Researchers identified a significant relationship between oral HPV-16 infection and behavioral and objective biomarkers of current tobacco use, according to data published in JAMA.
“These findings highlight the need to evaluate the role of tobacco in the natural history of oral HPV-16 infection and progression to malignancy,” Carole Fakhry, MD, MPH, of Johns Hopkins University School of Medicine, and colleagues, wrote in a research letter. “Although adjusted for sexual behavior, we cannot entirely exclude the possibility that tobacco use is a marker for risky behavior.”
For the cross-sectional, population-based study, the researchers used data from the National Health and Nutrition Examination Survey (NHANES). The analysis included 6,887 participants aged 18 to 59 years who had data available on oral HPV-16 and recent tobacco use. Tobacco use and sexual behaviors were reported in self interviews. The participants also were evaluated for two biomarkers of recent tobacco use: serum cotinine and urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL).
Among the participants, 2,012 were current tobacco users, and 63 had oral HPV-16 detected. In a bivariable analysis, self-reported and biological markers of tobacco exposure were significantly associated with prevalent oral HPV-16 infection, as was oral sexual behavior. The prevalence of oral HPV-16 was greater in current tobacco users than never users and former users. The mean cotinine and NNAL levels were greater in participants with oral HPV-16 infection.
After adjustment for other factors, including sexual behavior, all behavioral and biological markers of tobacco use remained associated with oral HPV-16 infection.
“Tobacco use has local and systemic immunosuppressive effects; however, the specific biological mechanisms underlying our observed associations are unknown,” the researchers wrote. “Tobacco use may alter determinants of oral HPV-16 prevalence, such as incidence, persistence, or reactivation of infection.”
Disclosure: Two researchers report financial relationships with Merck and/or GlaxoSmithKline.