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Background:  Ano-genital infection with high risk 16 and 18 papilloma viruses is frequent in HIV-infected patients, but little is known about the prevalence of oral human papilloma viris (HPV) infection during HIV infection. Our study assessed the presence of HPV16 and HPV18 in saliva of HIV-infected patients by real-time quantitative polymerase chain reaction (PCR).

Method:  In an observational study, 125 HIV-positive individuals (63 men, 62 women) were prospectively enrolled. All patients gave blood and oral samples (saliva and cytobrush). Among them, 33 women underwent an additional cervical smear for cytological and virological tests. In-house real-time PCR (Light Cycler) was performed by amplification of the region E6 (HPV16) and E7(HPV18). Quantification was carried out by an external standard curve obtained by serial dilutions of recombinant plasmids. b globin gene co-amplification was used as an internal control. The threshold of detection was10 copies/500 nanogramme (ng) of DNA.

Results: Of the 125 patients, 16 (13%) had HPV16 or HPV18 in oral samples by patients (13 and 3 of the 16, respectively). Oral HPV loads ranged from 10 copies to 10⁵ copies/500 ng of DNA. All blood samples were negative for HPV DNA. Among the 33 women with oral and cervical samples, 16 (48 %) were positive for HPV16 or HPV18 in the genital area (11 HPV16, 1 HPV18, 4 HPV16/18 co-infections). Genital HPV loads ranged from 10 copies to 2.10⁷ copies/500 ng of DNA. Three out of 33 (9 %) excreted HPV16 (2) or HPV18 (1) in saliva with a low viral load ( < 100 copies/500 ng of DNA) and without visible oral lesion. The 3 corresponding cervical samples showed abnormal cytology (low-grade squamous intraepithelial [LSIL]) with higher genital HPV viral loads than women without HPV detection in saliva. All the 17 women without HPV in genital samples were negative for HPV detection in saliva. The presence of oral HPV was not correlated with HIV status (Centers for Disease Control classification, CD4 cell count and plasmatic viral load).

Conclusion:  We found a higher prevalence (13%) of oral HPV 16-18 in HIV-infected patients than the 6% previously reported, probably due to epidemiological or technical differences. Women with HPV in saliva showed a higher HPV load in genital area than women without HPV in saliva. The natural history of oral and genital HPV infections in HIV-infected patients requires further study to understand the relationships and the consequences of this bipolar infection.

Keywords: Human papillomavirus; Saliva; Real time PCR