title: Natural history of anal vs oral HPV infection in HIV-infected men and women.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-infected individuals are at greater risk for human papillomavirus (HPV)-associated anal than oropharyngeal cancers. The prevalence of anal vs oral HPV infections is higher in this population, but whether this is explained by higher incidence or persistence is unknown.
  
  
  METHODS
  Oral rinse and anal swab samples were collected semiannually from 404 HIV-infected adults in Baltimore, Maryland. Samples were tested for 37 HPV types using PGMY09/11 primers and reverse line-blot hybridization. Risk factors for HPV persistence were explored using adjusted Wei-Lin-Weissfeld models.
  
  
  RESULTS
  The prevalence (84% vs 28%), incidence (145 vs 31 per 1000 person-months), and 12-month persistence (54% vs 29%) were higher for anal vs oral HPV infections, respectively (each P < .001). Heterosexual men had lower incidence of anal HPV than men who have sex with men and women, but a higher incidence of oral HPV infection (test of interaction P < 0.001). In adjusted analyses, risk factors for HPV persistence included prevalent vs incident (adjusted hazard ratio [aHR] = 4.0; 95% confidence interval [CI], 3.5-4.8) and anal vs oral HPV infections (aHR = 1.5; 95% CI, 1.2-1.9).
  
  
  CONCLUSIONS
  The higher incidence and persistence of anal vs oral HPV infections likely contributes to the higher burden of anal as compared to oral HPV-associated cancers in HIV-infected individuals.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Beachler
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sugar
authors.forename: Wiehong
authors.initials: W
authors.lastname: Xiao
authors.forename: Maura L
authors.initials: ML
authors.lastname: Gillison
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000821:virology; D001004:Anus Diseases / Q000453:epidemiology* / Q000821:virology; D015142:Baltimore / Q000453:epidemiology; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D020010:Heterosexuality; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000821:virology*; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology* / Q000821:virology; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior
keywords: HIV; anal HPV; incidence; natural history; oral HPV; persistence; risk factors; variably detected