This study estimated the prevalence, genotype distribution, and the factors associated with oral human papillomavirus (HPV) in people who use crack-cocaine (PWUCC) in a remote Brazilian region.
Materials and methods
This cross-sectional study used community-based snowball sampling methods for participant recruitment. Socio-demographic, economic, drug use, and health-related information was collected from 278 PWUCC in the cities of Bragança and Capanema in northern Brazil. HPV diagnosis and genotyping were performed by a real-time polymerase chain reaction. Logistic regression identified the factors independently associated with oral HPV.
In total, 111 (39.9%) PWUCC had HPV DNA. Several genotypes were identified, some of them with high oncogenic potential. Crack-cocaine use ≥40 months, unprotected sex, more than 10 sexual partners in the last 12 months, oral sex, exchange of sex for money or illicit drugs, oral mucosa lesions, not having access to public health services, and the absence of vaccination against HPV was all associated with HPV DNA.
This study identified important epidemiological characteristics of oral HPV infection among PWUCC—a highly marginalized risk population—underlining the high prevalence of oral HPV with oncogenic potential and the urgent need for control and prevention measures, especially vaccination against this virus.
It is necessary to understand the prevalence and risk factors of oral HPV in risk populations as people who use crack-cocaine.
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Bastos FI, Bertoni N (2014) Pesquisa Nacional sobre o uso de crack: quem são os usuários de crack e/ou similares do Brasil? Quantos são nas capitais brasileiras? Publisher ICICT/FIOCRUZ. Available in, Rio de Janeiro https://www.arca.fiocruz.br/bitstream/icict/10019/2/UsoDeCrack.pdf. Accessed 14 Jul 2020
Fischer B, Cruz MS, Bastos FI, Tyndall M (2013) Crack across the Americas - a massive problem in continued search of viable answers: exemplary views from the North (Canada) and the South (Brazil). Int J Drug Policy 24:631–633. https://doi.org/10.1016/j.drugpo.2013.09.003
Butler AJ, Rehm J, Fischer B (2017) Health outcomes associated with crack-cocaine use: systematic review and meta-analyses. Drug Alcohol Depend 180:401–416. https://doi.org/10.1016/j.drugalcdep.2017.08.036
de Oliveira MGA, Dos Santos JN, Cury PR, da Silva VHP, Oliveira NRC, Padovani RC et al (2014) Cytogenetic biomonitoring of oral mucosa cells of crack cocaine users. Environ Sci Pollut Res Int 21:5760–5764. https://doi.org/10.1007/s11356-013-2447-6
Albini MB, Malacarne IT, Batista TBD, de Lima AAS, Machado MAN, Johann ACBR et al (2017) Cytopathological changes induced by the crack use in oral mucosa. Eur Addict Res 23:77–86. https://doi.org/10.1159/000465518
Antoniazzi RP, Lago FB, Jardim LC, Sagrillo MR, Ferrazzo KL, Feldens CA (2018) Impact of crack cocaine use on the occurrence of oral lesions and micronuclei. Int J Oral Maxillofac Surg 47:888–895. https://doi.org/10.1016/j.ijom.2017.12.005
Oliveira-Filho AB, Reis ER, Santos FJA, Kupek E, Silva FQ, Reis GM, (2019) Características sociais, demográficas, de uso de drogas e de saúde de pessoas que usavam crack: informações para promoção de saúde em município ao norte do Brasil. In: Prevenção e Promoção da Saúde 3. Silva Neto BR (Org.). Ponta Grossa, PR: Atena Editora, pp 15–31. https://doi.org/10.22533/at.ed.2981909123
Rautava J, Syrjänen S (2011) Human papillomavirus infections in the oral mucosa. J Am Dent Assoc 142:905–914. https://doi.org/10.14219/jada.archive.2011.0297
Syrjänen S (2018) Oral manifestations of human papillomavirus infections. Eur J Oral Sci 126(Suppl 1):49–66. https://doi.org/10.1111/eos.12538
D'Souza G, Agrawal Y, Halpern J, Bodison S, Gillison ML (2009) Oral sexual behaviors associated with prevalent oral human papillomavirus infection. J Infect Dis 199:1263–1269. https://doi.org/10.1086/597755
de Martel C, Plummer M, Vignat J, Franceschi S (2017) Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer 141:664–670. https://doi.org/10.1002/ijc.30716
Mehanna H, Beech T, Nicholson T, El-Hariry I, McConkey C, Paleri V et al (2013) Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer - systematic review and meta-analysis of trends by time and region. Head Neck 35:747–755. https://doi.org/10.1002/hed.22015
Petito G, Carneiro MA, Santos SH, Silva AMTC, Alencar RC, Gontijo AP et al (2017) Human papillomavirus in oral cavity and oropharynx carcinomas in the central region of Brazil. Braz J Otorhinolaryngol 83:38–44. https://doi.org/10.1016/j.bjorl.2016.01.004
Colpani V, Falcetta FS, Bidinotto AB, Kops NL, Falavigna M, Hammes LS et al (2020) Prevalence of human papillomavirus (HPV) in Brazil: a systematic review and meta-analysis. PLoS One 15:e0229154. https://doi.org/10.1371/journal.pone.0229154
Ribeiro MGM, Marcolino LD, Ramos BRA, Trento CL, de Araujo KCGM, Santos JR et al (2019) Elevated prevalence of high-risk HPV in healthy oral mucosa of users and nonusers of drugs in Northeastern Brazil. Braz Oral Res 33:e031. https://doi.org/10.1590/1807-3107bor-2019.vol33.0031
Araújo MV, Pinheiro HH, Pinheiro JJ, Quaresma JA, Fuzii HT, Medeiros RC (2014) Prevalence of human papillomavirus (HPV) in Belém, Pará State, Brazil, in the oral cavity of individuals without clinically diagnosable injuries. Cad Saude Publica 30:1115–1119. https://doi.org/10.1590/0102-311x00138513
Vieira RC, Monteiro JS, Manso EP, dos Santos MRM, Tsutsumi MY, Ishikawa EAY, et al (2015) Prevalence of type-specific HPV among female university students from northern Brazil. Infect Agent Cancer 10:21. https://doi.org/10.1186/s13027-015-0017-x
Oliveira-Filho AB, Silva FQ, Santos FJA, Cardoso YMN, di Miceli JFF, Resque RL et al (2020) Prevalence and risk factors for HIV-1 infection in people who use illicit drugs in northern Brazil. Trans R Soc Trop Med Hyg 114:213–221. https://doi.org/10.1093/trstmh/trz106
Oliveira-Filho AB, Santos FJA, Silva FQ, Raiol NC, Costa CCS, Piauiense JNF et al (2019) Hepatitis C virus infection status and associated factors among a multi-site sample of people who used illicit drugs in the Amazon region. BMC Infect Dis 19:634. https://doi.org/10.1186/s12879-019-4270-2
Oliveira-Filho AB, Araújo APS, Souza APC, Gomes CM, Silva-Oliveira GC, Martins LC et al (2019) Human T-lymphotropic virus 1 and 2 among people who used illicit drugs in the state of Pará, northern Brazil. Sci Rep 9:14750. https://doi.org/10.1038/s41598-019-51383-7
Cavalcante NDS, Lima HRR, Tabosa DF, Barbosa ESS, Costa NPS, Costa LM et al (2019) Syphilis in female sex workers: an epidemiological study of the highway system of the state of Pará, northern Brazil. Rev Soc Bras Med Trop 52:e20180064. https://doi.org/10.1590/0037-8682-0064-2018
Castro TMPG, Neto CER, Scala KA, Scala WA (2004) Oral manifestations related to papillomavirus (HPV). Rev Bras Otorrinolaringol 70:546–550. https://doi.org/10.1590/S0034-72992004000400017
Venceslau EM, Bezerra MM, Lopes ACM, Souza EV, Onofre ASC, Melo CM et al (2014) HPV detection using primers MY09/MY11 and GP5+/GP6+ in patients with cytologic and/or colposcopic changes. J Bras Patol Med Lab 50:280–285. https://doi.org/10.5935/1676-2444.20140028
Andrade T, Santiago L, Amari E, Fischer B (2011) ‘What a pity!’ – exploring the use of ‘pitilho’ as harm reduction among crack users in Salvador, Brazil. Drugs: Educ Prev Policy 18:382–386. https://doi.org/10.3109/09687637.2010.506898
Santos Cruz M, Andrade T, Bastos FI, Leal E, Bertoni N, Villar LM, et al (2013) Key drug use, health and socio-economic characteristics of young crack users in two Brazilian cities. Int J Drug Policy 24:432–438. https://doi.org/10.1016/j.drugpo.2013.03.012
Criscuolo M, Belardinelli P, Morelatto R, Mosmann J, Venezuela R, Kiguen A et al (2018) Prevalence of oral human papillomavirus (HPV) in the adult population of Córdoba, Argentina. Transl Res Oral Oncol. https://doi.org/10.1177/2057178X18757334
Gonzalez-Losa MR, Barrera ES, Herrera-Pech V, Conde-Ferráez L, Puerto-Solís M, Ayora-Talavera G (2015) Epidemiology of oral HPV in the oral mucosa in women without signs of oral disease from Yucatan, Mexico. Braz J Microbiol 46:301–306. https://doi.org/10.1590/S1517-838246120130976
Lupato V, Holzinger D, Höfler D, Menegaldo A, Rossi PG, Del Mistro A et al (2017) Prevalence and determinants of oral human papillomavirus infection in 500 young adults from Italy. PLoS One 12:e0170091. https://doi.org/10.1371/journal.pone.0170091
Antonsson A, Cornford M, Perry S, Davis M, Dunne MP, Whiteman DC (2014) Prevalence and risk factors for oral HPV infection in young Australians. PLoS One 9:e91761. https://doi.org/10.1371/journal.pone.0091761
Anaya-Saavedra G, Ramírez-Amador V, Irigoyen-Camacho ME, García-Cuellar CM, Guido-Jiménez M, Méndez-Martínez R et al (2008) High association of human papillomavirus infection with oral cancer: a case-control study. Arch Med Res 39:189–197. https://doi.org/10.1016/j.arcmed.2007.08.003
Tristão W, Ribeiro RM, Oliveira CA, Betiol JC, Bettini JS (2012) Epidemiological study of HPV in oral mucosa through PCR. Braz J Otorhinolaryngol 78:66–70
da Silva LN, França DDS, Del-Rio NHA, Carneiro MAS, Martins RMB, Guimarães RA et al (2017) Low prevalence, low immunization and low adherence to full hepatitis B vaccine scheme and high-risk behaviors among crack cocaine users in central Brazil. J Infect Public Health 10:76–83. https://doi.org/10.1016/j.jiph.2016.02.010
Castro AGN, Silva DC, Figueiroa MD (2016) Main mental disorders in crack-cocaine users treated at Psychosocial Care Centers for Alcohol and Drugs in the city of Recife, Brazil. Trends Psychiatry Psychother 38:227–233. https://doi.org/10.1590/2237-6089-2016-0002
Narvaez JC, Jansen K, Pinheiro RT, Kapczinski F, Silva RA, Pechansky F et al (2014) Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population. Compr Psychiatry 55:1369–1376. https://doi.org/10.1016/j.comppsych.2014.04.021
Fischer B, Blanken P, Da Silveira D, Gallassi A, Goldner EM, Rehm J et al (2015) Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: a comprehensive narrative overview of English-language studies. Int J Drug Policy 26:352–363. https://doi.org/10.1016/j.drugpo.2015.01.002
Krawczyk N, Filho CLV, Bastos FI (2015) The interplay between drug-use behaviors, settings, and access to care: a qualitative study exploring attitudes and experiences of crack cocaine users in Rio de Janeiro and São Paulo. Brazil. Harm Reduct J 12:24. https://doi.org/10.1186/s12954-015-0059-9
Scheinmann R, Hagan H, Lelutiu-Weinberger C, Stern R, Des Jarlais DC, Flom PL et al (2007) Non-injection drug use and Hepatitis C Virus: a systematic review. Drug Alcohol Depend 89:1–12. https://doi.org/10.1016/j.drugalcdep.2006.11.014
Schuch-Goi SB, Scherer JN, Kessler FHP, Sordi AO, Pechansky F, von Diemen L (2017) Hepatitis C: clinical and biological features related to different forms of cocaine use. Trends Psychiatry Psychother 39:285–292. https://doi.org/10.1590/2237-6089-2016-0076
The authors are grateful for the generous assistance of the facilitators who collaborated with the recruitment of the PWUCC in the study sites. LFAM, GCSO, and ABOF acknowledge research support from Universidade Federal do Pará, Brazil. BF acknowledges research support from the Hugh Green Chair in Addiction Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand, and from the Chair in Addiction, Department of Psychiatry, University of Toronto, Canada.
Ministério da Saúde/Secretaria de Vigilância em Saúde (MS/SVS) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ) provided financial resources for the purchase of reagents and commercial kits used in this study.
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the Committee for Ethics in Research of the Núcleo de Medicina Tropical of the UFPA in Belém (PA), Brazil (CAAE: 37536314.4.0000.5172).
All participants were included in the study after providing informed and written consent. They received results of laboratory tests, and participants infected with HPV were advised and directed for treatment in the public health network.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Rodrigues, M.S.A., Nascimento, R.S., Fonseca, R.R.S. et al. Oral HPV among people who use crack-cocaine: prevalence, genotypes, risk factors, and key interventions in a remote Northern Brazilian region. Clin Oral Invest (2020). https://doi.org/10.1007/s00784-020-03698-3
- Oral HPV
- Oncogenic viruses