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. 2024 Sep 23;230(3):726-735.
doi: 10.1093/infdis/jiae004.

Association of Oral Microbiome With Oral Human Papillomavirus Infection: A Population Study of the National Health and Nutrition Examination Survey, 2009-2012

Xinyi Feng  1 , Eshan U Patel  1   2 , Jodie L White  1 , Shilan Li  3 , Xianming Zhu  1 , Ni Zhao  2 , Jianxin Shi  3 , Daniel E Park  4 , Cindy M Liu  4 , Rupert Kaul  5 , Jessica L Prodger  6   7 , Thomas C Quinn  1   2   8 , M Kate Grabowski  1   2 , Aaron A R Tobian  1   2
Affiliations

Association of Oral Microbiome With Oral Human Papillomavirus Infection: A Population Study of the National Health and Nutrition Examination Survey, 2009-2012

Xinyi Feng et al. J Infect Dis. .

Abstract

Background: Oral human papillomavirus (HPV) infection and the oral microbiome are associated with oropharyngeal cancer. However, population-based data on the association of oral microbiome with oral HPV infection are limited.

Method: A cross-sectional analysis of 5496 20-59-year-old participants in the 2009-2012 National Health and Nutrition Examination Survey was performed. Associations with oral HPV infection were assessed using multivariable logistic regression for oral microbiome α-diversity (within-sample diversity), and using principal coordinate analysis and permutational multivariate analysis of variance for β-diversity (between-sample heterogeneity).

Results: Overall, for α-diversity, a lower number of observed amplicon sequence variants (adjusted odds ratio [aOR] = 0.996; 95% confidence interval [CI] = .992-.999) and reduced Faith's phylogenetic diversity (aOR = 0.95; 95% CI = .90-.99) were associated with high-risk oral HPV infection. β-diversity showed differentiation of oral microbiome community by high-risk oral HPV infection as measured by Bray-Curtis dissimilarity (R2 = 0.054%; P = .029) and unweighted UniFrac distance (R2 = 0.046%; P = .045). There were differential associations when stratified by sex.

Conclusions: Both oral microbiome α-diversity and β-diversity were marginally associated with oral HPV infection. Longitudinal studies are needed to characterize the role of the microbiome in the natural history of oral HPV infection.

Keywords: HPV; National Health and Nutrition Examination Survey; human papillomavirus; oral microbiome.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Flow chart of study population selection. We narrowed our study's population age range to 20–59 years to ensure a comprehensive evaluation of all covariates. The oral microbiome data was confined to individuals aged 14–69 years, while the accessible data on oral HPV encompassed ages 18–69 years. Data on the number of sexual partners was limited to ages 18–59 years. As for smoking status, the assessment methods differed significantly between adults over 20 years and those aged 12–19 years. Abbreviations: HPV, human papillomavirus; MEC, mobile examination centers; NHANES, National Health and Nutrition Examination Surveys.
Figure 2.
Figure 2.
β-diversity of oral microbiome by any oral HPV infection status. The β-diversity (Bray-Curtis dissimilarity, unweighted UniFrac distance, weighted UniFrac distance) by any oral HPV infection using PCoA applying poststratification weights. Each dot represents an individual. The ellipses illustrated the 95% confidence ellipses for any oral HPV negative and positive group; the triangles represent the centroid of individuals for any oral HPV negative and positive group. PERMANOVA results adjusted for age in years, sex, race/ethnicity, educational attainment, marital status, past 30-day cigarette smoking, and number of lifetime oral sexual partners. Abbreviations: HPV, human papillomavirus; PCoA, principal coordinate analysis; PERMANOVA, permutational multivariate analysis of variance; se, standard error.
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