeal mucosa to HPV infection with consequence of increased risk for oropharyngeal carcinoma depends on specific sexual behavior. Male gender, older age, race or ethnicity, oral hygiene and current cigarette smoking are independently associated with any prevalent oral HPV infection.
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Affiliation(s)
- Malgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, University of Medical Sciences, 49 Stanisława Przybyszewskiego, 60-357 Poznań, Poland
| | - Jens Peter Klussmann
- ENT Clinic of the University Hospital of Cologne, Kerpener Str. 62, 50931 Cologne, Germany
| | - Michel R San Giorgi
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Nora Wuerdemann
- ENT Clinic of the University Hospital of Cologne, Kerpener Str. 62, 50931 Cologne, Germany
| | - Frederik G Dikkers
- Amsterdam UMC, University of Amsterdam, Department of Otorhinolaryngology, Head and Neck Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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6
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Mazul AL, Hartman C, Kramer J, White DL, Royse K, Raychaudhury S, Sandulache V, Ahmed ST, Richardson P, Sikora AG, Chiao E. Incidence and survival for oropharynx and non-oropharynx head and neck cancers among veterans living with HIV. Cancer Med 2020; 9:9326-9335. [PMID: 33094910 PMCID: PMC7774719 DOI: 10.1002/cam4.3539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/27/2020] [Accepted: 09/28/2020] [Indexed: 01/06/2023] Open
Abstract
Background People living with HIV/AIDS (PLWH) have an excess risk for head and neck squamous cell carcinoma (HNSCC) compared to the general U.S. population, but little is known about HIV‐specific risk factors associated with the incidence and outcomes HNSCC. We aim to identify clinical and HIV‐specific risk factors associated with oropharyngeal and non‐oropharyngeal HNSCC incidence and outcomes separately. Methods We constructed a retrospective cohort study of 45,052 PLWH aged 18 or above from the national Veteran Affairs (VA) Corporate Data from 1999 to 2015. We extracted demographic data and risk factor information, including history of alcohol abuse, smoking, CD4 count (cells/μl), and percent of follow‐up time with undetectable HIV viral load as time‐updated variables. We calculated the age‐standardized incidence rates of oropharyngeal and non‐oropharyngeal HNSCC and estimated adjusted hazard ratios (HR). We also examined overall survival using Kaplan–Meier curves and adjusted HR. Results The standardized incidence rate of oropharyngeal and non‐oropharyngeal HNSCC in this veteran cohort of PLWH is 23.0 (95% confidence intervals (CIs): 17.1‐28.9) and 55.4 (95% CI: 46.5‐64.3) per 100,000 person‐years, respectively. Nadir CD4 count ≤200 was associated with an increased risk of non‐oropharyngeal HNSCC (HR: 1.78; 95% CI: 1.31‐2.30 vs >200). Five‐year overall survival of OPSCC (37.0%) was significantly lower than non‐oropharyngeal HNSCC (49.1%). Conclusions PLWH who receive care in the VA had higher age‐adjusted HNSCC incidence rates than reported in the general population, suggesting that HIV and immunosuppression play a role. Additional studies should be conducted to study the interaction between HPV and HIV.
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Affiliation(s)
- Angela L Mazul
- Department of Otolaryngology/Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA.,Division of Public Health Science, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Christine Hartman
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jennifer Kramer
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Donna L White
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn Royse
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Vlad Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sarah T Ahmed
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Peter Richardson
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Andrew G Sikora
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Otolaryngology Section, Operative Care Line Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Elizabeth Chiao
- VA Health Services Research Center of Innovations in Quality, Effectiveness, and Safety (IQuESt, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
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7
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Anti-Retroviral Protease Inhibitors Regulate Human Papillomavirus 16 Infection of Primary Oral and Cervical Epithelium. Cancers (Basel) 2020; 12:cancers12092664. [PMID: 32961945 PMCID: PMC7563395 DOI: 10.3390/cancers12092664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/10/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary In 2016, globally, 36.7 million people were living with Human Immunodeficiency Virus (HIV), of which 53% had access to anti-retroviral therapy (ART) (UNAIDS 2017 Global HIV Statistics). The risk of Human Papillomavirus (HPV) associated oropharyngeal, cervical and anal cancers are higher among patients infected with HIV in the era of ART. Generally, HPV infections are self-limiting, however, persistent HPV infection is a major risk to carcinogenic progression. Long intervals between initial infection and cancer development imply cofactors are involved. Co-factors that increase infectivity, viral load, and persistence increase risk of cancer. We propose that the ART Protease Inhibitors (PI) class of drugs are novel co-factors that regulate HPV infection in HIV-infected patients. We developed a model system of organotypic epithelium to study impact of PI treatment on HPV16 infection. Our model could be used to study mechanisms of HPV infection in context of ART, and for developing drugs that minimize HPV infections. Abstract Epidemiology studies suggest that Human Immunodeficiency Virus (HIV)-infected patients on highly active anti-retroviral therapy (HAART) may be at increased risk of acquiring opportunistic Human Papillomavirus (HPV) infections and developing oral and cervical cancers. Effective HAART usage has improved survival but increased the risk for HPV-associated cancers. In this manuscript, we report that Protease Inhibitors (PI) treatment of three-dimensional tissues derived from primary human gingiva and cervical epithelial cells compromised cell-cell junctions within stratified epithelium and enhanced paracellular permeability of HPV16 to the basal layer for infection, culminating in de novo biosynthesis of progeny HPV16 as determined using 5-Bromo-2′-deoxyuridine (BrdU) labeling of newly synthesized genomes. We propose that HAART/PI represent a novel class of co-factors that modulate HPV infection of the target epithelium. Our in vitro tissue culture model is an important tool to study the mechanistic role of anti-retroviral drugs in promoting HPV infections in HAART-naïve primary epithelium. Changes in subsequent viral load could promote new infections, create HPV reservoirs that increase virus persistence, and increase the risk of oral and cervical cancer development in HIV-positive patients undergoing long-term HAART treatment.
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8
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Tang KD, Vasani S, Menezes L, Taheri T, Walsh LJ, Hughes BGM, Frazer IH, Kenny L, Scheper GC, Punyadeera C. Oral HPV16 DNA as a screening tool to detect early oropharyngeal squamous cell carcinoma. Cancer Sci 2020; 111:3854-3861. [PMID: 32713038 PMCID: PMC7540991 DOI: 10.1111/cas.14585] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 12/28/2022] Open
Abstract
Given that oropharyngeal squamous cell carcinoma (OPSCC) have now surpassed cervical cancer as the most common human papillomavirus (HPV)‐driven cancer, there is an interest in developing non‐invasive predictive biomarkers to early detect HPV‐driven OPSCC. In total, 665 cancer‐free individuals were recruited from Queensland, Australia. Oral HPV16 DNA positivity in those individuals was determined by our in‐house developed sensitive PCR method. Individuals with (n = 9) or without (n = 12) oral HPV16 infections at baseline were followed for a median duration of 24 mo. Individuals with persistent oral HPV16 infection (≥ 30 mo) were invited for clinical examination of their oral cavity and oropharynx by an otolaryngologist. Oral HPV16 DNA was detected in 12 out of 650 cancer‐free individuals (1.8%; 95% confidence interval [CI]: 1.0‐3.2). Of the 3 individuals with persistent oral HPV16 infection, the first individual showed no clinical evidence of pathology. The second individual was diagnosed with a 2 mm invasive squamous cell carcinoma (T1N0M0) positive for both p16INK4a expression and HPV16 DNA. The third individual was found to have a mildly dysplastic lesion in the tonsillar region that was negative for p16INK4a expression and HPV16 DNA and she continues to have HPV16 DNA in her saliva. Taken together, our data support the value of using an oral HPV16 DNA assay as a potential screening tool for the detection of microscopic HPV‐driven OPSCC. Larger multicenter studies across various geographic regions recruiting populations at a higher risk of developing HPV‐driven OPSCC are warranted to extend and confirm the results of the current investigation.
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Affiliation(s)
- Kai D Tang
- Saliva & Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Translational Research Institute, Woolloongabba, QLD, Australia
| | - Sarju Vasani
- Department of Otolaryngology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Lilian Menezes
- Saliva & Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Touraj Taheri
- Department of Anatomical Pathology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,The University of Queensland School of Medicine, Saint Lucia, QLD, Australia
| | - Laurence J Walsh
- The University of Queensland School of Dentistry, Saint Lucia, QLD, Australia
| | - Brett G M Hughes
- The University of Queensland School of Medicine, Saint Lucia, QLD, Australia.,Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Ian H Frazer
- Faculty of Medicine, The University of Queensland, Translational Research Institute, Brisbane, QLD, Australia
| | - Liz Kenny
- The University of Queensland School of Medicine, Saint Lucia, QLD, Australia.,Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Central Integrated Regional Cancer Service, Queensland Health, Brisbane, QLD, Australia
| | - Gert C Scheper
- Janssen Vaccines & Prevention BV, Leiden, the Netherlands
| | - Chamindie Punyadeera
- Saliva & Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Translational Research Institute, Woolloongabba, QLD, Australia
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9
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Auguste A, Deloumeaux J, Joachim C, Gaete S, Michineau L, Herrmann-Storck C, Duflo S, Luce D. Joint effect of tobacco, alcohol, and oral HPV infection on head and neck cancer risk in the French West Indies. Cancer Med 2020; 9:6854-6863. [PMID: 32750236 PMCID: PMC7520253 DOI: 10.1002/cam4.3327] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022] Open
Abstract
We investigated the role of tobacco and alcohol consumption on the occurrence of head and neck squamous cell carcinomas (HNSCC), and the joint effects of these factors with oral human papillomavirus (HPV) infection in the French West Indies, in the Caribbean. We conducted a population‐based case‐control study (145 cases and 405 controls). We used logistic regression models to estimate adjusted odds ratios (OR) and their 95% confidence intervals (CI). Two‐way interactions were assessed on both multiplicative and additive scales. Current smoking (OR = 11.6, 95% CI = 6.7‐20.1), drinking more than five glasses of alcohol per day (OR = 2.7, 95% CI = 1.2‐4.7), and oral infection with High‐risk HPV (OR = 2.4, 95% CI = 1.1‐5.0) were significantly associated with HNSCC. The combined exposure to tobacco and alcohol produced a significant synergistic effect on the incidence of HNSCC. Oral infection with High‐risk HPV increased the risk of HNSCC in never smokers and nondrinkers. The effects of tobacco, alcohol, and of the combined exposure of tobacco and alcohol were substantially lower in HPV‐positive than in HPV‐negative HNSCC. This is the first case‐control study to investigate the role of tobacco smoking, alcohol drinking and oral HPV infection in an Afro‐Caribbean population. Although each of these risk factors has a significant effect, our findings indicate that tobacco and alcohol play a less important role in Hr‐HPV‐positive HNSCC. Further investigations are warranted notably on the interaction of these three risk factors by cancer site.
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Affiliation(s)
- Aviane Auguste
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Pointe-à-Pitre, France
| | - Jacqueline Deloumeaux
- General Cancer Registry of Guadeloupe, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe.,Karubiotec™ Biological Resources Center, Centre de Ressources Biologiques de Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | - Clarisse Joachim
- Martinique Cancer Registry, UF 1441 Registre des Cancers, Pôle de Cancérologie Hématologie Urologie Pathologie, University Hospital of Martinique, Fort-de-France, Martinique
| | - Stanie Gaete
- Karubiotec™ Biological Resources Center, Centre de Ressources Biologiques de Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | - Leah Michineau
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Pointe-à-Pitre, France
| | - Cécile Herrmann-Storck
- Laboratory of Microbiology, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | - Suzy Duflo
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe
| | - Danièle Luce
- Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Pointe-à-Pitre, France
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10
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Suehiro TT, Damke GMZF, Damke E, de Azevedo Ramos PLR, de Andrade Pereira Silva M, Pelloso SM, Huh WK, Franco RAF, da Silva VRS, Scarinci IC, Consolaro MEL. Cervical and oral human papillomavirus infection in women living with human immunodeficiency virus (HIV) and matched HIV-negative controls in Brazil. Infect Agent Cancer 2020; 15:31. [PMID: 32426032 PMCID: PMC7216672 DOI: 10.1186/s13027-020-00301-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background Despite the demonstrated role of human Papillomavirus (HPV) in the etiology of cervical cancer and the strong evidence suggesting the importance of HPV in the development of oropharyngeal cancer, several aspects of the interrelationship between HPV infection in both body sites remain unknown, specifically in female human immunodeficiency virus (HIV)-positive (HIV+) patients. We aimed to assess the prevalence, distribution, and concordance of cervical and oral HPV in HIV+ women and matched HIV-negative (HIV-) controls in Brazil. Material and methods Cervical and endocervical samples for cytological screening and HPV detection and oral samples were collected from 115 HIV+ women using highly active antiretroviral therapy (HAART) and 139 HIV-matched controls (HIV-) in Maringá City, Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding HIV infection were obtained from the patients’ medical records. HPV detection and typing were performed using the Kit Multiplex XGEN Multi HPV Chip HS12. Results HIV infection was well controlled in this cohort, but women who exhibited detectable HIV loads were significantly associated with HPV-positive status overall (P = 0.03) and in cervical mucosa (P = 0.01). HIV+ women had significantly more abnormal cytological findings (P = 0.04) than HIV- women. Of the 115 HIV+ women, 48.7% were positive for cervical and/or oral HPV DNA; of the 139 HIV- women, 41% were positive for cervical and/or oral HPV (P = 0.25). Both HIV+ and HIV- women had a statistically higher prevalence of cervical HPV infection than oral infection. The concurrent HPV infection in two anatomical sites was similar in HIV+ and HIV- women; however, HPV type concordance was not observed. HPV type distribution was different between the anatomical sites in both groups, and HIV+ women presented less common types, mainly in oral mucosa. Conclusion Our data support the importance of testing HPV infection in HIV+ women, even when the HIV infection is well controlled. Prospective studies are required to better understand the natural history of HPV infection in both anatomical sites, specifically in HIV+ women.
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Affiliation(s)
- Tamy Taianne Suehiro
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | - Edilson Damke
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | | | | | - Warner K Huh
- 3School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Vânia Ramos Sela da Silva
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | - Marcia Edilaine Lopes Consolaro
- 1Laboratory of Clinical Cytology, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
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11
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Roberts S, Evans D, Mehanna H, Parish JL. Modelling human papillomavirus biology in oropharyngeal keratinocytes. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180289. [PMID: 30955493 PMCID: PMC6501899 DOI: 10.1098/rstb.2018.0289] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Most human papillomavirus (HPV) positive head and neck cancers arise in the tonsil crypts; deep invaginations at the tonsil surface that are lined with reticulated epithelium infiltrated by immune cells. As in cervical HPV infections, HPV16 is the most prevalent high-risk type in the oropharyngeal cancers, and a genital-oral route of infection is most likely. However, the natural history of HPV-driven oropharyngeal pathogenesis is an enigma, although there is evidence that it is different to that of cervical disease. It is not known if the virus establishes a productive or abortive infection in keratinocytes of the tonsil crypt, or if viral infections progress to cancer via a neoplastic phase, as in cervical HPV infection. The HPV DNA is more frequently found unintegrated in the cancers of the oropharynx compared to those that arise in the cervix, and may include novel HPV-human DNA hybrids episomes. Here, we review current understanding of HPV biology in the oropharynx and discuss the cell-based systems being used to model the HPV life cycle in tonsil keratinocytes and how they can be used to inform on HPV-driven neoplastic progression in the oropharynx. This article is part of the theme issue ‘Silent cancer agents: multi-disciplinary modelling of human DNA oncoviruses’.
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Affiliation(s)
- Sally Roberts
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Vincent Drive, Birmingham B15 2TT , UK
| | - Dhananjay Evans
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Vincent Drive, Birmingham B15 2TT , UK
| | - Hisham Mehanna
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Vincent Drive, Birmingham B15 2TT , UK
| | - Joanna L Parish
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham , Vincent Drive, Birmingham B15 2TT , UK
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12
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Giuliano AR, Nedjai B, Lorincz AT, Schell MJ, Rahman S, Banwait R, Boulware D, Sirak B, Martin-Gomez L, Abrahamsen M, Isaacs-Soriano KA, Wenig B, Chung CH, Caudell J. Methylation of HPV 16 and EPB41L3 in oral gargles: Associations with oropharyngeal cancer detection and tumor characteristics. Int J Cancer 2020; 146:1018-1030. [PMID: 31304592 PMCID: PMC7787351 DOI: 10.1002/ijc.32570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 12/14/2022]
Abstract
Oropharyngeal cancer (OPC) incidence is increasing significantly among men and often requires intensive therapy causing significant morbidity. Early detection of OPC is needed, when monotherapy can be safely delivered with less treatment-associated morbidity, while maintaining high cure rates. We conducted a study of 101 pretreatment male OPC cases matched 1:1 to 101 disease-free controls for age and smoking history. Oral gargles were collected from cases and controls with additional biopsies or aspirates from cases. The HPV SPF10 -LiPA25 PCR assay was utilized for HPV genotyping. Methylation of three CpG sites (438, 427 and 425) in the EPB41L3 gene and methylation status of the L1 (6,367, 6,389), L2 (4,257, 4,262, 4,266, 4,269, 4,275, 4,282) and E2 (3,412, 3,415, 3,417, 3,433, 3,436) CpG sites of HPV 16 positive specimens was assessed by pyrosequencing. Significant correlations were observed between tumor and oral specimens for all methylation biomarkers (p < 0.01). EPB41L3 and HPV 16 L1, L2 and E2 methylation were significantly (p < 0.0001) higher among cases than controls, regardless of early vs. late disease. When HPV 16 genes and EPB41L3 methylation status were combined in a logistic regression analysis, a sensitivity of 70.3% and a specificity of 90.9% were observed for the detection of OPC from an oral gargle. Our data suggest that methylation biomarkers measured in oral gargles may have utility in identifying OPC early. Future studies are needed to replicate these findings and to inform additional biomarkers that can maximize specificity and sensitivity for early OPC detection.
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Affiliation(s)
- Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL
| | - Belinda Nedjai
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, United Kingdom
| | - Attila T. Lorincz
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, United Kingdom
| | - Michael J. Schell
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL
| | - Shams Rahman
- Department of Public Health, Bethune-Cookman University, Daytona Beach, FL
| | - Rawinder Banwait
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, United Kingdom
| | - David Boulware
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL
| | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL
| | - Laura Martin-Gomez
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL
| | | | - Bruce Wenig
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL
| | - Christine H. Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL
| | - Jimmy Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
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13
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Näsman A, Du J, Dalianis T. A global epidemic increase of an HPV-induced tonsil and tongue base cancer - potential benefit from a pan-gender use of HPV vaccine. J Intern Med 2020; 287:134-152. [PMID: 31733108 DOI: 10.1111/joim.13010] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022]
Abstract
In 2007, human papillomavirus (HPV) type 16 was finally recognized as a risk factor, besides smoking and alcohol, for oropharyngeal squamous cell carcinoma (OPSCC), including tonsillar squamous cell carcinoma (TSCC), by the International Agency for Research against Cancer. Just before, in 2006, the Food and Drug Administration had approved Gardasil, the first vaccine against HPV16, 18, 6 and 11, for preventive vaccination women against cervical cancer. Concurrently, some Western countries, where smoking was decreasing, disclosed an epidemic increase in the incidence of OPSCC, especially of TSCC and base of tongue cancer (BOTSCC), together accounting for 80-90% of all OPSCCs, and mainly affecting men. The epidemic was later revealed to be due to a rise in HPV-positive cases, and scientists in the field suggested HPV vaccination also of boys. Globally, there are roughly 96 000 incident OPSCC cases/year of which 20-24% are caused by HPV, thereby accounting for around 22 000 OPSCC cases annually. Of these cases, 80-90% are due to HPV16 infection and would be prevented with the presently registered HPV vaccines. In Western countries, such as Sweden (with almost 400 TSCC and BOTSCC cases per year) and the United States, HPV prevalence in OPSCC is higher and around 70%. HPV vaccination of girls has been initiated in many countries, and the vaccines have been efficient and their side effects limited. HPV vaccination of boys has, however, been the exception, but should definitely not be delayed any further. It would benefit both girls and boys directly, and result in better and more robust herd immunity. Today, we have the possibility to eliminate several high-risk HPV types in the younger generations and avoid more than 600 000 cancer cases annually worldwide, and this possibility should be embraced by offering global pan-gender HPV vaccination.
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Affiliation(s)
- A Näsman
- From the, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - J Du
- Department of Microbiology, Tumor Biology and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Stockholm, Sweden
| | - T Dalianis
- From the, Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
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14
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Parsi M. Case of an Incidentally Found Squamous Cell Carcinoma of the Tonsil: Are We Underestimating Its Incidence? Cureus 2019; 11:e6383. [PMID: 31938661 PMCID: PMC6957034 DOI: 10.7759/cureus.6383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 65-year-old male was incidentally found to have a human papillomavirus-16 (HPV)-associated squamous cell carcinoma of the tonsil. His only major risk factor was chronic and heavy alcohol and smoking history. Fortunately, surgery, followed by chemoradiation led to clinical remission. HPV is a common and known cause of oro- and anogenital squamous cell carcinoma (SCC). However, unlike anogenital SCC, there is no screening method available for the detection of oro-genital SCC. HPV vaccination is known to prevent a majority of these cancers. However, rates of HPV vaccination have been declining in the United States, thus causing an increase in these preventable cancers. This case report highlights the need for increased HPV vaccination rates, which can only be made through adequate physician recommendations and patient education.
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Affiliation(s)
- Meghana Parsi
- Internal Medicine, Crozer-Chester Medical Center, Upland, USA
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15
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Mitochondrial somatic mutations and the lack of viral genomic variation in recurrent respiratory papillomatosis. Sci Rep 2019; 9:16625. [PMID: 31719597 PMCID: PMC6851396 DOI: 10.1038/s41598-019-53148-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/24/2019] [Indexed: 12/20/2022] Open
Abstract
Recurrent Respiratory Papillomatosis (RRP) is a rare disease of the aerodigestive tract caused by the Human Papilloma Virus (HPV) that manifests as profoundly altered phonatory and upper respiratory anatomy. Current therapies are primarily symptomatic; enhanced insight regarding disease-specific biology of RRP is critical to improved therapeutics for this challenging population. Multiplex PCR was performed on oral rinses collected from twenty-three patients with adult-onset RRP every three months for one year. Twenty-two (95.6%) subjects had an initial HPV positive oral rinse. Of those subjects, 77.2% had an additional positive oral rinse over 12 months. A subset of rinses were then compared to tissue samples in the same patient employing HPViewer to determine HPV subtype concordance. Multiple HPV copies (60–787 per human cell) were detected in RRP tissue in each patient, but a single dominant HPV was found in individual samples. These data confirm persistent oral HPV infection in the majority of patients with RRP. In addition, three novel HPV6 isolates were found and identical HPV strains, at very low levels, were identified in oral rinses in two patients suggesting potential HPV subtype concordance. Finally, somatic heteroplasmic mtDNA mutations were observed in RRP tissue with 1.8 mutations per sample and two nonsynonymous variants. These data provide foundational insight into both the underlying pathophysiology of RRP, but also potential targets for intervention in this challenging patient cohort.
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16
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Demirel D, Erkul E, Güngör A, Çekin E, Ramzy I. Laryngeal cytology: A cytological, histological, P16 and human papillomavirus study. Cytopathology 2019; 31:26-34. [PMID: 31630464 DOI: 10.1111/cyt.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 09/29/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Invasive diagnostic methods, such as punch biopsies, have a potential to produce undesirable side effects in the larynx, such as scarring and vocal dysfunction. This study is an attempt to assess the diagnostic potential of cytology to efficiently diagnose premalignant and malignant laryngeal lesions, while sparing patients the risk of complications of punch biopsies. METHODS Laryngeal smears, using endocervical-type brushes, and punch biopsies were procured from each patient. Smears were prepared and the brush was cut and put in Surepath preservative solution for cytological analysis and human papillomavirus (HPV) DNA testing. A Real-TM Quant kit that detects 14 HPV types was used for genotyping. Immunohistochemical staining for p16 was performed on cytological and histological specimens. RESULTS Cytological diagnosis was correct in 84.6%, 100% and 100% of cases with a histological diagnosis of squamous cell carcinomas, high-grade squamous intraepithelial lesions and benign lesions, respectively. However, cytological interpretation was correct only in 25% of low-grade squamous intraepithelial lesions. HPV DNA test was positive in only one case, which was a laryngeal polyp. Testing for p16 was negative in all the cytological and histological material. CONCLUSION Laryngeal cytology is a useful diagnostic tool in establishing the diagnosis of high-grade squamous epithelial cell abnormalities. Recognition of low-grade lesions, however, is challenging. HPV genotyping and p16 staining do not seem to be helpful ancillary techniques in cytological material procured from the larynx.
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Affiliation(s)
- Dilaver Demirel
- Department of Pathology, University of Health Sciences, Gaziosmanpasa Health Application and Research Center, Istanbul, Turkey
| | - Evren Erkul
- Department of Otorhinolaryngology, University of Health Sciences, Gulhane School of Medicine, Sultan Abdulhamid Han Health Application and Research Center, Istanbul, Turkey
| | - Atila Güngör
- Department of Otorhinolaryngology, Medical Park Hospital, Istanbul, Turkey
| | - Engin Çekin
- Department of Otorhinolaryngology, University of Health Sciences, Sultan Abdulhamid Han Health Application and Research Center, Istanbul, Turkey
| | - Ibrahim Ramzy
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA
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17
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Tumban E. A Current Update on Human Papillomavirus-Associated Head and Neck Cancers. Viruses 2019; 11:v11100922. [PMID: 31600915 PMCID: PMC6833051 DOI: 10.3390/v11100922] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus (HPV) infection is the cause of a growing percentage of head and neck cancers (HNC); primarily, a subset of oral squamous cell carcinoma, oropharyngeal squamous cell carcinoma, and laryngeal squamous cell carcinoma. The majority of HPV-associated head and neck cancers (HPV + HNC) are caused by HPV16; additionally, co-factors such as smoking and immunosuppression contribute to the progression of HPV + HNC by interfering with tumor suppressor miRNA and impairing mediators of the immune system. This review summarizes current studies on HPV + HNC, ranging from potential modes of oral transmission of HPV (sexual, self-inoculation, vertical and horizontal transmissions), discrepancy in the distribution of HPV + HNC between anatomical sites in the head and neck region, and to studies showing that HPV vaccines have the potential to protect against oral HPV infection (especially against the HPV types included in the vaccines). The review concludes with a discussion of major challenges in the field and prospects for the future: challenges in diagnosing HPV + HNC at early stages of the disease, measures to reduce discrepancy in the prevalence of HPV + HNC cases between anatomical sites, and suggestions to assess whether fomites/breast milk can transmit HPV to the oral cavity.
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Affiliation(s)
- Ebenezer Tumban
- Department of Biological Sciences, Michigan Technological University, 1400 Townsend Dr, Houghton, MI 49931, USA.
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18
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Abstract
Papillomaviruses are one of the oldest viruses known, dating back 330 million years. During this long evolution, human papillomaviruses (HPV) have developed into hijackers of human cellular and immune systems in which they replicate and remain silent. Systematic studies on oral HPV infections and their outcomes are still scarce. Oral HPV infections have been linked to sexual behaviour, but recent evidence supports their horizontal, mouth‐to‐mouth, transmission. Most HPV infections in infants are acquired vertically from the mother during the intrauterine period, during delivery, or later via saliva. The best‐known benign clinical manifestations of HPV infection are oral papilloma/condyloma and focal epithelial hyperplasia. Evidence is emerging which suggests that some oral HPV infections might persist. Persistent HPV infection is mandatory for HPV‐associated malignant transformation. However, progression of HPV‐induced lesions to malignancy requires additional cofactors. In the early 1980s, we provided the first evidence that a subset of oral cancers and other head and neck cancers might be causally linked to HPV infection. This review summarizes current knowledge on the virus itself, its transmission modes, as well as the full spectrum of oral HPV infections – from asymptomatic infections to benign, potentially malignant oral lesions, and squamous cell carcinoma.
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Affiliation(s)
- Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland.,Department of Pathology, Turku University Hospital, Turku, Finland
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19
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Abstract
Human papillomavirus (HPV) is the first identified necessary cause of human cancers and is associated with nearly 100% of all cervical cancers. Compared to the general female populations, HIV+ women have higher prevalence and incidence of cervical HPV infections, higher risks of persistent HPV infections and subsequent cervical intraepithelial lesions, and a higher incidence of cervical cancer. Although the wide use of combined antiretroviral therapy (cART) has improved the immune function and the longevity of HIV+ women, the incidence of cervical cancer in HIV+ women has not declined. For HIV+ women who follow routine cervical cancer screenings, their incidence of cervical cancer is comparable to that in HIV-negative women. Thus, adherence to the recommended cervical cancer screening is still critical for HIV+ women to prevent cervical cancer. Prophylactic HPV vaccines may also benefit HIV+ women, but prospective studies are needed to determine the effectiveness of HPV vaccination on reducing cervical cancer incidence in HIV+ women.
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Affiliation(s)
- Ping Du
- Department of Medicine, Department of Public Health Sciences, Penn State Hershey College of Medicine, 90 Hope Drive, Suite 2200, A210, Hershey, PA, USA.
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20
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Abstract
Since their discovery as the etiologic agents of cervical cancer in the mid-1970s, human papillomaviruses (HPVs) have been linked with a growing number of epithelial-derived tumors, including head and neck squamous cell carcinomas. HPV demonstrates a particular predilection for causing tumors of the oropharynx, with the majority of cases involving infection with high-oncogenic risk HPV-16. People living with HIV are at increased risk of infection with HPV- and HPV-related oral complications even with adequate control of their HIV infection with antiretroviral therapy. In this chapter, we discuss the molecular mechanisms that underlie HPV-mediated oncogenesis in the oropharynx. We also describe the progress that has been made in understanding the epidemiology of oral HPV infection and the determinants of oral HPV-related pathology. Finally, we examine what can be done to treat and prevent oral HPV infection, benign lesions, and cancer, particularly in the context of the HIV-positive patient.
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21
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Looker KJ, Rönn MM, Brock PM, Brisson M, Drolet M, Mayaud P, Boily M. Evidence of synergistic relationships between HIV and Human Papillomavirus (HPV): systematic reviews and meta-analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status. J Int AIDS Soc 2018; 21:e25110. [PMID: 29873885 PMCID: PMC5989783 DOI: 10.1002/jia2.25110] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/27/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Observational studies suggest HIV and human papillomavirus (HPV) infections may have multiple interactions. We reviewed the strength of the evidence for the influence of HIV on HPV acquisition and clearance, and the influence of HPV on HIV acquisition. METHODS We performed meta-analytic systematic reviews of longitudinal studies of HPV incidence and clearance rate by HIV status (review 1) and of HIV incidence by HPV status (review 2). We pooled relative risk (RR) estimates across studies using random-effect models. I2 statistics and subgroup analyses were used to quantify heterogeneity across estimates and explore the influence of participant and study characteristics including study quality. Publication bias was examined quantitatively with funnel plots and subgroup analysis, as well as qualitatively. RESULTS AND DISCUSSION In review 1, 37 publications (25 independent studies) were included in the meta-analysis. HPV incidence (pooled RR = 1.55, 95% CI: 1.29 to 1.88; heterosexual males: pooled RR = 1.95, 95% CI: 1.62, 2.34; females: pooled RR = 1.63, 95% CI: 1.26 to 2.11; men who have sex with men: pooled RR = 1.36, 95% CI: 1.01 to 1.82) and high-risk HPV incidence (pooled RR = 2.20, 95% CI: 1.90 to 2.54) was approximately doubled among people living with HIV (PLHIV) whereas HPV clearance rate (pooled RR = 0.53, 95% CI: 0.42 to 0.67) was approximately halved. In review 2, 14 publications (11 independent studies) were included in the meta-analysis. HIV incidence was almost doubled (pooled RR = 1.91, 95% CI 1.38 to 2.65) in the presence of prevalent HPV infection. There was more evidence of publication bias in review 2, and somewhat greater risk of confounding in studies included in review 1. There was some evidence that adjustment for key confounders strengthened the associations for review 2. Misclassification bias by HIV/HPV exposure status could also have biased estimates toward the null. CONCLUSIONS These results provide evidence for synergistic HIV and HPV interactions of clinical and public health relevance. HPV vaccination may directly benefit PLHIV, and help control both HPV and HIV at the population level in high prevalence settings. Our estimates of association are useful for mathematical modelling. Although observational studies can never perfectly control for residual confounding, the evidence presented here lends further support for the presence of biological interactions between HIV and HPV that have a strong plausibility.
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Affiliation(s)
- Katharine J Looker
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Minttu M Rönn
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
- Department of Global Health and PopulationHarvard T.H Chan School of Public HealthBostonUSA
| | - Patrick M Brock
- Institute of Biodiversity, Animal Health and Comparative MedicineCollege of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Marc Brisson
- Centre de recherche du CHU de Québec‐Université LavalAxe santé des populations et pratiques optimales en santéQuébecCanada
| | - Melanie Drolet
- Centre de recherche du CHU de Québec‐Université LavalAxe santé des populations et pratiques optimales en santéQuébecCanada
| | - Philippe Mayaud
- Department of Clinical ResearchFaculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| | - Marie‐Claude Boily
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
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22
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Tam S, Fu S, Xu L, Krause KJ, Lairson DR, Miao H, Sturgis EM, Dahlstrom KR. The epidemiology of oral human papillomavirus infection in healthy populations: A systematic review and meta-analysis. Oral Oncol 2018; 82:91-99. [PMID: 29909908 DOI: 10.1016/j.oraloncology.2018.04.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/02/2018] [Accepted: 04/07/2018] [Indexed: 10/16/2022]
Abstract
Human papillomavirus (HPV) is a potentially oncogenic sexually transmitted infection. As the incidence of oropharyngeal cancer (OPC) caused by oral HPV infections is rising, further investigation into the natural history of such infections is needed. This systematic review and meta-analysis aimed to synthesize data on the prevalence, incidence, clearance, and persistence of oral HPV infections in healthy individuals. A systematic review of literature published between January 1995 and August 2017 was conducted using Ovid MEDLINE, PubMed, Embase, and the Cochrane Library. Meta-analysis of prevalence and incidence data was conducted. Clearance and persistence data were extracted. Sixty-six studies met the inclusion criteria. Meta-analysis demonstrated an overall prevalence of 7.7% for all types of HPV and 1.4% for high-risk HPV16. The overall incidence was 4.38 cases per 1000 person-months for all HPV types and 0.92 cases per 1000 person-months for HPV16. This systematic review and meta-analysis demonstrated that oral HPV infection has a lower prevalence and incidence than cervicogenital HPV infection in healthy individuals. Nonetheless, oral HPV is still an important concern, given its oncogenicity and the rising incidence of oropharyngeal cancer. Consistency of methodology will allow for better future comparisons, particularly of infection clearance and persistence.
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Affiliation(s)
- Samantha Tam
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
| | - Shuangshuang Fu
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA.
| | - Li Xu
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1445, Houston, TX 77030, USA.
| | - David R Lairson
- Department of Management, Policy, and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA.
| | - Hongyu Miao
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA.
| | - Erich M Sturgis
- Department of Head and Neck Surgery, Division of Surgery, and Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX 77030, USA.
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23
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Wittekindt C, Wagner S, Sharma SJ, Würdemann N, Knuth J, Reder H, Klußmann JP. [HPV - A different view on Head and Neck Cancer]. Laryngorhinootologie 2018; 97:S48-S113. [PMID: 29905354 PMCID: PMC6540966 DOI: 10.1055/s-0043-121596] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Head and neck cancer is the sixth most common cancer with over 500000 annually reported incident cases worldwide. Besides major risk factors tobacco and alcohol, oropharyngeal squamous cell carcinomas (OSCC) show increased association with human papillomavirus (HPV). HPV-associated and HPV-negative OSCC are 2 different entities regarding biological characteristics, therapeutic response, and patient prognosis. In HPV OSCC, viral oncoprotein activity, as well as genetic (mutations and chromosomal aberrations) and epigenetic alterations plays a key role during carcinogenesis. Based on improved treatment response, the introduction of therapy de-intensification and targeted therapy is discussed for patients with HPV OSCC. A promising targeted therapy concept is immunotherapy. The use of checkpoint inhibitors (e.g. anti-PD1) is currently investigated. By means of liquid biopsies, biomarkers such as viral DNA or tumor mutations in the will soon be available for disease monitoring, as well as detection of treatment failure. By now, primary prophylaxis of HPV OSCC can be achieved by vaccination of girls and boys.
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Affiliation(s)
- Claus Wittekindt
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Steffen Wagner
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Shachi Jenny Sharma
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Nora Würdemann
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Jennifer Knuth
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Henrike Reder
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Jens Peter Klußmann
- Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
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Castillejos-García I, Ramírez-Amador VA, Carrillo-García A, García-Carrancá A, Lizano M, Anaya-Saavedra G. Type-specific persistence and clearance rates of HPV genotypes in the oral and oropharyngeal mucosa in an HIV/AIDS cohort. J Oral Pathol Med 2018; 47:396-402. [PMID: 29380908 DOI: 10.1111/jop.12687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oral high-risk human papillomavirus (HR-HPV) infections are frequent and persistent among the HIV-positive population and are associated with an increased risk for head and neck cancer (HNC). In this study, we sought to determine the incidence, persistence and clearance of HPV infections in oral and oropharyngeal samples from HIV/AIDS subjects. METHODS A longitudinal, observational and analytical study was performed with an ongoing cohort of HIV/AIDS subjects in Mexico City (September 2013-February 2015). The study was approved by institutional committees, and demographic and clinical data were registered. At the baseline and three-month visits, oral examinations and cytobrush samples were obtained. DNA was purified, quantified and used to detect an HPV-L1 gene fragment by nested PCR, using MY09/MY11 and GP5 + /GP6 + primers. HPV DNA products were purified, sequenced and typed according to HPV databases. Risk factors were assessed, and a multivariate modelling approach was used to determine independent effects. RESULTS This study included 97 HIV/AIDS individuals (91% men [86.4% of which are men who have sex with men], median age: 36 years, 72.2% under HAART). From the baseline visit, HPV was observed in 55.7% (HR-HPV: 26.8%; HPV-18: 24.1%), with a higher HPV-positive samples for smokers (61.1 vs 32.6%, P = .005). The three-month overall HPV incidence was 33.9%; type-specific HPV persistence was 33.3% (HR-HPV: 13.3%); and 13 of the 33 (39.4%) baseline HPV-positive individuals cleared the infection (HR-HPV: 53.8%). CONCLUSIONS Although HR-HPV persistence was low, and clearance of the infection was observed in most cases, a close follow-up is necessary, given the increase in HNC among HIV-subjects, particularly HPV-related cancer.
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Affiliation(s)
- Itzel Castillejos-García
- Oral Pathology and Medicine Postgraduate Program, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Velia A Ramírez-Amador
- Oral Pathology and Medicine Postgraduate Program, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Adela Carrillo-García
- Biomedical Research Unit, Instituto Nacional de Cancerología (INCan)/Instituto de Investigaciones Biomédicas, UNAM, México City, Mexico
| | - Alejandro García-Carrancá
- Biomedical Research Unit, Instituto Nacional de Cancerología (INCan)/Instituto de Investigaciones Biomédicas, UNAM, México City, Mexico
| | - Marcela Lizano
- Biomedical Research Unit, Instituto Nacional de Cancerología (INCan)/Instituto de Investigaciones Biomédicas, UNAM, México City, Mexico
| | - Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Postgraduate Program, Universidad Autónoma Metropolitana, Mexico City, Mexico
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25
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Lafaurie GI, Perdomo SJ, Buenahora MR, Amaya S, Díaz-Báez D. Human papilloma virus: An etiological and prognostic factor for oral cancer? ACTA ACUST UNITED AC 2018; 9:e12313. [DOI: 10.1111/jicd.12313] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/17/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Gloria I. Lafaurie
- Unit of Basic Oral Investigation, School of Dentistry, El Bosque University; Bogotá Colombia
| | - Sandra J. Perdomo
- Unit of Basic Oral Investigation, School of Dentistry, El Bosque University; Bogotá Colombia
| | - María R. Buenahora
- Unit of Oral Clinical Epidemiology; School of Dentistry, El Bosque University; Bogotá Colombia
| | - Sandra Amaya
- School of Dentistry, University of Valle; Cali Colombia
| | - David Díaz-Báez
- Unit of Basic Oral Investigation, School of Dentistry, El Bosque University; Bogotá Colombia
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26
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Rosales C, Rosales R. Prophylactic and Therapeutic Vaccines against Human Papillomavirus Infections. Vaccines (Basel) 2017. [DOI: 10.5772/intechopen.69548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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27
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Beachler DC, Kuhs KAL, Struijk L, Schussler J, Herrero R, Porras C, Hildesheim A, Cortes B, Sampson J, Quint W, Gonzalez P, Kreimer AR. The Natural History of Oral Human Papillomavirus in Young Costa Rican Women. Sex Transm Dis 2017; 44:442-449. [PMID: 28608796 PMCID: PMC6299456 DOI: 10.1097/olq.0000000000000625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Oral human papillomavirus (HPV) infection and related oropharyngeal cancer are uncommon in lower-income countries, particularly compared to HPV-associated cervical cancer. However, little is known about the natural history of oral HPV in less-developed settings and how it compares to the natural history of cervical HPV. METHODS Three hundred fifty women aged 22 to 33 years from the Costa Rica Vaccine Trial provided exfoliated cells from the cervical and oral regions at 2 visits 2 years apart. Samples from both visits were tested for 25 characterized α HPV types by the SPF10 PCR-DNA enzyme immunoassay-LiPA25 version 1 system. Risk factors for oral HPV persistence were calculated utilizing generalized estimating equations with a logistic link. RESULTS Among the 82 women with characterized α oral HPV DNA detected at baseline, 14 persisted and were detected 2 years later (17.6%; 95% confidence interval [CI], 10.9-28.5%) and was similar to the persistence of α cervical HPV (40/223; 17.7%; 95% CI, 13.1-23.9%; P = 0.86). Acquisition of new α oral HPV type was low; incident infection (1.7%; 95% CI, 0.6-3.7%). CONCLUSIONS Oral HPV DNA is uncommon in young women in Latin America, and often appears to clear within a few years at similar rates to cervical HPV.
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Affiliation(s)
- Daniel C. Beachler
- Division of Cancer Epidemiology, and Genetics, National Cancer Institute, NIH, Bethesda, MD
| | - Krystle A. Lang Kuhs
- Division of Cancer Epidemiology, and Genetics, National Cancer Institute, NIH, Bethesda, MD
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Linda Struijk
- DDL Diagnostic Laboratory, Voorburg, the Netherlands
| | | | | | - Carolina Porras
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Costa Rica
| | - Allan Hildesheim
- Division of Cancer Epidemiology, and Genetics, National Cancer Institute, NIH, Bethesda, MD
| | - Bernal Cortes
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Costa Rica
| | - Joshua Sampson
- Division of Cancer Epidemiology, and Genetics, National Cancer Institute, NIH, Bethesda, MD
| | - Wim Quint
- DDL Diagnostic Laboratory, Voorburg, the Netherlands
| | - Paula Gonzalez
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, Costa Rica
| | - Aimée R. Kreimer
- Division of Cancer Epidemiology, and Genetics, National Cancer Institute, NIH, Bethesda, MD
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28
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Lorenzi A, Rautava J, Kero K, Syrjänen K, Longatto-Filho A, Grenman S, Syrjänen S. Physical state and copy numbers of HPV16 in oral asymptomatic infections that persisted or cleared during the 6-year follow-up. J Gen Virol 2017; 98:681-689. [PMID: 28100295 DOI: 10.1099/jgv.0.000710] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Persistent human papillomavirus (HPV) infection is a key event in HPV-induced carcinogenesis. As part of the prospective Finnish Family HPV Study, we analysed the physical state and viral copy numbers of HPV16 in asymptomatic oral infections that either persisted or cleared during the 6-year follow-up. The persister group comprised 14 women and 7 men with 51 and 21 HPV16-positive brush samples. The clearance group included 41 women and 13 men, with 64 and 24 samples, respectively. Physical state and viral DNA load were assessed by using quantitative PCR for HPV16 E2 and E6 genes. E2/E6 ratio was calculated and HPV16 was classified as episomal, mixed or integrated with values of 0.93-1.08, <0.93 and 0, respectively. In both genders, the physical state of HPV16 was significantly different between the cases and controls (P<0.001). HPV16 was episomal in all men and 66 % (27/41) of women who cleared their infection. HPV16 was mixed and/or integrated in71 % and 57 %of the women and men persisters, respectively. The mean HPV16 copy number per 50 ng genomic DNA was nearly 5.5-fold higher in the women than in the men clearance group (P=0.011). Only in men, HPV16 copy numbers were higher in persisters than in the clearance group (P=0.039). To conclude, in both genders, persistent oral HPV16 infections were associated with the mixed or integrated form of HPV16, while in the clearance groups, episomal HPV16 predominated. This indicates that HPV16 integration is a common event even in asymptomatic oral infections, which might predispose the infected subjects to progressive disease.
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Affiliation(s)
- Adriana Lorenzi
- Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, MediCity Research Laboratory, University of Turku, Turku, Finland
- Institute of Education and Research (IEP), Molecular Oncology Research Centre, Barretos Cancer Hospital, Pio XII Foundation, Brazil
- Faculty of Medicine, Alfredo Nasser University, UNIFAN, Aparecida de Goiânia, Goiás, Brazil
| | - Jaana Rautava
- Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, MediCity Research Laboratory, University of Turku, Turku, Finland
- Department of Pathology, Turku University Central Hospital, Turku, Finland
| | - Katja Kero
- Department of Obstetrics and Gynaecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Kari Syrjänen
- Department of Clinical Research, Biohit Oyj, Helsinki, Finland
| | - Adhemar Longatto-Filho
- Institute of Education and Research (IEP), Molecular Oncology Research Centre, Barretos Cancer Hospital, Pio XII Foundation, Brazil
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Seija Grenman
- Department of Obstetrics and Gynaecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Stina Syrjänen
- Department of Pathology, Turku University Central Hospital, Turku, Finland
- Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, MediCity Research Laboratory, University of Turku, Turku, Finland
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Zhang C, Liu F, Pan Y, Deng Q, Li X, He Z, Liu M, Ning T, Guo C, Liang Y, Xu R, Zhang L, Cai H, Ke Y. Incidence and clearance of oral human papillomavirus infection: A population-based cohort study in rural China. Oncotarget 2017; 8:59831-59844. [PMID: 28938686 PMCID: PMC5601782 DOI: 10.18632/oncotarget.16306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
The natural history of oral human papillomavirus (HPV) infection which is linked with the increased incidence of oropharyngeal squamous cell cancer (OPSCC) has been incompletely studied. Oral swab specimens and questionnaire data were obtained bi-annually for up to 6 visits from 4314 healthy adults aged 25-69 in rural Anyang, China. HPV infection status was evaluated with PCR-based sequencing. Participants with at least two consecutive valid HPV results within the study period were included in the incidence and clearance analysis. Among 3289 participants included in this analysis (median follow-up time 18.3 months), incidence rates of mucosal HPV, oncogenic mucosal HPV and cutaneous HPV were 0.53 (95% CI: 0.39-0.73), 0.30 (95% CI: 0.20-0.46), and 4.17 (95% CI: 3.70-4.70) per 1,000 person-months respectively. Most newly acquired infections were cleared within one year. Recent practice of oral sex increased the risk of incident infection with mucosal HPV (Adjusted HR, 5.03; 95% CI, 1.16-21.73) and oncogenic mucosal HPV (Adjusted HR, 10.13; 95% CI, 2.14-48.06). Newly acquired oral mucosal HPV infections are rare and most are cleared within one year in rural Chinese. This study expands understanding of the natural history of oral HPV in countries with a lower incidence of HPV-OPSCC.
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Affiliation(s)
- Chaoting Zhang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Fangfang Liu
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yaqi Pan
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Qiuju Deng
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiang Li
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Mengfei Liu
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Tao Ning
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Chuanhai Guo
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yongmei Liang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ruiping Xu
- Anyang Cancer Hospital, Anyang 455000, China
| | - Lixin Zhang
- Anyang Cancer Hospital, Anyang 455000, China
| | - Hong Cai
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yang Ke
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Guo T, Goldenberg D, Fakhry C. AHNS series: Do you know your guidelines? Management of head and neck cancer in the era of human papillomavirus: Educating our patients on human papillomavirus. Head Neck 2017; 39:833-839. [PMID: 28263449 DOI: 10.1002/hed.24693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/30/2016] [Indexed: 12/16/2022] Open
Abstract
Human papillomavirus (HPV) has changed the face of head and neck cancer over the past 2 decades. No longer is this solely a disease of older patients with a history of heavy tobacco and alcohol use. Patients with HPV-related head and neck cancers tend to be younger, healthier, and have an improved prognosis, compared with those with HPV-negative tumors. As more patients are diagnosed with HPV-related head and neck cancer, physicians have important topics to consider. These include prevalence, transmission, and natural history of HPV, the role of screening, vaccines, and HPV testing in head and neck cancer. This article continues a series developed by the American Head and Neck Society's Education Committee entitled "Do you know your guidelines?" and is intended to provide guidance for navigating common questions and concerns patients may have about HPV infection and HPV-related head and neck cancer. © 2017 Wiley Periodicals, Inc. Head Neck 39: 833-839, 2017.
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Affiliation(s)
- Theresa Guo
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Carole Fakhry
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Verma M, Erwin S, Abedi V, Hontecillas R, Hoops S, Leber A, Bassaganya-Riera J, Ciupe SM. Modeling the Mechanisms by Which HIV-Associated Immunosuppression Influences HPV Persistence at the Oral Mucosa. PLoS One 2017; 12:e0168133. [PMID: 28060843 PMCID: PMC5218576 DOI: 10.1371/journal.pone.0168133] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/24/2016] [Indexed: 02/07/2023] Open
Abstract
Human immunodeficiency virus (HIV)-infected patients are at an increased risk of co-infection with human papilloma virus (HPV), and subsequent malignancies such as oral cancer. To determine the role of HIV-associated immune suppression on HPV persistence and pathogenesis, and to investigate the mechanisms underlying the modulation of HPV infection and oral cancer by HIV, we developed a mathematical model of HIV/HPV co-infection. Our model captures known immunological and molecular features such as impaired HPV-specific effector T helper 1 (Th1) cell responses, and enhanced HPV infection due to HIV. We used the model to determine HPV prognosis in the presence of HIV infection, and identified conditions under which HIV infection alters HPV persistence in the oral mucosa system. The model predicts that conditions leading to HPV persistence during HIV/HPV co-infection are the permissive immune environment created by HIV and molecular interactions between the two viruses. The model also determines when HPV infection continues to persist in the short run in a co-infected patient undergoing antiretroviral therapy. Lastly, the model predicts that, under efficacious antiretroviral treatment, HPV infections will decrease in the long run due to the restoration of CD4+ T cell numbers and protective immune responses.
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Affiliation(s)
- Meghna Verma
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States of America
| | - Samantha Erwin
- Department of Mathematics, Virginia Tech, Blacksburg, VA, United States of America
| | - Vida Abedi
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States of America
| | - Raquel Hontecillas
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States of America
| | - Stefan Hoops
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States of America
| | - Andrew Leber
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States of America
| | - Josep Bassaganya-Riera
- Nutritional Immunology and Molecular Medicine Laboratory, Biocomplexity Institute of Virginia Tech, Blacksburg, VA, United States of America
| | - Stanca M Ciupe
- Department of Mathematics, Virginia Tech, Blacksburg, VA, United States of America
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Race is Associated With Sexual Behaviors and Modifies the Effect of Age on Human Papillomavirus Serostatus Among Perimenopausal Women. Sex Transm Dis 2016; 43:231-7. [PMID: 26967299 DOI: 10.1097/olq.0000000000000426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) causes oropharyngeal and cervical cancers. Oropharyngeal cancer primarily affects whites, but cervical cancer is more common among blacks. Reasons for this distinct epidemiology are unclear. METHODS Serum was collected from women aged 35 to 60 years in the HPV in Perimenopause cohort and evaluated for antibodies to 8 HPV types. Demographic and behavioral data were collected by telephone questionnaire. Associations between sexual behaviors, race, age, HPV serostatus, and strength of serologic response to HPV were evaluated. RESULTS There were 781 women in this analysis, including 620 white (79%) and 161 (21%) black women. Whites were less likely to report 5+ vaginal sex partners (prevalence ratio [PR], 0.86; 95% confidence interval [CI], 0.77-0.97), but more likely to report 5+ oral sex partners (PR, 2.38; 95% CI, 1.62-3.49) compared with blacks. Seropositivity to most individual HPV types and at least 3 types was significantly lower in whites than in blacks (PR, 0.62; 95% CI, 0.47-0.80). Human papillomavirus seropositivity was independently associated with younger age among blacks, but with sexual exposures among whites. Furthermore, strength of serologic response to most HPV types significantly decreased with older age among blacks, but not among whites. CONCLUSIONS Racial differences in immune markers of HPV exposure and the epidemiology of HPV-related cancers may be linked to differences in patterns of sexual behaviors.
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Lam JO, Sugar EA, Cranston RD, Weber KM, Burk RD, Wiley DJ, Reddy S, Margolick JB, Strickler HD, Wentz A, Jacobson L, Coles CL, Bream JH, Rositch AF, Guo Y, Xiao W, Gillison ML, D'Souza G. The association of medication use with clearance or persistence of oral HPV infection. Cancer Causes Control 2016; 27:1491-1498. [PMID: 27804058 DOI: 10.1007/s10552-016-0826-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/25/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Persistent oral human papillomavirus (HPV) infection increases risk for oropharyngeal carcinoma, and people living with HIV have higher rates of oral HPV infection and related cancers. Some prescription medications have immunomodulatory effects, but the impact of medication use on oral HPV natural history is unknown. METHODS Scope® oral rinse-and-gargle samples were collected semi-annually from 1,666 participants and tested for 37 types of oral HPV DNA using PCR; 594 HPV-infected participants with 1,358 type-specific oral HPV infections were identified. Data were collected on recent (past 6 months) use of medications. The relationship between medication use and oral HPV clearance was evaluated using Wei-Lin-Weissfeld regression, adjusting for biologic sex, prevalent versus incident infection, age, HIV status and CD4+ T cell count. RESULTS Out of 11 medications examined, oral HPV clearance was significantly reduced in participants reporting recent use of antipsychotics (HR 0.75, 95% CI 0.57-0.99), anxiolytics/sedatives (HR 0.78, 95% CI 0.63-0.96) and antidepressants (HR 0.82, 95% CI 0.67-0.999). Among antipsychotics users, effect modification by HIV status was observed, with reduced clearance in HIV-infected (HR 0.67, 95% CI 0.49-0.91), but not HIV-uninfected participants (p-interaction = 0.009). After adjusted analysis, antipsychotic use remained significantly associated with reduced oral HPV clearance overall (aHR 0.75, 95% CI 0.57-0.99), and when restricted to only HIV-infected participants (aHR 0.66, 95% CI 0.48-0.90). After adjustment, anxiolytic/sedative use and antidepressant use were no longer significantly associated with reduced oral HPV clearance. CONCLUSIONS Some medications were associated with decreased oral HPV clearance, most notably antipsychotic medications. These medications are prescribed for conditions that may have immunomodulating effects, so characteristics of underlying illness may have partially contributed to reduced oral HPV clearance.
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Affiliation(s)
- Jennifer O Lam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Sugar
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Ross D Cranston
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen M Weber
- Hektoen Institute of Medicine, The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Robert D Burk
- Departments of Pediatrics, Microbiology and Immunology, and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Dorothy J Wiley
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Susheel Reddy
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Howard D Strickler
- Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Alicia Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Lisa Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Christian L Coles
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jay H Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Yingshi Guo
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Weihong Xiao
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Maura L Gillison
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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Epidemiology of Human Papillomavirus Detected in the Oral Cavity and Fingernails of Mid-Adult Women. Sex Transm Dis 2016; 42:677-85. [PMID: 26562696 DOI: 10.1097/olq.0000000000000362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Oral and fingernail human papillomavirus (HPV) detection may be associated with HPV-related carcinoma risk at these nongenital sites and foster transmission to the genitals. We describe the epidemiology of oral and fingernail HPV among mid-adult women. METHODS Between 2011 and 2012, 409 women aged 30 to 50 years were followed up for 6 months. Women completed health and behavior surveys and provided self-collected oral, fingernail, and vaginal specimens at enrollment and exit for type-specific HPV DNA testing. Concordance of type-specific HPV detection across anatomical sites was described with κ statistics. Using generalized estimating equations or exact logistic regression, we measured the univariate associations of various risk factors with type-specific oral and fingernail HPV detection. RESULTS Prevalence of detecting HPV in the oral cavity (2.4%) and fingernails (3.8%) was low compared with the vagina (33.1%). Concordance across anatomical sites was poor (κ < 0.20 for all comparisons). However, concurrent vaginal infection with the same HPV type (odds ratio [OR], 101.0; 95% confidence interval [CI], 31.4-748.6) and vaginal HPV viral load (OR per 1 log10 viral load increase, 2.2; 95% CI, 1.5-5.5) were each associated with fingernail HPV detection. Abnormal Papanicolaou history (OR, 11.1; 95% CI, 2.8-infinity), lifetime number of male vaginal sex partners at least 10 (OR vs. 0-3 partners, 5.0; 95% CI, 1.2-infinity), and lifetime number of open-mouth kissing partners at least 16 (OR vs. 0-15 partners, infinity; 95% CI, 2.6-infinity, by exact logistic regression) were each associated with oral HPV detection. CONCLUSIONS Although our findings support HPV DNA deposition or autoinoculation between anatomical sites in mid-adult women, the rarity of HPV in the oral cavity and fingernails suggests that oral/fingernail HPV does not account for a significant fraction of HPV in genital sites.
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Müller EE, Rebe K, Chirwa TF, Struthers H, McIntyre J, Lewis DA. The prevalence of human papillomavirus infections and associated risk factors in men-who-have-sex-with-men in Cape Town, South Africa. BMC Infect Dis 2016; 16:440. [PMID: 27549219 PMCID: PMC4994415 DOI: 10.1186/s12879-016-1706-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We investigated the prevalence of human papillomavirus (HPV) infection and associated behavioural risk factors in men-who-have-sex-with-men (MSM) attending a clinical service in Cape Town, South Africa. METHODS MSM were enrolled at the Ivan Toms Centre for Men's Health in Cape Town. A psychosocial and sexual behavioral risk questionnaire was completed for each participant and urine, oro-pharyngeal and anal swabs were collected for HPV testing using the Linear Array HPV Genotyping Test. Logistic regression analyses were performed to determine sexual risk factors associated with HPV infection at the three anatomical sites. RESULTS The median age of all 200 participants was 32 years (IQR 26-39.5), of which 31.0 % were black, 31.5 % mixed race/coloured and 35.5 % white. The majority of the participants (73.0 %) had completed high school, 42.0 % had a tertiary level qualification and 69.0 % were employed. HPV genotypes were detected in 72.8 % [95 % CI: 65.9-79.0 %], 11.5 % [95 % CI: 7.4-16.8 %] and 15.3 % [95 % CI: 10.5-21.2 %] of anal, oro-pharyngeal and urine specimens, respectively. Prevalence of high-risk (HR)-HPV types was 57.6 % [95 % CI: 50.3-64.7 %] in anal samples, 7.5 % [95 % CI: 4.3-12.1 %] in oro-pharyngeal samples and 7.9 % [95 % CI: 4.5-12.7 %] in urine, with HPV-16 being the most common HR-HPV type detected at all sites. HPV-6/11/16/18 was detected in 40.3 % [95 % CI: 33.3-47.6 %], 4.5 % [95 % CI: 2.1-8.4 %] and 3.2 % [95 % CI: 1.2-6.8 %] of anal, oro-pharyngeal and urine samples, respectively. Multiple HPV types were more common in the anal canal of MSM while single HPV types constituted the majority of HPV infections in the oropharynx and urine. Among the 88 MSM (44.0 %) that were HIV positive, 91.8 % [95 % CI: 83.8-96.6 %] had an anal HPV infection, 81.2 % [95 % CI: 71.2-88.8 %] had anal HR-HPV and 85.9 % [95 % CI: 76.6-92.5 %] had multiple anal HPV types. Having sex with men only, engaging in group sex in lifetime, living with HIV and practising receptive anal intercourse were the only factors independently associated with having any anal HPV infection. CONCLUSIONS Anal HPV infections were common among MSM in Cape Town with the highest HPV burden among HIV co-infected MSM, men who have sex with men only and those that practiced receptive anal intercourse. Behavioural intervention strategies and the possible roll-out of HPV vaccines among all boys are urgently needed to address the high prevalence of HPV and HIV co-infections among MSM in South Africa.
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Affiliation(s)
- Etienne E. Müller
- Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Kevin Rebe
- Anova Health Institute, Johannesburg, South Africa
- Anova Health Institute, Cape Town, South Africa
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Tobias F. Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa
- Anova Health Institute, Cape Town, South Africa
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - James McIntyre
- Anova Health Institute, Johannesburg, South Africa
- Anova Health Institute, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - David A. Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, University of Sydney, Sydney, Australia
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Nguyen NP, Nguyen LM, Thomas S, Hong-Ly B, Chi A, Vos P, Karlsson U, Vinh-Hung V. Oral sex and oropharyngeal cancer: The role of the primary care physicians. Medicine (Baltimore) 2016; 95:e4228. [PMID: 27428229 PMCID: PMC4956823 DOI: 10.1097/md.0000000000004228] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/29/2016] [Accepted: 06/20/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND We aimed to study the prevalence of oral sex and its possible association with human papillomavirus (HPV) 16 infection in the development of oropharyngeal cancer in the US population for possible prevention. METHODS We conduct a systemic review on the prevalence of oral sex among Americans among different age groups, the prevalence of HPV 16 infection reported in oropharyngeal cancer, and correlation between oral sex and oropharyngeal cancer. RESULTS Oral sex is prevalent among adolescents and sexually active adults. Sixty percent of oropharyngeal cancer reported in the United States is associated with HPV 16 infections. Individuals who practiced oral sex with multiple partners are at risk for developing oropharyngeal cancer and need to be informed about practicing safe sex or getting vaccination. CONCLUSION Family physicians will play a key role in prevention and educating the public about the risk of oral sex.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC
| | | | - Sroka Thomas
- Department of Radiation Oncology, Darmouth College of Medicine, New Lebanon, NH
| | - Bevan Hong-Ly
- Department of Radiation Oncology, University of Miami, Miami, FL
| | - Alexander Chi
- Department of Radiation Oncology, University of West Virginia, Morgantown, WV
| | - Paul Vos
- Department of Biostatistics, East Carolina University, Greenville, NC
| | - Ulf Karlsson
- Department of Radiation Oncology, Marshfield Clinic, Marshfield, WI
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, University of Martinique, Martinique, France
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Human papillomavirus infection in the oral cavity of HIV patients is not reduced by initiating antiretroviral therapy. AIDS 2016; 30:1573-82. [PMID: 26919735 PMCID: PMC4900420 DOI: 10.1097/qad.0000000000001072] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: The incidence of human papillomavirus (HPV)-related oral malignancies is increasing among HIV-infected populations, and the prevalence of oral warts has reportedly increased among HIV patients receiving antiretroviral therapy (ART). We explored whether ART initiation among treatment-naive HIV-positive adults is followed by a change in oral HPV infection or the occurrence of oral warts. Design: Prospective, observational study. Methods: HIV-1 infected, ART-naive adults initiating ART in a clinical trial were enrolled. End points included detection of HPV DNA in throat-washes, changes in CD4+ T-cell count and HIV RNA, and oral wart diagnosis. Results: Among 388 participants, 18% had at least one HPV genotype present before initiating ART, and 24% had at least one genotype present after 12–24 weeks of ART. Among those with undetectable oral HPV DNA before ART, median change in CD4+ count from study entry to 4 weeks after ART initiation was larger for those with detectable HPV DNA during follow-up than those without (P = 0.003). Both prevalence and incidence of oral warts were low (3% of participants having oral warts at study entry; 2.5% acquiring oral warts during 48 weeks of follow-up). Conclusion: These results suggest: effective immune control of HPV in the oral cavity of HIV-infected patients is not reconstituted by 24 weeks of ART; whereas ART initiation was not followed by an increase in oral warts, we observed an increase in oral HPV DNA detection after 12–24 weeks. The prevalence of HPV-associated oral malignancies may continue to increase in the modern ART era.
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Taylor S, Bunge E, Bakker M, Castellsagué X. The incidence, clearance and persistence of non-cervical human papillomavirus infections: a systematic review of the literature. BMC Infect Dis 2016; 16:293. [PMID: 27301867 PMCID: PMC4908763 DOI: 10.1186/s12879-016-1633-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 06/07/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines were designed to prevent cervical cancer in women and their provision remains a major public health need. However, HPV is also a major cause of non-cervical anogenital and oropharyngeal cancers and the potential benefit of vaccination likely extends beyond cervical cancer. METHODS A systematic literature search of PubMed (1995-2014) identified publications assessing the incidence, persistence, and clearance of non-cervical anogenital/oral HPV infections. Comparability with cervical HPV was assessed by identifying articles assessing the same or similar populations. RESULTS Available data suggest high incidence rates of non-cervical HPV infection in men and women, with HPV-16 predominating in all sites. The incidence of high risk HPV per 100 person-years ranged from 11.4 to 72.9 for penile infections, 6.7-47.9 at other male genital sites, and 4.4-36.7 and 5.3-23.4 for anal infections in men and women, respectively. The incidence per 100 person-years of oral infection with any HPV type ranged from 5.7 to 6.7 in men and 6.8-39.6 in women. Within the limitations of the data, there was a general pattern of higher incidence and clearance of non-cervical genital HPV infections, compared to cervical infections. HIV status, circumcision, number of sex partners and partner HPV status significantly influenced high-risk HPV incidence/clearance at male anogenital sites. Few studies assessed risk factors for oral HPV. CONCLUSIONS Parallels appear to exist between the epidemiology of cervical and non-cervical HPV infections in terms of incidence, HPV-type distribution, and risk factors for infection. Available data suggest that non-cervical genital HPV infections may occur more frequently, with higher clearance rates, than cervical infections. More extensive studies could provide useful information for estimating vaccine impact, the wider cost-benefit of HPV vaccination, and guiding vaccination policy. TRIAL REGISTRATION Not applicable, as systematic review of the literature.
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Affiliation(s)
- Sylvia Taylor
- GSK Vaccines, 20, Avenue Fleming, Parc de la Noire Epine, B-1300, Wavre, Belgium.
| | - Eveline Bunge
- Pallas Health Research and Consultancy BV, Rotterdam, The Netherlands
| | - Marina Bakker
- Pallas Health Research and Consultancy BV, Rotterdam, The Netherlands
| | - Xavier Castellsagué
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Menezes LJ, Poongulali S, Tommasino M, Lin HY, Kumarasamy N, Fisher KJ, Saravanan S, Gheit T, Ezhilarasi C, Jeeva A, Lu B, Giuliano AR. Prevalence and concordance of human papillomavirus infection at multiple anatomic sites among HIV-infected women from Chennai, India. Int J STD AIDS 2016; 27:543-53. [PMID: 26002318 DOI: 10.1177/0956462415587226] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/23/2015] [Indexed: 11/15/2022]
Abstract
Human papillomavirus (HPV) infection at the cervix, anus and oropharynx has been rarely concurrently estimated among HIV-infected women. Using multiplex polymerase chain reaction testing, we prospectively evaluated HPV genotype distribution across three anatomic sites among 50 eligible HIV-infected women from Chennai, India, who provided biological specimens and answered a sexual behaviour questionnaire. We also assessed clinical and behavioural factors related to HPV prevalence. Oncogenic HPV prevalence was comparable between the anus and cervix at 52.2% and 52.0% and lower at the oropharynx at 13.2%; 78% of women with a cervical HPV infection had the same type in the anus. Newly acquired oncogenic HPV infections were lower at cervix (24%) than anus (35%) at three months. 'Any type' cervical HPV prevalence was higher among women with low education and less than five years since HIV diagnosis. CD4+ count and antiretroviral therapy status were not associated with HPV prevalence at the three anatomic sites; however, enrolment cervical HPV16 prevalence was elevated among women with nadir CD4+ <200 cells/µL and enrolment CD4+ <350 cells/µL. Regular cervical screening is essential in HIV-infected Indian women irrespective of CD4+ count and antiretroviral therapy status. Additional research clarifying the natural history of anal HPV infection is also needed in this population.
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Affiliation(s)
- Lynette J Menezes
- Division of Infectious Disease, University of South Florida, Tampa, FL, USA
| | | | | | - Hui-Yi Lin
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Kate J Fisher
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Tarik Gheit
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Beibei Lu
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Anna R Giuliano
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Kahn JA, Rudy BJ, Xu J, Kapogiannis B, Secord E, Gillison M. Prevalence and risk factors for oral DNA tumor viruses in HIV-infected youth. J Med Virol 2016; 88:1944-52. [PMID: 27096166 DOI: 10.1002/jmv.24555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 01/01/2023]
Abstract
Human papillomavirus (HPV), Epstein-Barr virus (EBV), and Kaposi sarcoma-associated herpes virus (KSHV) may promote oral cancers, especially among immunosuppressed individuals. The aims of this study were to examine whether demographic characteristics, medical history, sexual behaviors, substance use, CD4+ T-cell count, HIV viral load, and HPV vaccination were associated with HPV, EBV, and KSHV infection and viral load. Multivariable modeling using logistic or linear regression examined associations between independent variables and infection or viral load, respectively. Among 272 HIV-infected 12-24-year-old youth, 19.5% were positive for oral HPV, 88.2% for EBV, and 11.8% for KSHV. In multivariable models, recent marijuana use (OR 1.97, 95%CI 1.02-3.82) and lower CD4+ T-cell count (<350 vs. ≥350 cells/mm(3) : OR 1.92, 95%CI 1.003-3.69) were associated with HPV infection; lifetime tobacco use (estimated coefficient [EC] 1.55, standard error [SE] 0.53, P = 0.0052) with HPV viral load; recent tobacco use (OR 2.90, 95%CI 1.06-7.97), and higher HIV viral load (>400 vs. <400 copies/ml: OR 3.98, 95%CI 1.84-8.74) with EBV infection; Black versus White race (EC 1.18, SE 0.37, P = 0.0023), and lower CD4+ T-cell count (EC 0.70, SE 0.28, P = 0.017) with EBV viral load, male versus female gender (OR 10, 95%CI 1.32-100) with KSHV infection, and younger age at HIV diagnosis (1-14 vs. 18-20 years: EC 0.33, SE 0.16, P = 0.049; 15-17 vs. 18-20 years: EC 0.35, SE 0.13, P = 0.0099) with KSHV viral load. In conclusion, substance use and immunosuppression are associated with oral DNA tumor viruses in HIV-infected youth. J. Med. Virol. 88:1944-1952, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jessica A Kahn
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bret J Rudy
- New York University School of Medicine, New York, New York
| | | | - Bill Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland
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Guo T, Eisele DW, Fakhry C. The potential impact of prophylactic human papillomavirus vaccination on oropharyngeal cancer. Cancer 2016; 122:2313-23. [PMID: 27152637 DOI: 10.1002/cncr.29992] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 12/11/2022]
Abstract
The incidence of oropharyngeal cancer (OPC) is significantly increasing in the United States. Given that these epidemiologic trends are driven by human papillomavirus (HPV), the potential impact of prophylactic HPV vaccines on the prevention of OPC is of interest. The primary evidence supporting the approval of current prophylactic HPV vaccines is from large phase 3 clinical trials focused on the prevention of genital disease (cervical and anal cancer, as well as genital warts). These trials reported vaccine efficacy rates of 89% to 98% for the prevention of both premalignant lesions and persistent genital infections. However, these trials were designed before the etiologic relationship between HPV and OPC was established. There are differences in the epidemiology of oral and genital HPV infection, such as differences in age and sex distributions, which suggest that the vaccine efficacy observed in genital cancers may not be directly translatable to the cancers of the oropharynx. Evaluation of vaccine efficacy is challenging in the oropharynx because no premalignant lesion analogous to cervical intraepithelial neoplasia in cervical cancer has yet been identified. To truly investigate the efficacy of these vaccines in the oropharynx, additional clinical trials with feasible endpoints are needed. Cancer 2016;122:2313-2323. © 2016 American Cancer Society.
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Affiliation(s)
- Theresa Guo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Gooi Z, Chan JYK, Fakhry C. The epidemiology of the human papillomavirus related to oropharyngeal head and neck cancer. Laryngoscope 2016; 126:894-900. [DOI: 10.1002/lary.25767] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Zhen Gooi
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland U.S.A
| | - Jason Y. K. Chan
- Department of Otorhinolaryngology-Head and Neck Surgery; The Chinese University of Hong Kong; Prince of Wales Hospital Shatin Hong Kong SAR
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland U.S.A
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Behavioral, immunologic, and virologic correlates of oral human papillomavirus infection in HIV-infected youth. Sex Transm Dis 2015; 42:246-52. [PMID: 25868136 DOI: 10.1097/olq.0000000000000264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the epidemiology or risk factors for oral human papillomavirus (HPV) in HIV-infected youth. The objectives of this study were to determine the prevalence and correlates of oral HPV infection and to explore the association between HPV vaccination and oral infection in HIV-infected youth. METHODS Youth 12 to 24 years of age with behaviorally acquired HIV were recruited for this cross-sectional study. Procedures involved medical chart review, survey, and collection of an oral rinse sample. Univariable and multivariable logistic regression models were used to determine whether demographic, behavioral, immunologic, and virologic factors and history of vaccination were significantly associated with oral HPV infection. RESULTS Mean age of the 272 participants was 21.5 years; 64% were non-Hispanic black and 20.2% were Hispanic; and 10.8% of men compared with 20.3% of women were fully vaccinated. Human papillomavirus prevalence was 19.7% in men and 18.6% in women (P = 1.0). Only men were positive for vaccine-type HPV: 5.6% were positive for HPV-6, HPV-11, HPV-16, and/or HPV-18, and 4.2% were positive for HPV-16 and/or HPV-18. Among men who were fully vaccinated, none were positive for HPV-6, HPV-11, HPV-16, and/or HPV-18, compared with 12 (6.3%) of men who were not fully vaccinated (P = 0.37). Two variables were marginally associated with oral HPV (P < 0.10): marijuana use in the previous 3 months and lower CD4+ T-cell count. CONCLUSIONS Prevalence rates of oral HPV were relatively high in this population of HIV-infected youth and were similar in male and female youth. No fully vaccinated men were infected with vaccine-type HPV.
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Reed SG, Wahlquist AE. Adults With Oral High-risk Human Papillomavirus (HPV) and/or Smoking History Have a Higher Risk for Clinically Diagnosed Oral Premalignant Lesions. J Evid Based Dent Pract 2015; 15:134-6. [PMID: 26337588 DOI: 10.1016/j.jebdp.2015.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Susan G Reed
- Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425-9170, USA. Tel.:+1 843 792 1577.
| | - Amy E Wahlquist
- Research Instructor, Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC 29425-8350, USA.
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Prendes BL, Wang SJ, Groppo ER, Eisele DW, Palefsky JM. Oral human papillomavirus infection in men who have sex with men with anal squamous intraepithelial lesions. Head Neck 2015; 38 Suppl 1:E399-405. [PMID: 25580925 DOI: 10.1002/hed.24006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the association between oral and anogenital human papillomavirus (HPV) infections. METHODS Oral and anal samples from 66 men who have sex with men with a history of HPV-related anogenital squamous intraepithelial lesions were analyzed using polymerase chain reaction (PCR), and typed for 38 HPV types. RESULTS Prevalence of oral HPV infection was 30%, versus 82% for anal infection. Prevalence of oral and anal high-risk HPV infection was 11% and 64%, respectively. Concurrent oral-anal any-type HPV infection was found in 26% of participants, whereas concordant type-specific HPV prevalence was 5%. In multivariate analysis, number of partners from whom the participant received oral-penile sex and number of partners on whom the participant performed oral-penile sex were associated with oral HPV infection. CONCLUSION Oral HPV prevalence in this cohort is high, however, concordant type-specific oral-anal HPV infection was rare. Increased risk of oral HPV infection was associated with oral-penile sex. © 2015 Wiley Periodicals, Inc. Head Neck 38: E399-E405, 2016.
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Affiliation(s)
- Brandon L Prendes
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Steven J Wang
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Eli R Groppo
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - David W Eisele
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Joel M Palefsky
- Department of Medicine, University of California, San Francisco, San Francisco, California
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46
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Bui TC, Tran LTH, Markham CM, Huynh TTT, Tran LT, Pham VTT, Tran QM, Hoang NH, Hwang LY, Sturgis EM. Self-reported oral health, oral hygiene, and oral HPV infection in at-risk women in Ho Chi Minh City, Vietnam. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:34-42. [PMID: 26093681 DOI: 10.1016/j.oooo.2015.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to examine the relationships among self-reported oral health, oral hygiene practices, and oral human papillomavirus (HPV) infection in women at risk for sexually transmitted infections (STIs) in Ho Chi Minh City, Vietnam. STUDY DESIGN Convenience and referral sampling methods were used in a clinic-based setting to recruit 126 women aged 18-45 years between August and October 2013. Behavioral factors were self-reported. Oral-rinse samples were tested for HPV DNA of 2 low-risk and 13 high-risk genotypes. RESULTS A higher unadjusted prevalence of oral HPV infection was associated with poorer self-rated overall oral health (P = .001), reported oral lesions or problems in the past year (P = .001), and reported a tooth loss not because of injury (P = .001). Higher unadjusted prevalence of oral HPV infection was also associated with two measures of oral hygiene: lower frequencies of toothbrushing per day (P = .047) and gargling without toothbrushing (P = .037). After adjusting for other factors in multivariable logistic regression models, poorer self-rated overall oral health remained statistically associated with oral HPV infection (P = .042); yet the frequency of tooth-brushing per day did not (P = .704). CONCLUSION Results corroborate the association between self-reported poor oral health and oral HPV infection. The effect of oral hygiene on oral HPV infection remains inconclusive.
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Affiliation(s)
- Thanh Cong Bui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Ly Thi-Hai Tran
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Christine M Markham
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Loi Thi Tran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Vietnam National University in Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | | | - Quan Minh Tran
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ngoc Hieu Hoang
- Biochemistry Department, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lu-Yu Hwang
- Department of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Erich Madison Sturgis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Chelimo C, Elwood JM. Sociodemographic differences in the incidence of oropharyngeal and oral cavity squamous cell cancers in New Zealand. Aust N Z J Public Health 2015; 39:162-7. [DOI: 10.1111/1753-6405.12352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/01/2014] [Accepted: 11/01/2014] [Indexed: 01/27/2023] Open
Affiliation(s)
- Carol Chelimo
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences; University of Auckland; New Zealand
- Department of Obstetrics and Gynaecology, School of Medicine; University of Auckland; New Zealand
| | - J. Mark Elwood
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences; University of Auckland; New Zealand
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48
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Sexual behaviors and other risk factors for oral human papillomavirus infections in young women. Sex Transm Dis 2015; 41:486-92. [PMID: 25013976 DOI: 10.1097/olq.0000000000000159] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral human papillomavirus (HPV) is associated with a rising incidence of certain head and neck cancers, and oral sex has been associated with oral HPV. This study sought to identify more specific patterns of oral sexual activity, including self-inoculation, that are associated with oral HPV infections in young women. METHODS A total of 1010 women attending a large university completed a computer-based questionnaire and provided oral specimens that were tested for any oral HPV using a Linear Array assay that detects any HPV as well as 37 HPV genotypes. Twenty-seven women provided additional samples up to 12 months after enrollment. Bivariable and multivariable analyses were conducted to identify oral sexual patterns and other risk factors associated with prevalent oral HPV. RESULTS Nineteen women had prevalent oral HPV (1.9%), with 10 women (1%) having a type-specific infection. Oral HPV was significantly associated with lifetime coital sex partnership numbers (P = 0.03), lifetime and yearly oral sex partnership numbers (P < 0.01), and hand and/or sex toy transfer from genitals to mouth (P < 0.001). Oral HPV was also associated with greater use of alcohol, cigarettes, marijuana, and sharing of smoking devices, lipstick, or toothbrushes (P < 0.05 for each), with an apparent dose-response for alcohol use and smoking behavior, stratified by number of sexual partners. Of 7 women with prevalent HPV who provided follow-up samples, none had evidence of a persistent type-specific infection. CONCLUSIONS These data provide additional evidence of transmission of oral HPV from oral sexual activity and also suggest possible transmission from self-inoculation or sharing of oral products.
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Pierce Campbell CM, Kreimer AR, Lin HY, Fulp W, O'Keefe MT, Ingles DJ, Abrahamsen M, Villa LL, Lazcano-Ponce E, Giuliano AR. Long-term persistence of oral human papillomavirus type 16: the HPV Infection in Men (HIM) study. Cancer Prev Res (Phila) 2015; 8:190-6. [PMID: 25575501 DOI: 10.1158/1940-6207.capr-14-0296] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Persistent infection with oral HPV16 is believed to drive the development of most oropharyngeal cancers. However, patterns of oral HPV16 persistence remain understudied, particularly among HIV-negative individuals. Oral HPV16 persistence was evaluated among 1,626 participants of the HPV Infection in Men (HIM) Study. Twenty-three oral HPV16-positive men who provided an oral gargle sample on ≥2 study visits were included in the analysis. Archived oral samples from all follow-up visits were tested for HPV16 using Linear Array and INNO-LiPA detection methods. Persistence was evaluated using consecutive HPV16-positive visits held approximately 6 months apart and using the Kaplan-Meier method. Oral HPV16-positive men were aged 18 to 64 years [median, 36 years; interquartile range (IQR), 25-42] and were followed for a median of 44.4 months (IQR, 29.9-49.5). Of 13 incident infections, 4 (30.8%) persisted ≥12 months, 1 (10.0%) persisted ≥24 months, and none persisted ≥36 months [median infection duration, 7.3 months; 95% confidence interval (CI), 6.4-NA)]. Of 10 prevalent infections, 9 (90.0%) persisted ≥12 months, 8 (80.0%) persisted ≥24 months, 4 (57.1%) persisted ≥36 months, and 2 (40.0%) persisted ≥48 months (median infection duration, NA). Twelve-month persistence of incident infections increased significantly with age (Ptrend = 0.028). Prevalent oral HPV16 infections in men persisted longer than newly acquired infections, and persistence appeared to increase with age. These findings may explain the high prevalence of oral HPV observed at older ages. Understanding oral HPV16 persistence will aid in the identification of men at high-risk of developing HPV-related oropharyngeal cancer.
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Affiliation(s)
- Christine M Pierce Campbell
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hui-Yi Lin
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - William Fulp
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michael T O'Keefe
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Donna J Ingles
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Martha Abrahamsen
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Luisa L Villa
- Molecular Biology Laboratory, Center of Translational Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil. Department of Radiology and Oncology, School of Medicine, University of São Paulo, São Paulo, Brazil. HPV Institute, School of Medicine, Santa Casa de São Paulo, São Paulo, Brazil
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Anna R Giuliano
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida. Center for Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida.
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Rettig E, Kiess AP, Fakhry C. The role of sexual behavior in head and neck cancer: implications for prevention and therapy. Expert Rev Anticancer Ther 2015; 15:35-49. [PMID: 25193346 PMCID: PMC4385715 DOI: 10.1586/14737140.2015.957189] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HPV-positive oropharyngeal squamous cell carcinoma (HPV-OSCC) is associated with oral sexual behaviors. The sharp rise in incidence of HPV-OSCC in the USA has been attributed to changes in sexual norms over the past five decades, with lower age at sexual debut and higher numbers of sexual partners per individual. In addition, variations in HPV-OSCC prevalence by race, age cohort and gender may be attributable to differences in oral sexual behaviors among these groups. Oral HPV infection is the putative precursor to HPV-OSCC. Risk factors for oral HPV incidence, prevalence, clearance and persistence are crucial to understanding how, and in whom, oral HPV infection progresses to malignancy. Future investigation should focus on elucidating the natural history of oral HPV infection persistence and malignant transformation, developing effective screening tools and exploring opportunities for prevention such as vaccination and public health education.
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Affiliation(s)
- Eleni Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, 601 N. Caroline St, Baltimore, MD 21287, USA
| | - Ana Ponce Kiess
- Department of Radiation Oncology, Johns Hopkins Medicine, 401 N. Broadway, Baltimore, MD 21231, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, 601 N. Caroline St, Baltimore, MD 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
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