Factors associated with oral HPV infection and clearance in people living with HIV and populations at increased risk of HIV acquisition: a systematic review and meta-analysis

Background Oral human papillomavirus (HPV) infection precedes most HPV-related oropharyngeal cancers, but determinants of oral HPV prevalence and incidence in people living with HIV (PLWH) and populations at increased risk of HIV acquisition remain unclear. Methods PubMed, Embase, and the Cochrane Library were searched through July 10, 2026, for observational studies of laboratory-confirmed oral HPV prevalence, incidence, or clearance in adults with or at risk for HIV. Adjusted estimates were pooled by random-effects meta-analysis and assessed with GRADE. Results Twenty-seven studies with a cumulative reported sample size of 13,625 participants were included, of which 25 contributed to the meta-analysis. For oral HPV prevalence, smoking (n = 8; OR, 2.11; 95% CI, 1.58–2.83), HIV infection (n = 6; OR, 2.44; 95% CI, 1.69–3.52), and lower CD4 count (n = 8; OR, 3.02; 95% CI, 2.10–4.35) were significantly associated with higher odds, whereas alcohol, recent oral-sex partners, and HIV viral load were not. For oral HPV incidence, more recent oral-sex partners (n = 3; HR, 1.88; 95% CI, 1.41–2.49), more lifetime oral-sex partners (n = 3; HR, 2.19; 95% CI, 1.03–4.68), HIV infection (n = 2; HR, 1.90; 95% CI, 1.20–3.02), lower CD4 count (n = 4; HR, 1.85; 95% CI, 1.43–2.40), and higher HIV viral load (n = 2; HR, 2.51; 95% CI, 1.28–4.93) were significantly associated with increased incidence, whereas smoking and alcohol were not. HIV infection showed a borderline association with reduced clearance (n = 3; HR, 0.43; 95% CI, 0.19–1.00). Certainty of evidence ranged from low to very low. Conclusions Smoking was associated with oral HPV prevalence, whereas greater oral-sex exposure and higher HIV viral load were more clearly associated with incidence. HIV infection and lower CD4 counts were associated with both outcomes, while evidence for clearance remained inconclusive. Further prospective studies are needed.