Prevalence and incidence of human papilloma virus-related dysplasia of oropharyngeal, cervical, and anal mucosae in Spanish people with HIV

Abstract

Background: Objectives were to determine the prevalence/incidence of HPV-related dysplasia and clearance/acquisition rates of high-risk HPV (HR-HPV) genotypes in genital mucosa of women with HIV (WWHIV) and oropharyngeal and anal mucosa of people with HIV (PWH) and to evaluate factors related to HR-HPV infection in oropharyngeal mucosa at 12-months.

Material and methods: Prospective, longitudinal study with 12-month follow-up, enrolled PWH between December 2022 and April 2023. At baseline and 12 months, HIV-related clinical and analytical variables were recorded, oropharyngeal mucosa exudates were taken for PCR studies for human papilloma virus (HPV) and other sexually transmitted infections, whereas anal and female genital samples were self-sampled for HPV detection and genotyping by PCR and thin-layer cytology.

Results: Two hundred and seventy-six PWH with mean age of 45.3 years, 79% men, 24.3% with history of AIDS, 100% under antiretroviral therapy (ART), and 30.1% with completed HPV vaccination. HPV infection prevalence in oropharyngeal mucosa was 11.6% at baseline, most frequently by genotype 16 (2.2%), without dysplasia. No oropharyngeal dysplasia was observed at 12 months, and HR-HPV clearance and acquisition rates were 5.5 and 4.4%, respectively. Incidence of anal high grade squamous intraepithelial lesion (HSIL) was 1811.6 cases × 100 000 people-year, and HR-HPV clearance and acquisition rates were 16.2 and 25.6%, respectively. Incidence of CIN2/CIN3 or cervical cancer was zero, and HR-HPV clearance and acquisition rates were 11.3 and 7.5%. HIV-RNA viral load less than 50 copies/ml protected against HPV infection in oropharyngeal mucosa [97.2 vs. 87%, hazard ratio 0.044; 95% confidence interval (95% CI 0.042 - 0.956)].

Conclusion: Among PWH, HSIL incidence and HR-HPV acquisition rate are higher in anal versus oropharyngeal and genital mucosae. Nondetectability protects against oropharyngeal HPV infection.