title: Oral human papillomavirus infection before and after treatment for human papillomavirus 16-positive and human papillomavirus 16-negative head and neck squamous cell carcinoma.
abstract: OBJECTIVE
  Oral human papillomavirus (HPV) infection is a risk factor for head and neck squamous cell carcinoma (HNSCC), and is a concern for patients with HPV-positive HNSCC and their partners. The prevalence of oral HPV infection before and after cancer therapy was investigated among patients with HPV16-positive and HPV16-negative HNSCC.
  
  
  METHODS
  Serial oral rinse samples (ORS) were collected from a cohort of 135 HNSCC cases as frequently as every 3 months for up to 3 years. Tumor HPV status was determined by HPV16 in situ hybridization. HPV was detected in ORS by consensus PCR and line blot hybridization. The HPV16 variants in positive oral rinse-tumor pairs were determined by sequencing. The odds of oral HPV infection among HPV16-positive and HPV16-negative cases were compared by use of generalized estimating equations.
  
  
  RESULTS
  Patients were followed for a median of 21 months and provided a median of 4 samples. Forty-four of 135 patients had HPV16-positive tumors. HPV16-positive cases were more likely than HPV16-negative cases to have an oral HPV infection detected before (odds ratio, 8.6; 95% confidence interval, 3.5-21) and after therapy (OR, 2.9; 95% confidence interval, 1.1-7.4). Oral infections by HPV16 and other high-risk, but not low-risk, types were more common among HPV16-positive cases both before and after therapy. Most HPV16 variants in ORS were European, unique, and identical to that in the tumor. Persistence of a type-specific oral infection was demonstrable for as long as 5 years.
  
  
  CONCLUSIONS
  Oral high-risk HPV infections are more frequent among patients with HPV16-positive than HPV16-negative HNSCC, consistent with a behavioral and/or biological disposition to infection.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21231, USA.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Agrawal
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Koch
authors.forename: Weihong
authors.initials: W
authors.lastname: Xiao
authors.forename: William H
authors.initials: WH
authors.lastname: Westra
authors.forename: Anna L
authors.initials: AL
authors.lastname: Trivett
authors.forename: David E
authors.initials: DE
authors.lastname: Symer
authors.forename: Maura L
authors.initials: ML
authors.lastname: Gillison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000821:virology*; D015331:Cohort Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006258:Head and Neck Neoplasms / Q000821:virology*; D052162:Human papillomavirus 16 / Q000235:genetics; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000150:complications / Q000453:epidemiology / Q000821:virology*; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology; D012306:Risk
chemical_list: D004279:DNA, Viral