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.

National Institute of Health (NIH)
Research Project (R01)
Project #
Application #
Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Rodriguez-Chavez, Isaac R
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
Fakhry, Carole; Gillison, Maura L; D'Souza, Gypsyamber (2014) Tobacco use and oral HPV-16 infection. JAMA 312:1465-7
Marks, Morgan A; Chaturvedi, Anil K; Kelsey, Karl et al. (2014) Association of marijuana smoking with oropharyngeal and oral tongue cancers: pooled analysis from the INHANCE consortium. Cancer Epidemiol Biomarkers Prev 23:160-71
Beachler, Daniel C; Abraham, Alison G; Silverberg, Michael J et al. (2014) Incidence and risk factors of HPV-related and HPV-unrelated Head and Neck Squamous Cell Carcinoma in HIV-infected individuals. Oral Oncol 50:1169-76
Dýýsouza, Gypsyamber; Carey, Thomas E; William Jr, William N et al. (2014) Epidemiology of head and neck squamous cell cancer among HIV-infected patients. J Acquir Immune Defic Syndr 65:603-10
Abraham, Alison G; D'Souza, Gypsyamber; Jing, Yuezhou et al. (2013) Invasive cervical cancer risk among HIV-infected women: a North American multicohort collaboration prospective study. J Acquir Immune Defic Syndr 62:405-13
Beachler, Daniel C; DýýSouza, Gypsyamber (2013) Oral human papillomavirus infection and head and neck cancers in HIV-infected individuals. Curr Opin Oncol 25:503-10
Abraham, Alison G; Strickler, Howard D; D'Souza, Gypsyamber (2013) Invasive cervical cancer risk among HIV-infected women is a function of CD4 count and screening. J Acquir Immune Defic Syndr 63:e163
Beachler, Daniel C; Weber, Kathleen M; Margolick, Joseph B et al. (2012) Risk factors for oral HPV infection among a high prevalence population of HIV-positive and at-risk HIV-negative adults. Cancer Epidemiol Biomarkers Prev 21:122-33