Association of Alcohol Consumption with Oral High-Risk Human Papillomavirus Infection: a Cross-Sectional Study Within the Multinational HPV Infection in Men (HIM) Cohort

Background:Human papillomavirus (HPV)-related oropharyngeal cancer arises from persistent high-risk HPV (HR-HPV) oral infection. Smoking is a risk factor for oral HPV, but alcohol's role is unclear. We investigated the association between alcohol consumption and oral HPV infection. Methods:This cross-sectional analysis used baseline data from the HIM Study. Oral HPV was detected with SPF10 PCR-DEIA-LiPA25 on oral gargle specimens. Associations between alcohol consumption and oral HPV were assessed using adjusted logistic regression models, exploring effect modification by smoking. Findings:Among 3121 males (median age 33 years, interquartile range [IQR] 25, 41), 39% were from Brazil (n = 1229), 32% from Mexico (n = 1014), and 28% from the United States (n = 878); 76% (n = 2365) reported alcohol use in the past month (median 8 drinks, IQR 0, 24). Oral HPV was detected in 20% (n = 469) participants reporting alcohol use, including 6.1% (n = 145) with HR-HPV and 14% (n = 324) low-risk HPV (LR-HPV). HR-HPV detection increased with alcohol intake, peaking at 7.6% (n = 75) among those consuming ≥16 drinks/month (p = 0.005). Consuming ≥16 drinks/month was independently associated with HR-HPV after adjustment (adjusted odd ratio [aOR] 1.60, 95% confidence interval [CI] 1.07, 2.40), whereas consuming 3-15 drinks was not (aOR 1.15, 95% CI: 0.76, 1.76). Exploratory stratified analyses showed aOR 2.57 (95% CI: 1.37, 4.96) in males who had never smoked and 1.12 (95% CI: 0.67, 1.88) in those who currently or formerly smoked, with no evidence of effect modification. Interpretation:Higher monthly alcohol consumption was modestly associated with oral HR-HPV in this cross-sectional analysis; longitudinal studies are needed to assess extension to oral HPV persistence, a recognized precursor of cancer. Funding:National Institute of Health, American Cancer Society.