1. The prevalence of HPV infection was significantly higher among men reporting alcohol intake in the highest quartile than in the lower quartiles.
2. This association remained significant after accounting for smoking and sexual behavior, among other potential confounders.
Evidence Rating Level: 2 (Good)
Study Rundown: Patients with compromised immunity with HPV infection are more likely to have viral persistence and have an increased risk of subsequent cancer development. As alcohol consumption can decrease immune function and there is literature supporting the association between alcohol intake and HPV prevalence, this cross-sectional study sought to elucidate the association in the American male population. The prevalence of infection by various HPV subtypes was assessed across quartiles of alcohol intake. Further, the association of alcohol intake and prevalent HPV controlling for multiple potential confounders was investigated. Prevalent HPV infection was significantly higher in the highest quartile of alcohol intake (>9.91g/day) compared to the lower quartiles. Men in the highest quartile of alcohol intake had an increased risk of prevalent HPV independent of number of sexual partners and in never-smokers or current smokers.
Perhaps the most important limitation of this study is that much of the data are self-reported. Sensitive questions such as alcohol consumption and sexual activity are subject to reporting socially acceptable responses, which could lead to underreporting of alcohol consumption and number of sexual partners. Self-reported data are also subject to recall bias. While the HPV in Men (HIM) study from which these data are derived provides valuable information about behavior of American men, and detailed information was available about HPV subtypes in tested men, such studies are also limited by potential unmeasured confounders. Nevertheless, this study represents one of the largest of its kind and provides clear evidence that high alcohol intake is, at the very least, associated with an increased risk of HPV infection in men.
In-Depth [cross-sectional study]: This study evaluated the prevalence of HPV infection by different levels of alcohol intake in 1,313 American men who completed the alcohol intake questionnaire and genital HPV testing during the prospective HPV in Men (HIM) study. Alcohol intake was categorized by quartile, Q1 <0.10 g/day; Q2 ≥0.10 to <3.13 g/day; Q3 ≥3.13 to <9.91 g/day and Q4 ≥9.91 g/day. Wilcoxon rank-sum test was used to assess difference sin the median alcohol intake, and Pearson’s chi-square test was used to assess differences in the distribution of HPV infection across alcohol intake quartiles. Prevalence ratios were calculated using multivariable Poisson regression. The prevalence of HPV was significantly higher in the highest quartile of alcohol intake (68.9%) compared to the lowest quartile (56.7%, p<0.001), for any HPV type. This finding was similar and significant for oncogenic HPV types (35.2% vs. 22.8%, p<0.001), non-oncogenic HPV types (19.5% vs. 16.1%, p=0.002), and for the quadrivalent vaccine HPV types (19.5% vs. 11.7%, p<0.001). The middle quartiles of alcohol consumption had similar HPV prevalence as the lowest quartile. Multivariable analysis supported the association as well (prevalence ratio 1.12 [CI95% 1.03-1.27]). The association held true after controlling for confounding by age, race, smoking status, ethnicity, circumcision, number of female partners in the last 3 months and total number of female sexual partners. Additionally, after stratification by smoking status, the association was significant in never smokers for any HPV type and oncogenic HPV type, was of borderline significance among current smokers, and was not significant among former smokers.
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