title: HPV oral lesions in HIV-infected patients: the impact of long-term HAART.
abstract: BACKGROUND
  Since the introduction of highly active antiretroviral therapy (HAART), an increase in the frequency of human papillomavirus-associated oral lesions (HPV-OL) has been observed. Thus, the aim of this study was to determine the prevalence and factors associated with HPV-OL in Mexican HIV-infected patients, as well as its genotyping, in the HAART era.
  
  
  METHODS
  In a cross-sectional study developed at an HIV/AIDS referral center in Mexico City, HIV-infected patients were consecutively included from 2004 to 2011. An oral exam was performed; lymphocyte CD4(+) count, HIV-viral load, CDC-stage, and HAART use were recorded. HPV-OL samples were taken for routine histopathological analysis (H-E) and HPV-DNA amplification/sequencing. Logistic regression models were performed and the interactions tested using the STATA software.
  
  
  RESULTS
  Among 787 HIV patients, 55 (6.9%) showed HPV-OL. HPV-OLs were independently associated with age (≥40 years) and with a longer time of HAART use (≥12 months). The most frequent lesion was squamous cell papilloma in 22 (40%) cases, followed by multifocal epithelial hyperplasia in 15 (27.3%) cases. Labial mucosa was the most common site involved (56.4%). Of the sequences obtained, 65.4% corresponded to low risk and 11.5% to high risk. Mixed high- and low-risk infection were identified in 7.7% of the cases.
  
  
  CONCLUSIONS
  Human papillomavirus-associated oral lesions were associated with older age and longer HAART use. All lesions were benign in nature and most of the HPV sequences corresponded to low-risk types. The rise of HPV-OLs in HIV patients on HAART may be related with the longer life expectancy of individuals with an impaired immune system rather than a direct effect of HAART.
authors.affiliation: Universidad Autónoma Metropolitana-Xochimilco, Ciudad de México, Mexico.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Anaya-Saavedra
authors.forename: Bertha
authors.initials: B
authors.lastname: Flores-Moreno
authors.forename: Alejandro
authors.initials: A
authors.lastname: García-Carrancá
authors.forename: Esther
authors.initials: E
authors.lastname: Irigoyen-Camacho
authors.forename: Miriam
authors.initials: M
authors.lastname: Guido-Jiménez
authors.forename: Velia
authors.initials: V
authors.lastname: Ramírez-Amador
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000328:Adult; D000367:Age Factors; D052685:Alphapapillomavirus / Q000145:classification / Q000235:genetics / Q000502:physiology*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D017573:Focal Epithelial Hyperplasia / Q000453:epidemiology / Q000821:virology; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008047:Lip Diseases / Q000453:epidemiology / Q000821:virology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009059:Mouth Diseases / Q000453:epidemiology / Q000821:virology*; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000821:virology; D010212:Papilloma / Q000453:epidemiology / Q000821:virology; D030361:Papillomavirus Infections / Q000453:epidemiology*; D017422:Sequence Analysis, DNA; D019562:Viral Load
chemical_list: D004279:DNA, Viral
keywords: HAART; human papillomavirus; oral warts