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Current tobacco use linked to oral HPV-16 infection
Tobacco users demonstrated twice the risk for oral HPV-16 infection than former tobacco users or never users, according to study results.
HPV-16, a sexually transmitted infection, is considered the primary reason for the sharp increase in oropharyngeal squamous cell carcinoma incidence in the United States during the past 2 decades.
“The practice of oral sex is common, but this cancer is rare. So there must be cofactors in the process that explain why some people develop persistent HPV-16 infections and HPV-positive oropharyngeal cancers when most other people don’t,” researcher Gypsyamber D’Souza, PhD, MS, MPH, associate professor of epidemiology at Johns Hopkins Bloomberg School of Health and Johns Hopkins Kimmel Cancer Center, said in a press release. “It appears that tobacco exposure increases the likelihood of having an oral HPV-16 infection, and although we do not yet know why, we suspect that the virus may not be cleared from the body as easily in people who use tobacco.”
D’Souza and colleagues evaluated data from 6,887 adults aged 18 to 59 years who participated in the National Health and Nutrition Examination Survey.
All participants completed computer-assisted self-interviews at baseline to assess current tobacco use — defined as use within the prior 5 days — and sexual behaviors. Slightly more than one-quarter (n=2,112; 28.6%; 95% CI, 26.5-30.9) of study participants were current tobacco users.
Current tobacco users were more likely to be male, younger, have less education and have a higher number of lifetime oral sexual partners than non-tobacco users (
Researchers also conducted oral HPV DNA testing on all participants and detected oral HPV-16 in 63 participants (1%; 95% CI, 0.8-1.3%).
Overall, the incidence of oral HPV-16 was significantly higher in current tobacco users compared with never or former users (2% vs. 0.6%;
Results of a multivariate analysis showed self-reported tobacco use was significantly associated with oral HPV-16 infection (OR=2.7; 95% CI, 1.35-5.41).
Researchers also evaluated the association between tobacco use and oral HPV-16 according to biologic biomarkers.
They observed a significant association HPV-16 and levels of cotinine, a major nicotine metabolite (
Carole Fakhry
A log increase in cotinine, which equates to approximately three cigarettes per day, was independently associated with oral HPV-16 (adjusted OR=1.31; 95% CI, 1.07-1.6). Researchers observed a similar trend for a log increase in NNAL, which equates to four cigarettes per day (adjusted OR=1.68; 95% CI, 1.23-2.28).
“We found that increasing levels of tobacco exposure were associated with higher odds of oral HPV-16 prevalence,” researcher Carole Fakhry, MD, MPH, assistant professor of otolaryngology — head and neck surgery at Johns Hopkins University School of Medicine, said in the press release. “These results may provide an additional reason for smoking cessation and suggest that even modest amounts of tobacco use are associated with higher oral HPV prevalence.”
Disclosure: The researchers report research support from and consultant roles with GlaxoSmithKline and Merck.