HIV Modifies the Effect of Tobacco Smoking On Oral HPV

Objectives: People living with HIV (PLWH) are more likely to smoke and harbour oral human papillomavirus (HPV) infections, putting them at higher risk for head and neck cancer (HNCs). We hypothesized that HIV seropositivity may modify the association between smoking and oral HPV.
Methods: PLWH (n=169) and HIV-negative (n=126) individuals were recruited between 2004 and 2013 from outpatient clinics at two large health centers in New York and New Jersey, United States. Lifetime smoking history and other use habits were collected by questionnaire, and participants underwent oral examination and provided oral rinse samples at baseline and 6 and 12 months later, for HPV genotyping. Next-Generation Sequencing was used to identify α-, β-, and γ-HPV DNA types, including high-risk α-type HPV16 detected in most HNCs. We used multivariable logistic regression models to test for the differential effects of smoking on oral HPV detection by HIV status.
Results: PLWH were more likely to have smoked (76%) and to present with oral HPV, including α (39%), β (73%), and γ-types (33%) than HIV-negative individuals (65%, 28%, 63% and 20%, respectively). Among PLWH, an average ever-smoker (15.4 pack-years of smoking) was significantly more likely to have an α-HPV (odds ratio [OR]=2.95, 95% confidence interval[CI]:1.1-7.7], β-HPV (OR=3.01, 95%CI:1.1-8.2), or γ-HPV type (OR=2.14, 95%CI: 0.8-5.8), compared to HIV-negative smokers. Similar, albeit non-significant, associations were also observed with detection of persistent oral HPV of the same type at consecutive visits among PLWH vs. HIV-negative individuals. HIV significantly modified the association between smoking and detection of oral HPV, including high-risk types (p=0.015).
Conclusions: Our results show consistently stronger associations between tobacco smoking and oral HPV detection, including α-, β-, and γ-HPV types, among PLWH compared to at-risk HIV-negative individuals.