Oral HPV among people who use crack-cocaine: prevalence, genotypes, risk factors, and key interventions in a remote Northern Brazilian region



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.

Clinical relevance

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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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.

Author information




All authors contributed to the research development. Study Design: ABOF. Conceptualization: MSAR, EK, BF, and ABOF. Data collection and biological samples: MSAR, RSN, RRSF, GCSO, and ABOF. Laboratory procedures: MSAR, RSN, GCSO, LFAM, and ABOF. Data analysis: MSAR, EK, BF, and ABOF. Writing and original draft: MSAR, EK, BF, and ABOF. Review and editing: RSN, RRSF, GCSO, and LFAM. Project administration: RRSF, LFAM, GCSO, and ABOF. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Aldemir B. Oliveira-Filho.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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).

Informed consent

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.

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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 25, 759–767 (2021). https://doi.org/10.1007/s00784-020-03698-3

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  • Oral HPV
  • Crack-cocaine
  • Oncogenic viruses
  • Epidemiology
  • Interventions
  • Brazil