Short Bites: Human Papillomavirus (HPV) Update

HPV oral and oropharyngeal cancers are more difficult to detect than tobacco-related cancers because the symptoms are not always obvious to an individual, and health professionals may lack the education and background to diagnose HPV-related lesions. Although there are many adjunctive oral cancer screening devices and tests, none of them can currently detect early-stage HPV-positive oral and oropharyngeal cancers. My rule of thumb: Any lesion that persists for 2 weeks should be referred to an oral medicine specialist or oral surgeon to evaluate and biopsy, if indicated. HPV is the leading cause of oropharyngeal cancers, primarily occurring on the tonsils, tonsillar crypt, base of the tongue, and in a very small number of cases, at the front of the mouth. HPV16 is the strain most responsible for oropharyngeal cancer, affecting both males and females.

Oral HPV infection is commonly detected in HIV-infected individuals, and it occurs at elevated rates among individuals with a higher number of lifetime oral sex partners, those who currently use tobacco, and those who are immunosuppressed. While HIV-infected individuals are at much higher risk of most HPV-associated cancers than the general population, studies suggest HIV-infected individuals have a more modest 1.5- to 4-fold greater risk of HPV-associated head and neck cancers.[1] [2]

Updates to the section on Human Papillomavirus Disease in the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents were recently published. Among the changes are revised information on oropharyngeal warts and cancer related to HPV and the recommendation to administer the 9-valent HPV vaccine for women and men.

[1] Kreimer AR, Alberg AJ, Daniel R, et al. Oral human papillomavirus infection in adults is associated with sexual behavior and HIV serostatus. 2004 Feb 15;189(4):686-98.

[2] Shiels MS, Cole SR, Kirk GD, et al. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr. 2009 Dec;52(5):611-22.