title: Human papillomavirus infection in the oral cavity of HIV patients is not reduced by initiating antiretroviral therapy.
abstract: The incidence of human papillomavirus (HPV)-related oral malignancies is increasing among HIV-infected populations, and the prevalence of oral warts has reportedly increased among HIV patients receiving antiretroviral therapy (ART). We explored whether ART initiation among treatment-naive HIV-positive adults is followed by a change in oral HPV infection or the occurrence of oral warts.
  
  
  
  Prospective, observational study.
  
  
  
  HIV-1 infected, ART-naive adults initiating ART in a clinical trial were enrolled. End points included detection of HPV DNA in throat-washes, changes in CD4 T-cell count and HIV RNA, and oral wart diagnosis.
  
  
  
  Among 388 participants, 18% had at least one HPV genotype present before initiating ART, and 24% had at least one genotype present after 12-24 weeks of ART. Among those with undetectable oral HPV DNA before ART, median change in CD4 count from study entry to 4 weeks after ART initiation was larger for those with detectable HPV DNA during follow-up than those without (P =  0.003). Both prevalence and incidence of oral warts were low (3% of participants having oral warts at study entry; 2.5% acquiring oral warts during 48 weeks of follow-up).
  
  
  
  These results suggest: effective immune control of HPV in the oral cavity of HIV-infected patients is not reconstituted by 24 weeks of ART; whereas ART initiation was not followed by an increase in oral warts, we observed an increase in oral HPV DNA detection after 12-24 weeks. The prevalence of HPV-associated oral malignancies may continue to increase in the modern ART era.
authors.affiliation: aDepartment of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CaliforniabCenter for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MassachusettscDepartment of Dental Ecology, School of Dentistry, and Department of Microbiology and Immunology, School of Medicine University of North Carolina at Chapel Hill, Chapel Hill, North CarolinadCenter for Clinical AIDS Research & Education, Division of Infectious Diseases, University of California Los Angeles, Los AngeleseDepartment of Medicine, School of Medicine, University of California San Francisco, San Francisco, CaliforniafClinical Research Unit, New Jersey Medical School, Newark, New JerseygSocial and Scientific Systems, Inc., Silver Spring, Maryland, USA.
authors.forename: Caroline H
authors.initials: CH
authors.lastname: Shiboski
authors.forename: Anthony
authors.initials: A
authors.lastname: Lee
authors.forename: Huichao
authors.initials: H
authors.lastname: Chen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Webster-Cyriaque
authors.forename: Todd
authors.initials: T
authors.lastname: Seaman
authors.forename: Raphael J
authors.initials: RJ
authors.lastname: Landovitz
authors.forename: Malcolm
authors.initials: M
authors.lastname: John
authors.forename: Nancy
authors.initials: N
authors.lastname: Reilly
authors.forename: Linda
authors.initials: L
authors.lastname: Naini
authors.forename: Joel
authors.initials: J
authors.lastname: Palefsky
authors.forename: Mark A
authors.initials: MA
authors.lastname: Jacobson
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009059:Mouth Diseases / Q000453:epidemiology*; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology*; D010614:Pharynx / Q000821:virology; D015995:Prevalence; D011446:Prospective Studies; D014860:Warts / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D004279:DNA, Viral