Prevalence of oral human papillomavirus infection among Indian HIV-positive men who have sex with men: a cross-sectional study

Shelly Lensing,Murugesan Sivasubramanian,Joel M. Palefsky,Rajiv Karthik,Priya Abraham,Anantharam Raghavendran,Dilip Mathai,Jeannette Y. Lee,Alexandra L. Hernandez

doi:10.1186/s12879-021-06301-6

Abstract

BackgroundOral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. However, there is little information available on the prevalence of oral HPV in this population.MethodsWe tested 302 HIV-positive Indian MSM for oral HPV infection using L1 HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load (VL) were measured. Participants completed an interviewer-administered questionnaire including a sexual history.ResultsThe prevalence of oral HPV was 23.7% (95% CI: 19–29%) and 2.4% of participants had oncogenic HPV types. No participants had oral HPV type 16 (HPV-16) and the prevalence of other anogenital HPV types was low. Participants with higher CD4+ levels had reduced odds of having any oral HPV infection (OR: 3.1 [1.4–6.9]) in multivariable analyses.ConclusionsThis is the first report of oral HPV among Indian HIV-positive MSM. Our results show a high prevalence of oral HPV infection consistent with studies from Western populations. However, oncogenic anogenital HPV types were relatively uncommon in our study population. It is unknown what the impact of this distribution of oral HPV will be on oropharyngeal cancers. HIV-positive MSM in India should be monitored closely for oral and oropharyngeal pre-cancer and cancer.

Highlights

The incidence of oral squamous cell carcinoma (OSCC) is higher in India than in western countries
Men from Humsafar Trust were younger (38 vs. 32 years), a greater proportion had completed more than 10 years of school (27% vs 9%), they had a higher median income (6000 INR vs. 2000 INR), and more reported their religion as being “Muslim” (24% vs. 3%)
Almost half of our participants reported being married to a woman (47%)

Summary

Introduction

The incidence of oral squamous cell carcinoma (OSCC) is higher in India than in western countries. OSCCs comprise 40–50% of all malignancies diagnosed in India and they are the most common cancer among Indian men [3] This is in contrast to the global prevalence where oral cancers comprise only 2–4% of all cancers, and to the United States where cancers of the oral cavity and pharynx account for only 3% of all new cancer cases [4,5,6,7,8,9]. India has an additional lifestyle behavior that has been linked to oral cancers, i.e., the practice of chewing ‘betel quid’ (a combination of betel leaf, smokeless tobacco, areca nut, and lime paste). India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. There is little information available on the prevalence of oral HPV in this population

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