Persistence and clearance of oral human papillomavirus among a multi-national cohort of men

Abstract

In response to the growing burden of HPV-associated oropharyngeal cancer, this study investigated clearance of oral HPV, the obligate precursor, in a longitudinal cohort of men from the US, Brazil, and Mexico. Oral gargles collected every 6 months from the HPV Infection in Men Study were HPV genotyped using SPF₁₀ PCR-DEIA-LiPA₂₅. Oral HPV infection clearance and associated factors were assessed using Kaplan-Meier curves and Cox proportional hazards models, respectively. Median follow-up was 44.8 months with 403 and 186 men with an incident and prevalent oral HPV infection, respectively; and lower probability of clearance observed in prevalent infections. Infections were less likely to clear in the presence of increased sexual behaviors; and among prevalent infections, older men were less likely to clear their infection. Here, we report differences in prevalently and incidently detected infections with sexual behavior as a key factor and older age as a potential factor associated with clearance.

Fig. 1. Clearance of incident vs. prevalent oral oncogenic HPV infections identified in the HIM Study.

Kaplan–Meier curves with log-rank test investigated. A Clearance of an oral oncogenic HPV infection with a steep drop off is observed at the onset due to inclusion of transient infections. B Transient infections are excluded to determine clearance among only those infections that persisted 6 months or more.

Fig. 2. Clearance of oral oncogenic HPV infections identified in the HIM study, stratified by age tertiles (age at first HPV detection) with and without transient infections.

Represented are number of infections, not number of men with an infection—men could have multiple infections. Kaplan–Meier curves with log-rank test investigated. A Clearance of an incident oral oncogenic HPV infection, stratified by age group; B Clearance of an incident oral oncogenic HPV infection, stratified by age group, excluding transient infections; C Clearance of a prevalent oral oncogenic HPV infection, stratified by age group; D Clearance of a prevalent oral oncogenic HPV infection, stratified by age group (excluding transient infections).