Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, Florida.
Center for Observational and Real-World Evidence (CORE), Merck & Co, Inc, Rahway, New Jersey.
JAMA Otolaryngol Head Neck Surg. 2023 Sep 1;149(9):783-795. doi: 10.1001/jamaoto.2023.1573.
In the US, oropharyngeal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection, is the most frequent HPV-associated cancer, surpassing cervical cancer. However, little is known about oral HPV prevalence and genotype distribution in the general population.
To assess oral HPV prevalence and factors associated with HR and low-risk infection in a general US population.
DESIGN, SETTING, AND PARTICIPANTS: PROGRESS (Prevalence of Oral HPV Infection, a Global Assessment) was a cross-sectional observational study conducted between November 2021 and March 2022 in 43 dental offices in the US (24 urban, 13 urban cluster, and 6 rural sites), spanning 21 states. Eligible participants were aged 18 to 60 years, visiting dental clinics for routine dental examination. Dental clinics used targeted sampling to recruit equal distributions of men and women and across age groups.
Participants provided an oral gargle specimen for HPV DNA and genotyping and completed behavioral questionnaires, and dentists reported oral health status. Detection of HPV DNA and genotyping was performed using the SPF10/DEIA/LiPA25 system at a central laboratory.
Oral HPV prevalence.
Of the 3196 participants enrolled, mean (SD) age was 39.6 (12.1) years, and 55.5% were women. Oral HPV prevalence was 6.6% (95% CI, 5.7%-7.4%) for any HPV genotype, and 2.0% (95% CI, 1.5%-2.5%), 0.7% (95% CI, 0.4%-1.0%), and 1.5% (95% CI, 1.1%-1.9%) for HR, HPV-16, and 9-valent-HPV vaccine types, respectively. Among HPV-positive participants, HPV-16 was the most prevalent genotype (12.4% among men and 8.6% among women). Prevalence of HPV was higher in men than women and highest among men aged 51 to 60 years (16.8%, 6.8%, and 2.1% for any HPV, HR HPV, and HPV-16, respectively). Factors associated with HR oral infection included being male (adjusted odds ratio [AOR], 3.1; 95% CI, 1.2-8.5), being aged 51 to 60 years (AOR, 3.3; 95% CI, 1.5-7.3), having 26 or more lifetime male sex partners (AOR, 6.5; 95% CI, 2.3-18.7), and having 6 to 25 lifetime female oral sex partners (AOR, 3.4; 95% CI, 1.3-8.7).
In this cross-sectional study, oral HPV burden was highest among older men who may be at higher risk of developing oropharyngeal cancer. In addition to male sex and older age, HR oral HPV infection was also associated with sexual behaviors, including increasing number of male sex partners and female oral sex partners.
在美国，主要由高危（HR）人乳头瘤病毒（HPV）感染引起的口咽癌是最常见的 HPV 相关癌症，超过了宫颈癌。然而，对于一般人群中的口腔 HPV 流行率和基因型分布知之甚少。
评估美国一般人群中 HR 和低危感染的口腔 HPV 流行率和相关因素。
设计、地点和参与者：进展（口腔 HPV 感染的流行率，全球评估）是一项横断面观察性研究，于 2021 年 11 月至 2022 年 3 月在美国（24 个城市、13 个城市集群和 6 个农村地区）的 43 家牙科诊所进行，跨越 21 个州。符合条件的参与者年龄在 18 至 60 岁之间，因常规牙科检查而就诊牙科诊所。牙科诊所使用靶向抽样，按性别和年龄组进行均衡分配。
参与者提供口腔漱口样本进行 HPV DNA 检测和基因分型，并完成行为问卷，牙医报告口腔健康状况。HPV DNA 检测和基因分型在中央实验室使用 SPF10/DEIA/LiPA25 系统进行。
口腔 HPV 流行率。
在纳入的 3196 名参与者中，平均（SD）年龄为 39.6（12.1）岁，55.5%为女性。任何 HPV 基因型的口腔 HPV 流行率为 6.6%（95%CI，5.7%-7.4%），HR HPV、HPV-16 和 9 价 HPV 疫苗型分别为 2.0%（95%CI，1.5%-2.5%）、0.7%（95%CI，0.4%-1.0%）和 1.5%（95%CI，1.1%-1.9%）。在 HPV 阳性参与者中，HPV-16 是最常见的基因型（男性中为 12.4%，女性中为 8.6%）。男性 HPV 流行率高于女性，51 至 60 岁的男性最高（任何 HPV、HR HPV 和 HPV-16 分别为 16.8%、6.8%和 2.1%）。与 HR 口腔感染相关的因素包括男性（调整后的优势比[OR]，3.1；95%CI，1.2-8.5）、51 至 60 岁（OR，3.3；95%CI，1.5-7.3）、有 26 个或更多的终生男性性伴侣（OR，6.5；95%CI，2.3-18.7）和有 6 至 25 个终生女性口腔性伴侣（OR，3.4；95%CI，1.3-8.7）。
在这项横断面研究中，口腔 HPV 负担在年龄较大的男性中最高，这些男性可能面临更高的口咽癌发病风险。除了男性和年龄较大之外，HR 口腔 HPV 感染还与性行为有关，包括男性性伴侣和女性口腔性伴侣数量的增加。
