• Emergence of oral HPV infection among HIV-infected patients in the HAART era (TuOrB304)
  Authored by H.M. Blumberg, M.D. King, C.M. O'Daniels, N.M. Larsen, D. Reznick (United States)

HPV is the virus that causes warts, including genital and anal warts, and chronic infection with certain strains of HPV has long been associated with precancerous changes that can lead to cancer of the cervix and rectum. Abnormal precancerous changes of both the cervix and anus can be detected by a simple Pap test. (The Pap test involves obtaining cells from the area with a wooden scraper, smearing the cells on a glass slide, staining the cells and looking for abnormalities with a microscope.) Two studies looked at HPV infection at different sites.

One study used a case-control design to evaluate risk factors for HPV in the mouth. In 1997-98, the frequency of oral lesions due to HPV at Grady Hospital in Atlanta was relatively stable, with 18 total cases seen over those two years. However, in 1999, 34 cases were diagnosed. When the investigators matched their 52 cases with 104 control patients who were similar but did not have HPV disease, they found three factors that were associated with an increased risk of oral HPV: antibody to hepatitis B, a decrease in the viral load in the six months prior to the HPV diagnosis, and African-American heritage. Most opportunistic diseases related to HIV have decreased in frequency in the HAART era, so the increased rate at which this problem is currently being seen is puzzling. Longer term follow-up is needed to sort this out.

HIV-positive teenagers between 13 and 18 years old were evaluated for anal HPV infection, early precancerous changes and other STDs. The group included 83 boys and 265 girls. There were different risk factors identified for anal HPV infection and precancerous changes of the anus between the sexes. In adolescent boys, anal HPV infection was associated with having anal sex and with the presence of anal warts. In adolescent girls, anal HPV was associated with the presence of both anal warts and external genital warts, but not with anal intercourse. When the investigators excluded the presence of warts at any site, then the most important risk factor for boys was sexual orientation, and the most important factor for girls was having fewer than 200 CD4 cells. When they evaluated the risks for the development of precancerous changes of the anus, the risks were again somewhat different for the two sexes. For boys, these changes were associated with being HIV-positive and with detection of HPV, and for girls the changes were associated with having more than one sexual partner and with anal HPV. These data indicate that it is valuable to screen sexually active HIV-positive teenagers for both HPV and for precancerous changes.