Prevalence of oral human papillomavirus : systematic review and meta-analyses

Abstract

Background In view of the growing evidence indicating that oral human papillomavirus (HPV) infection as a causal factor for the increasing trend of a subset of head and neck cancers, and the initial evidence of prophylactic HPV vaccine for oral HPV prevention, this systematic review aims to review all the published literature in order to estimate the prevalence of oral HPV and its genotype-distribution among different populations.

Methods A systematic literature search was performed using MEDLINE, Pubmed and EMBASE databases to identify studies which investigated oral HPV prevalence using DNA-based testing methods on noncancerous population with sample size of 100 subjects or more. The primary outcome is the oral HPV prevalence among populations stratified by the risk of HPV infection. Meta-analyses were conducted to estimate the pooled prevalence of overall, high-risk (HR) HPV and HPV16 with relative 95% confidence intervals (CIs) by using random-effects models among different populations.

Results Fifty-three studies were included in this systematic review involving data of oral HPV prevalence on 35189 noncancerous individuals from 22 countries. There was substantial heterogeneity across the studies. Significant difference in oral HPV prevalence between general population and HR population was observed. The estimated overall, HR HPV and HPV 16 oral prevalence among general population was 5.4% (95% CI: 3.9-7.4% ), 1.1% (95% CI: 0.6-2.1%) and 0.9% (95% CI:0.4-1.7%) respectively, while the estimated prevalence among HR population was 14.8% (95% CI: 10.9-19.9%), 6.7% (95% CI: 3.2-13.7%) and 2.7% (95% CI: 1.8-3.9%) accordingly. Among the HR population, HIV-positive subgroup showed a significantly higher prevalence of oral HPV16 than the HIV-negative subgroup. The pooled proportion of genotypes covered by the latest HPV vaccine ranged from 26% to 46% among different populations.

Limitations Various detection and genotyping methods, and lack of representativeness in the samples collected in most of the studies resulted in substantial heterogeneity across studies. Additionally, only English publications were included in this systematic review, the results need to be interpreted with cautions.