The association of medication use with clearance or persistence of oral HPV infection.
OBJECTIVE
Persistent oral human papillomavirus (HPV) infection increases risk for oropharyngeal carcinoma, and people living with HIV have higher rates of oral HPV infection and related cancers. Some prescription medications have immunomodulatory effects, but the impact of medication use on oral HPV natural history is unknown.


METHODS
Scope®oral rinse-and-gargle samples were collected semi-annually from 1,666 participants and tested for 37 types of oral HPV DNA using PCR; 594 HPV-infected participants with 1,358 type-specific oral HPV infections were identified. Data were collected on recent (past 6 months) use of medications. The relationship between medication use and oral HPV clearance was evaluated using Wei-Lin-Weissfeld regression, adjusting for biologic sex, prevalent versus incident infection, age, HIV status and CD4+ T cell count.


RESULTS
Out of 11 medications examined, oral HPV clearance was significantly reduced in participants reporting recent use of antipsychotics (HR 0.75, 95% CI 0.57-0.99), anxiolytics/sedatives (HR 0.78, 95% CI 0.63-0.96) and antidepressants (HR 0.82, 95% CI 0.67-0.999). Among antipsychotics users, effect modification by HIV status was observed, with reduced clearance in HIV-infected (HR 0.67, 95% CI 0.49-0.91), but not HIV-uninfected participants (p-interaction = 0.009). After adjusted analysis, antipsychotic use remained significantly associated with reduced oral HPV clearance overall (aHR 0.75, 95% CI 0.57-0.99), and when restricted to only HIV-infected participants (aHR 0.66, 95% CI 0.48-0.90). After adjustment, anxiolytic/sedative use and antidepressant use were no longer significantly associated with reduced oral HPV clearance.


CONCLUSIONS
Some medications were associated with decreased oral HPV clearance, most notably antipsychotic medications. These medications are prescribed for conditions that may have immunomodulating effects, so characteristics of underlying illness may have partially contributed to reduced oral HPV clearance.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Jennifer O
JO
Lam
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
Elizabeth A
EA
Sugar
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Ross D
RD
Cranston
Hektoen Institute of Medicine, The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA.
Kathleen M
KM
Weber
Departments of Pediatrics, Microbiology and Immunology, and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
Robert D
RD
Burk
School of Nursing, University of California Los Angeles, Los Angeles, CA, USA.
Dorothy J
DJ
Wiley
Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Susheel
S
Reddy
Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Joseph B
JB
Margolick
Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
Howard D
HD
Strickler
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
Alicia
A
Wentz
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
Lisa
L
Jacobson
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Christian L
CL
Coles
Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Jay H
JH
Bream
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
Anne F
AF
Rositch
Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Yingshi
Y
Guo
Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Weihong
W
Xiao
Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
Maura L
ML
Gillison
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA. gdsouza2@jhu.edu.
Gypsyamber
G
D'Souza
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology / Q000821:virology; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
Antipsychotic; Clearance; HIV; Immunomodulatory; Oral HPV; Prescription medication