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hiv and oral health

HIV and Oral Health: HPV Updates

By: Mark Schweizer, DDS MPH
Director of Development and Special Projects
Dental Director Southeastern AIDS Training and Education Center
Nova Southeastern University College of Dental Medicine
[email protected]

    HPV oral and oropharyngeal cancers are more difficult to detect than tobacco related cancers because the symptoms are not always obvious to the individual and health professionals may lack the education and background to diagnose HPV related lesions.  Although there are many adjunctive oral cancer screening devices and tests, currently none of them can find HPV positive oral and oropharyngeal cancers early. My rule of thumb is any lesion that persists for two weeks should be referred to an oral medicine specialist or oral surgeon to evaluate and biopsy if indicated. HPV is the leading cause of oropharyngeal cancers; primarily the tonsils, tonsillar crypt, the base of the tongue, and a very small number of front of the mouth. HPV16 is the strain most responsible for oropharyngeal cancer and affects both males and females.

    Oral HPV infection is commonly detected in HIV-infected individuals and is elevated among those with a higher number of lifetime oral sexual partners, current tobacco use, and immunosuppression. While HIV-infected individuals are at much higher risk of most HPV-associated cancers than the general population, studies suggest HIV-infected individuals have a more modest 1.5-4-fold greater risk for HPV-associated head and neck cancers.1,2

    On March 7, 2018 updates to the section on Human Papilloma Disease in the Guidelines for the Prevention and Treatment of Opportunist Infections in HIV-Infected Adults and Adolescents were published. Among the changes are revised information on oropharyngeal warts and cancer related to HPV and the recommendation of the 9-valent HPV vaccine for women and men. For more information and the full text of this updates is available at:

    https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-opportunistic-infection/343/hpv

      References:

      1. Kreimer AR, Alberg AJ, Daniel R, et al. Oral human papillomavirus infection in adults is associated with sexual behavior and HIV serostatus. J Infect Dis. 2004; 189:686–98. [PubMed]

      2. Shiels MS, Cole SR, Kirk GD, Poole C. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr. 2009;52:611–622