title: Twelve-month incidence and clearance of oral HPV infection in HIV-negative and HIV-infected men who have sex with men: the H2M cohort study.
abstract: BACKGROUND
  Our aim was to compare the 12-month incidence and clearance of oral high-risk HPV infection between HIV-infected men who have sex with men (MSM) and HIV-negative MSM.
  
  
  METHODS
  MSM aged 18 years or older were recruited in Amsterdam, the Netherlands. Questionnaire data and oral-rinse and gargle samples were collected at baseline, and after 6 and 12 months. HPV DNA was genotyped using the SPF10-PCR & DEIA-LiPA25 system (version 1). Determinants of oral HPV incidence and clearance were explored using Cox and logistic regression analyses respectively.
  
  
  RESULTS
  433 HIV-negative and 290 HIV-infected MSM were included in these analyses. The median follow-up time per participant was 12 months (range 3-15). During follow-up, 114 incident oral high-risk HPV infections were observed. The incidence rate of HPV-16 was 3.5/1000 person-months (PM) in HIV-infected and 0.9/1000 PM in HIV-negative MSM (IRR 4.1; 95% CI 1.3-13.2). The incidence rates of other high-risk HPV types ranged between 1.3-3.5/1000 PM in HIV-infected and 0.0-1.1/1000 PM in HIV-negative MSM. In multivariable analyses, HIV infection (adjusted hazard ratio [aHR] 3.8; 95% CI 2.3-6.2) and a higher number of recent oral sex partners (aHR 2.4 for ≥8 partners compared to ≤2; 95% CI 1.4-4.2) were associated with HPV incidence. Of the 111 baseline oral high-risk infections, 59 (53.2%) were cleared. In multivariable analyses, only a higher number of recent oral sex partners was associated with HPV clearance (adjusted odds ratio 3.4 for ≥8 compared to ≤2 partners; 95% CI 1.3-9.0).
  
  
  CONCLUSIONS
  The incidence rate of oral high-risk HPV infection was higher in HIV-infected MSM and in those with a higher number of recent oral sex partners. Just over half of the oral high-risk HPV infections at baseline were cleared after 12 months, with a higher likelihood of clearance among MSM reporting higher numbers of recent oral sex partners, but no difference by HIV status.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), PO Box 1, 3720BA, Bilthoven, The Netherlands. fleur.van.aar@rivm.nl.
authors.forename: Fleur
authors.initials: F
authors.lastname: van Aar
authors.affiliation: Cluster of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands. somooij@ggd.amsterdam.nl.|Center for Infection and Immunity Amsterdam (CINIMA), Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. somooij@ggd.amsterdam.nl.
authors.forename: Sofie H
authors.initials: SH
authors.lastname: Mooij
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), PO Box 1, 3720BA, Bilthoven, The Netherlands. marianne.van.der.sande@rivm.nl.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. marianne.van.der.sande@rivm.nl.
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.affiliation: Department of Pathology, Vrije Universiteit-University Medical Center (VUmc), Amsterdam, The Netherlands. cjlm.meijer@vumc.nl.
authors.forename: Chris J L M
authors.initials: CJ
authors.lastname: Meijer
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), PO Box 1, 3720BA, Bilthoven, The Netherlands. audrey.king@rivm.nl.
authors.forename: Audrey J
authors.initials: AJ
authors.lastname: King
authors.affiliation: Department of Internal Medicine, Jan van Goyen Medical Center, Amsterdam, The Netherlands. dverhagen@jvg.nl.
authors.forename: Dominique W M
authors.initials: DW
authors.lastname: Verhagen
authors.affiliation: Cluster of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands. theijman@ggd.amsterdam.nl.
authors.forename: Titia
authors.initials: T
authors.lastname: Heijman
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), PO Box 1, 3720BA, Bilthoven, The Netherlands. r.a.coutinho@umcutrecht.nl.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. r.a.coutinho@umcutrecht.nl.
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.affiliation: Cluster of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands. mschimvdloeff@ggd.amsterdam.nl.|Center for Infection and Immunity Amsterdam (CINIMA), Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. mschimvdloeff@ggd.amsterdam.nl.
authors.forename: Maarten F
authors.initials: MF
authors.lastname: Schim van der Loeff
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000453:epidemiology / Q000821:virology; D000328:Adult; D015331:Cohort Studies; D005500:Follow-Up Studies; D005838:Genotype; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D052162:Human papillomavirus 16 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000821:virology*; D009059:Mouth Diseases / Q000453:epidemiology* / Q000821:virology; D009426:Netherlands / Q000453:epidemiology; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D019562:Viral Load