Effect of HIV and immunosuppression on oral HPV persistence in the HAART era

描述(申请人提供)：人乳头瘤病毒(HPV)是一种性传播感染，最近被证明会导致一些扁桃体癌症，但人们对口腔HPV的自然病史和影响这些感染持续和发展为扁桃体癌症的因素知之甚少。在美国，口咽癌(扁桃体)的发病率正在增加，而这些癌症中的大多数都是由HPV引起的。携带艾滋病毒的人口腔HPV感染率更高，患扁桃体癌的风险也更高。初步研究表明，抗逆转录病毒治疗并不能改善口腔HPV感染的清除。自从引入HAART以来，口腔疣(由HPV引起)和HPV相关癌症的患病率并没有下降。在一项前瞻性研究中，来自多中心艾滋病队列研究(MACS)和妇女机构间艾滋病毒研究(WIHS)的600名艾滋病毒感染者和400名未感染艾滋病毒的人将在四年内每六个月接受一次跟踪。在每次访问中，我们将使用口腔漱口水和漱口水从参与者的口腔中收集细胞，并测试这些细胞是否感染37种不同类型的HPV。我们将评估口腔HPV感染的常见程度，以及使这些感染更难清除的因素。比较HIV携带者和非HIV携带者的口腔HPV自然病史，将有助于我们了解HIV及其相关免疫抑制剂对清除口腔HPV感染能力的影响。 公共卫生相关性：这项研究对于了解清除口腔和喉咙中的人类乳头瘤病毒(HPV)感染需要多长时间，以及哪些因素使我们不太可能清除这些感染具有重要意义。由于有效的治疗，艾滋病毒阳性者的存活率提高，这可能使持续的口腔HPV感染有足够的时间发展为癌症，从而导致艾滋病毒携带者中与HPV相关的扁桃体癌持续增加。因此，了解HIV感染和免疫抑制对口腔HPV感染的影响，以开发更好地预防和筛查这些癌症的方法是至关重要的。

DESCRIPTION (provided by applicant): Human papillomavirus (HPV) is a sexually transmitted infection that has recently been shown to cause some tonsillar cancers, yet little is known about oral HPV natural history and factors which influence the persistence and progression of these infections into tonsillar cancers. The incidence of oropharyngeal (tonsillar) cancer is increasing the United States and most of these cancers are caused by HPV. People with HIV have a higher rate of oral HPV infection and higher risk of tonsillar cancer. Initial studies suggest antiretroviral therapy does not improve clearance of oral HPV infection. The prevalence of both oral warts (which is caused by HPV) and HPV-associated cancers have not decreased since the introduction of HAART. A prospective study is proposed in which 600 HIV- infected and 400 HIV-uninfected people from the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS) will be followed every six months for four years. At each visit we will collect cells from participants' mouths using an oral rinse and gargle and test these cells for 37 different types of HPV. We will evaluate how common oral HPV infections are and factors which make it harder to clear these infections. Comparing oral HPV natural history in people with and without HIV will help us to understand the effect that HIV and related immunosupression have on the ability to clear oral HPV infections. PUBLIC HEALTH RELEVANCE: This research is important to understand how long it takes to clear human papillomavirus (HPV) infections in our mouth and throat and what factors make us less likely to clear these infections. Improved survival of HIV-positive individuals due to effective therapies may allow for sufficient time for persistent oral HPV infections to develop into cancer resulting in a continuing increase in HPV-associated tonsillar cancer among those with HIV. It is therefore critical that we understand the effect of HIV infection and immunosupression on oral HPV infection to develop methods to better prevent and screen for these cancers.