Issues

The cover image is adapted from Fig. 2 in the article, “Oncogenic Oral Human Papillomavirus Clearance Patterns Over 10 Years,” by D'Souza and colleagues. Effective screening for oropharyngeal cancer (OPC) is lacking. To understand risk factors for progression to HPV-related oropharyngeal cancer (HPV-OPC), defining HPV clearance is key. This study explored oncogenic oral HPV clearance, the inverse of “persistence” which is necessary for development of HPV-OPC. Prospective multicenter cohort of participants living with/at-risk for HIV, with oral rinse and gargle samples collected every 6 to 12 months for up to 10 years and tested for oral HPV, the precursor of OPC. Four oncogenic HPV clearance definitions were explored to understand long-term natural history for persistent oncogenic oral HPV. HPV clearance definitions included 1 (clear1), 2 (clear2), 3 (clear3) consecutive negatives, or being negative at last two visits (clearlast). Figure 2 shows the clearance of prevalent and incident oncogenic oral HPV infections over 10 years. Detection of prevalent oncogenic oral HPV, older age, male sex, and living with HIV were independently associated with reduced clearance. Stringent clearance definitions requiring ≥2 negatives better captured individuals at-risk for HPV-OPC. Men with prevalent HPV16 and ≥2 consecutive HPV16 detections identified long-term persisters at increased risk for OPC, implying a potential for a targeted screening approach. For more information, see the article beginning on page 516.