According to Dutch researchers, prevalence of oral human papillomavirus (HPV) infection was high among gay men with HIV infection. Also, these men were more likely to be infected with HPV strains associated with high-risk of head and neck cancers.
Between 2010 and 2011, researchers in Amsterdam studied 767 gay men (median age 40 years), 41 percent of whom had HIV infection. The researchers collected data on smoking history, a risk factor for oral cancers, and the participants completed questionnaires about their sexual behaviors. They analyzed oral-rinse and gargle specimens for HPV DNA and conducted a sensitive PCR assay to determine the prevalence of HPV strains associated with oral and anogenital cancers.
Participants with HIV were more likely to report risky sexual behavior, cigarette smoking, and use of cannabis and popper. Most of the participants with HIV (87 percent) were being treated with antiretrovirals and 78 percent had an undetectable viral load. Approximately 40 percent of participants were positive for HPV DNA, and prevalence of HPV was significantly higher among men with HIV. Approximately 25 percent of the HIV-infected participants had oral infection with high-risk strains of HPV compared to 9 percent in the men who did not have HIV. After taking into account age, smoking habits, and sexual behavior, researchers associated HIV infection with a two-fold increase in the risk of oral HPV infection. Also, men with HIV had greater prevalence of infections with multiple strains of HPV and with HPV-16, a strain associated with very high risk of oral cancer.
The researchers concluded that “HIV infection was strongly and independently associated with oral HPV infection.” They also associated older age, recent use of poppers, a high number of sexual partners, and recent oral and/or anal sex with increased risk of oral infection with high-risk HPV strains in HIV-negative participants. After controlling for confounders, older age was the significant risk factor. Risk factors for infection with high-risk HPV strains for HIV-positive men included smoking and cannabis use in the past six months, but neither of the factors remained significant in the multivariate analysis. The researches acknowledge that additional research is needed “to assess the factors affecting the natural history of HPV infection, including HIV and the subsequent risk of developing HPV-related head and neck cancer.” They also suggest that HPV vaccination could be beneficial for men with HIV infection and others at high risk of HPV-related head and neck cancer.
The full report, “Oral Human Papillomavirus Infection in HIV-Negative and HIV-Infected Men Who Have Sex with Men: The HIV & HPV in MSM (H2M) Study,” was published online in the journal AIDS 27 (2013; doi: 10.1097/QAD.0b013e328362395c).