Prevalence and incidence of HPV-related dysplasia of oropharyngeal, cervical, and anal mucosae in Spanish people living with HIV (PLHIV).

Background: Objectives were to determine the prevalence/incidence of HPV-related dysplasia and clearance/acquisition rates of high-risk HPV (HR-HPV) genotypes in genital mucosa of women-LHIV and oropharyngeal and anal mucosa of PLHIV and to evaluate factors related to HR-HPV infection in oropharyngeal mucosa at 12-months.

Material and methods: Prospective, longitudinal study with 12-month follow-up, enrolled PLHIV between December 2022 and April 2023. At baseline and 12-months, HIV-related clinical and analytical variables were recorded, oropharyngeal mucosa exudates were taken for polymerase chain reaction (PCR) studies for HPV and other sexually transmitted infections, while anal and female genital samples were self-sampled for HPV detection and genotyping by PCR and thin-layer cytology.

Results: 276 PLHIV with mean age of 45.3 years, 79% male, 24.3% with history of AIDS, 100% under ART, and 30.1% with completed HPV vaccination. HPV infection prevalence in oropharyngeal mucosa was 11.6% at baseline, most frequently by genotype 16 (2.2%), without dysplasia. No oropharyngeal dysplasia was observed at 12 months, and HR-HPV clearance and acquisition rates were 5.5% and 4.4%, respectively. Incidence of anal HSIL was 1,811.6 casesx100,000 people-year, and HR-HPV clearance and acquisition rates were 16.2% and 25.6%, respectively. Incidence of CIN2/CIN3 or cervical cancer was zero, and HR-HPV clearance and acquisition rates were 11.3% and 7.5%. HIV-RNA viral load <50 cop/mL protected against HPV infection in oropharyngeal mucosa (97.2 vs. 87%, HR 0.044; 95%CI [0.042 - 0.956]).

Conclusions: Among PLHIV, HSIL incidence and HR-HPV acquisition rate are higher in anal versus oropharyngeal and genital mucosae. Non-detectability protects against oropharyngeal HPV infection.