Burden of non-vaccine high-risk oral HPV in updated cohort of people with HIV: Implications for public health strategies

Introduction/Background: Human papillomavirus (HPV) is the most common sexually transmitted infection and is considered the second infectious agent related to cancer. People with HIV (PWH) are at a higher risk of acquiring oral HPV infection, despite antiretroviral therapy, increasing their risk for oropharyngeal cancer (OPC). While there are more than 200 HPV genotypes, about 15 of them are classified as high-risk (hr) and responsible for HPV-related cancers. Currently, a nine-valent HPV vaccine is recommended in the US, providing protection against (6,11,16,18,31,33,45,52,58) HPV types. HPV vaccination is recommended for females, and males aged 13-26 years; for adults ages 27-45 years might get the HPV vaccination based on discussion with their clinician. In 2023, HPV vaccination rates among US Hispanics were 60%, but in Puerto Rico (PR) remain limited, particularly among PWH. Here, we described the prevalence of oral HPV infection by HPV genotypes among PWH, investigated HPV vaccination rates, and nonmedical factors associated with HPV infection. Methods: We evaluated 184 sexually active PWH with a median age of 48 years. Oral rinse samples were collected and analyzed for HPV and genotyped using the DNA ELISA kit HPV SPF10 and RHA kit HPV SPF10-LiPA25. An administered questionnaire collected sociodemographic characteristics and lifestyle variables. Statistical analyses were performed in R-statistical software. Results: The prevalence of oral HPV infection was 33%, of which 62% were hr genotypes, with HPV-18 being the most abundant (30%). Also, the prevalence of other hr HPV was 14% (HPV-35), 11% (HPV-33, HPV-16), 5% (HPV-39, HPV-51, HPV-53, HPV-56, HPV-59, HPV-74), and 3% (HPV-44, HPV-43, HPV-70). The prevalence of hr HPV genotypes not covered by the current nine-valent vaccine were more prevalent (57%) than vaccine covered hr genotypes (41%). There are not significantly difference between hr HPV, and socio-behavioral factors as current smokers (p=0.35), more than fifty sexual partners in lifetime (p=0.40), and education level (p=0.53). Conclusion: PWH exhibited an elevated prevalence of oral HPV infection, with rates higher than those previously documented in PR. Although current HPV vaccines offer broad protection to some hr HPV oncogenic genotypes, limited vaccination rates may contribute to the persistence of oral HPV infection. Additionally, we have observed several other hr HPV oncogenic genotypes which are not currently covered by the existing vaccines, highlight the need for novel improved HPV vaccines.