Prevalence of HPV-16 and 32
Oral Infections from 2000-2018

Michael Hagensee1, Jose A. Vazquez2, Jennifer Cameron1, Elizabeth Lilly1, Paul Fidel 1


Medical College of Georgia, Augusta, GA



Objective: The prevalence of oral HPV 16 and 32 infections werestudied in HIV-infected individuals over the past 19 years in New Orleans. Clinicians and dentists have noted a decrease in the prevalence of oral warts (HPV-32) and few oral cancers (HPV-16) in HIV+ individuals  over this time. This may be a long-term impact of anti-retroviral therapy (ART) and its effect on immunity. This analysis combines multiple cross-sectional studies from 2000-2018.


Methods: Saliva, oral gargles or swab samples were collected from cohorts of HIV+ individuals from 2000-04, 2005-09, and 2013-18. Isolated DNA from these samples were tested for HPV-16 and 32 by type-specific PCR assays or the Roche Linear Array. Demographic characteristics were collected as well as HIV viral loads and CD4 cell counts.


Results: The 2000-04 cohort (n=499) demonstrated a prevalence of 4.2% for oral HPV-16 infection and 7.8% for HPV-32 infection. Prevalence was markedly increased in a smaller cohort (n=110) enrolled from 2005-09 to 15 and 16%, respectively.

This correlated with a previously noted increased in oral warts. The 2013-18 cohort was much  larger (n=553) with a reduction in prevalence of HPV-32 to 5.2%. Prevalence of HPV-16 dropped to extremely low levels at 0.4% with only two detectible HPV-16 infections in this cohort.

Conclusions: In this examination of the prevalence of oral HPV infections spanning nearly 20 years, we observed  a peak of prevalent infections in the 2000-2009 decade. The reasons for this are not clear but may relate to restored oral immunity and to the type of ART that is currently in use. In the early and mid-2000's, there was extensive use of reverse transcriptase inhibitors, stavudine and zidovudine. These agents, which are no longer favored due to their impact on metabolic pathways, could have contributed to the higher prevalence of oral HPV infections seen in 2005-09.