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. ? ? ?
