Low incidence and high clearance of oral HPV infections in men

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1. The incidence of an oncogenic-type oral HPV infection acquired in one year was 1.7%. 

2. Of men with oncogenic-type oral HPV associated with oropharyngeal cancer, more than half were cleared of infection within one year, with a median infection duration of 6.3 months. 

Evidence Rating Level: 2 (Good) 

Study Rundown: This prospective study found that the incidence of oncogenic-type oral HPV infections acquired in one year was relatively low (1.7%) and that more than half of the newly acquired infections were cleared within 1 year. Oral HPV infections (specifically type 16) are considered largely responsible for the recent increase in incidence of oropharyngeal cancers, specifically in men. This is one of the first large-scale studies to examine the natural history of oral HPV infections in men.

To date this is the largest prospective study to evaluate this research question. However, a minority of patients (39.9%) were eligible for inclusion in analysis, as the majority of patients only had 1-2 follow-up visits, creating the opportunity for selection bias and limiting researchers’ ability to accurately assess and characterize clearance. Additionally, the study was primarily funded by Merck Sharp & Dohme, the producers of the leading HPV vaccine, though the funders had no role in study design or data collection. The findings of this work contribute to understanding of the natural history of oral HPV infection and serve as a basis for further, more focused investigations into the acquisition, persistence, and epidemiology of oral HPV.

Click to read the study in The Lancet

Click to read an accompanying editorial in The Lancet

Relevant Reading: Uptodate: Human papillomavirus associated head and neck cancer

In-Depth [prospective cohort study]: Researchers used a subset of participants from the HPV Infection in Men (HIM) study, a multinational cohort study of 4,072 healthy men ages 18-70 begun in 2005, to estimate the incidence and clearance of oral HPV infections. Men were included in this sub-analysis if they provided 2 or more oral rinse-and-gargle samples with valid HPV results and completed at least 1 follow-up visit questionnaire. Oral samples were genotyped for specific HPV infections, grouped into oncogenic and non-oncogenic), and linear array methods were used to calculate incidence and clearance.

Of the 4,072 men in the study, 1626 men (39.9%) were included in the analysis with a median follow-up of 12.7 months (IQR 12.1-14.7). Within the first 12 months, 4.4% (n=115, 95% CI=3.5-5.6) of men in the study acquired an oral HPV infection, 53 (12-month incidence of 1.7%) of which were oncogenic types. Smoking and cohabiting or being unmarried were significantly associated with increased incidence of oral oncogenic HPV infections. Age, country of origin, lifetime number of sexual partners, and recent oral sex were not associated with increased incidence. The median infection duration was 6.9 months (6.2-9.3) for any HPV type and 6.3 months (6.0-9.9) for oncogenic HPV types. More than half of new infections were cleared within 1 year.

By Maren Shapiro and Leah Hawkins, MD, MPH

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