Prevalence of and Risk Factors for Oral Human Papillomavirus Infection among HIV-Positive and HIV-Negative People Who Inject Drugs

Abstract

BackgroundHuman papillomavirus (HPV) causes most oropharyngeal cancers in the United States. Oral HPV prevalence is associated with immunosuppression, and drug use can be immunosuppressive, but the epidemiology of oral HPV among people who use drugs is not well described.MethodsWe enrolled men and women with a current or prior history of injection drug use in this cross-sectional sub-study within the AIDS Linked to the Intravenous Experience (ALIVE) cohort. We tested oral rinse samples for 37 types of HPV DNA and collected self-reported risk factor information. We compared oral HPV prevalence across categories using chi-squared statistics and multivariable logistic regression.ResultsAmong 199 subjects, 32% were HIV-positive (median CD4 count 384 cells/μL), 90% were Black, 56% had less than a high school education, 17% had recently used injection drugs, and the median age was 54 years. Most had performed oral sex (82%) but had fewer than 5 lifetime partners (58%). The prevalence of any oral HPV was 29%, and of any oncogenic oral HPV was 13%. Oral HPV prevalence was high among both heterosexual men (30%) and women (20%). After adjustment, odds of oral HPV were increased among HIV-positive individuals with a low CD4 count (<350 cells/μl, aOR = 2.7, 95%CI = 1.2–6.4, vs. HIV-negative individuals), but not among HIV-positive individuals with a higher CD4 cell count. Odds were also elevated for those who had recently performed oral sex on a woman (aOR = 2.2, 95%CI = 1.01–4.6) and, even after this adjustment, among bisexual/lesbian females (aOR = 5.6, 95%CI = 1.4–23, vs. heterosexual females). Oral HPV prevalence was not associated with vaginal sex, performing oral sex on a man, or recent drug use.ConclusionsRecent drug use was not associated with oral HPV prevalence in our study. However, despite modest numbers of sexual partners, the prevalence of oral HPV among this largely Black population with lower socioeconomic status was high.

A multiple robust propensity score method for longitudinal analysis with intermittent missing data

“…Also, all risk factors are significant in Models 4 and 5 based on the proposed multiple robust estimation, though the age effect is not significant ( P ‐value = .07) in the largest candidate model (Model 2). Comparing to the existing literature (Robbins et al ., 2015), our findings validate and agree with previous studies, for instance, odds of HPV positive diagnosis was increased among HIV‐positive individuals with a low CD4+ count. Additional results on model comparison and further evaluation of our proposed approach are provided in the Supplementary Material.…”

Human Papillomavirus Oral Infection: Review of Methodological Aspects and Epidemiology

“…Nonetheless, findings in this regard are conflicting. In a few studies, the low number of recent CD4+ T-cell count emerged as a strong predictor for Alpha-HPV infection [107,108,118,119]. A weaker immunological status also seemed to favor Beta and Gamma HPV infection, as suggested by the findings of Giuliani et al, who reported a more than 3-fold increase in the prevalence of these genera in those with a current CD4+ T-cell count <500 cells/mm 3 [113].…”

Burden of vaccine-preventable diseases among at-risk adult populations in the US

“…Conversely, there was heterogeneity among the identified publications reporting on the epidemiologic burden of HPV among PLWH, with the prevalence of anal HPV ranging from 12% to 90%. 33–36 – 40–47 Moreover, Kojic et al . (2018 and 2019) reported that the prevalence of cervical HPV among women with HIV was lower than the prevalence of anal HPV (6–83%).…”