Infection, Persistence & Clearance of Oral HPV in Women

描述(申请人提供)：与肛门区域相比，在那里，人乳头状瘤病毒(HPV)的持续存在是大多数宫颈上皮内瘤变和癌症发生的重要先决条件，而目前对女性口腔中HPV感染的感染、持续或清除知之甚少。HPV以非血源性方式传播，没有病毒期，并被认为是持续交叉感染或自身接种生殖器HPV类型的结果，在口腔中发生的量是可测量的。鉴于肛门和口腔区域的组织学相似性，口腔中高危HPV类型的持续存在可能是口腔某些区域上皮内疾病进展的强烈标志。然而，支持这一前提的令人信服的证据在文献中仍然难以捉摸。即使在扁桃体区域的基底样型肿瘤的情况下，这也是近年来几项研究的重点，其他因素也可能是受影响个人口腔HPV发病率上升的原因。这些包括延长癌症过程或治疗导致的免疫力受损，以及在病毒采样和检测方面与癌症有关的偏见。这项建议的主要目标是表征感染的病因决定因素，清除和持续在口腔中的HPV感染。这将通过对之前通过国家过敏和传染病研究所的女性机构间艾滋病毒研究(WIHS)计划和加州大学旧金山分校的上皮内异型增生诊所收集的数据进行二次分析来实现。与肛门生殖器区域相似，口腔中的HPV相关疾病可以通过适当的筛查和了解女性这种感染的危险因素来预防。与以前发表的研究相比，拟议的分析的潜在优势是有机会回答关于口腔、宫颈和肛门HPV感染与自然病史之间的时间相互关系的重要问题，因为每个地点都同时收集了个人数据。广泛的个体流行病学和行为危险因素信息可用于在这个大型数据集中进行详细分析。从这项研究中获得的知识将提供有关HPV在口腔疾病中的作用的重要信息，有助于解释早期HPV口腔研究结果的不一致，这些结果受到规模和暴露数据的限制，并有助于在干预和教育方面的公共卫生反应。

DESCRIPTION (provided by applicant): In contrast to the anogenital area, where the persistence of human papillomavirus (HPV) is an important prerequisite for the development of most cervical intraepithelial neoplasia and cancer, very little is currently known about the infection, persistence, or clearance of human papillomavirus (HPV) infection in the oral cavity of women. HPV is spread in a non-hematogenous fashion without a viremic phase, and is believed to occur in the oral cavity in measurable amounts as a consequence of persistent cross-infection or auto- inoculation with genital HPV types. Given the histologic similarity between the anogenital and oral cavity regions, the continuous presence of high-risk HPV types in the oral cavity is likely a strong marker for progression of intraepithelial disease in certain areas of the oral cavity. However, convincing evidence in support of this premise remains elusive in the literature. Even in the case of basaloid-type tumors of the tonsillar region, which have been the focus of several studies in recent years, other factors may underlie increased oral HPV rates in affected individuals. These include impaired immunity consequent of the extended cancer process or treatment, and cancer-related bias in sampling and detection of the virus. The major goal of this proposal is to characterize etiologic determinants of infection, clearance and persistence of HPV infection in the oral cavity. This will be accomplished by conducting secondary analysis of data previously collected through the National Institute of Allergy and Infectious Disease's Women's Interagency HIV Study (WIHS) program and the intraepithelial dysplasia clinic at the University of California, San Francisco. Similar to the anogenital region, HPV-related disease in the oral cavity may be preventable with appropriate screening and knowledge of risk factors for this infection in women. The underlying strength of the proposed analyses over previously published studies is the opportunity to answer important questions on the temporal interrelation of oral, cervical and anal HPV infection and natural history, since within-person data was concurrently collected at each of these sites. Extensive individual epidemiologic and behavioral risk factor information is available for detailed analysis in this large dataset. Knowledge gained from this study will provide important information about the role of HPV in oral disease, help explain inconsistencies in results from earlier HPV oral studies, which were constrained by size and exposure data, and aid public health response in intervention and education.