Oncogenic Oral Human Papillomavirus Clearance Patterns over 10 Years.

Area of Science:

• Oncology
• Virology
• Public Health

Background:

• Oropharyngeal cancer screening is currently insufficient.
• Understanding the natural history of oncogenic oral HPV (oncHPV) is crucial for developing effective screening strategies.
• Persistent oncHPV infections are precursors to oropharyngeal cancer.

Purpose of the Study:

• To explore four different definitions of oncogenic HPV clearance.
• To understand the long-term natural history of persistent oncogenic oral HPV infections.
• To identify risk factors associated with HPV clearance and persistence.

Main Methods:

• A prospective multicenter cohort study followed participants at risk for HIV for up to 10 years.
• Oral rinse and gargle samples were collected every 6-12 months and tested for oncogenic HPV.
• Four HPV clearance definitions were used: clear1, clear2, clear3 consecutive negatives, and clearlast (negative at last two visits).

Main Results:

• Median time to onc HPV clearance exceeded 2 years for conservative definitions (clear3, clearlast), but was under 1.2 years for lenient definitions (clear1, clear2).
• Prevalent onc HPV infections were less likely to clear than incident infections.
• Older age, male sex, living with HIV, and prevalent onc HPV were associated with reduced clearance. 13.8% had prevalent onc HPV, with 47.5% persisting ≥5 years.
• Two men with oral HPV16 developed oropharyngeal cancer; many with oral HPV16 persisted ≥5 years.

Conclusions:

• Most incident onc HPV infections clear relatively quickly.
• However, a significant proportion of prevalent onc HPV infections persist for over five years, indicating an elevated risk for oropharyngeal cancer.
• Persistent onc HPV, especially HPV16, at more than two visits suggests increased cancer risk.