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

描述（由申请人提供）：人乳头瘤病毒（HPV）是一种性传播感染，最近已被证明可导致某些扁桃体癌，但对口腔HPV自然史和影响这些感染持续和进展为扁桃体癌的因素知之甚少。在美国，口咽（扁桃体）癌的发病率正在增加，其中大多数癌症是由HPV引起的。艾滋病毒感染者口腔HPV感染率较高，扁桃体癌风险较高。初步研究表明，抗逆转录病毒治疗不能改善口腔HPV感染的清除。自HAART引入以来，口腔疣（由HPV引起）和HPV相关癌症的患病率并未下降。提出了一项前瞻性研究，其中来自多中心艾滋病队列研究（MACS）和妇女机构间艾滋病研究（WIHS）的600名艾滋病病毒感染者和400名艾滋病病毒未感染者将每六个月进行一次为期四年的随访。在每次访问时，我们将使用口腔冲洗和漱口液从参与者的口腔中收集细胞，并测试这些细胞中的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。比较有和没有HIV的人的口腔HPV自然史将有助于我们了解HIV和相关免疫抑制对清除口腔HPV感染的能力的影响。 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非常重要。由于有效的治疗，HIV阳性个体的生存率提高，可能会使持续的口腔HPV感染有足够的时间发展成癌症，导致HIV感染者中HPV相关扁桃体癌的持续增加。因此，我们必须了解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。

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.