Abstract A121: Population-level prevalence and risk of oral HPV infection with or without HPV vaccination

Abstract Introduction: Persistent oral human papillomavirus (HPV) is the precursor for HPV-associated oropharyngeal cancer, which now surpasses cervical cancer as the most common HPV-related malignancy in the U.S. While the HPV vaccine has been available since 2006, the FDA did not expand its indications to include oropharyngeal cancer prevention until 2020. Although the vaccine protects against oncogenic strains, disparities in uptake and HPV-related cancer incidence persists across racial and ethnic groups. We aimed to describe population-level oral HPV prevalence by race/ethnicity, HPV vaccination status, and HIV status. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2009-2016 among adults aged 18-64 years (n=9,940). Oral HPV was detected via self-collected oral rinse specimens. HIV status was laboratory-confirmed; HPV vaccination, smoking, and sexual behavior were self-reported. Survey-weighted Poisson regression estimated oral HPV prevalence by demographics. Among vaccine-eligible adults aged 18–26 (n=2,141), survey-weighted logistic regression estimated odds ratios (ORs) for oral HPV by vaccination status, adjusting for HIV, gender, race/ethnicity, smoking, and number of lifetime oral sex partners. Results: Overall, oral HPV among U.S. adults aged 18–64 years was 6.3% (95% CI: 5.6–7.1%). Among those aged 18–26, prevalence was 5.3% (95% CI: 4.1–6.4%); 27–45, 5.9% (95% CI: 5.1–6.6%); and 45-64, 7.4% (95% CI: 6.1-8.6%). Compared to Non-Hispanic White adults, Non-Hispanic Black adults had significantly higher oral HPV prevalence (aPR: 1.42, 95% CI: 1.18–1.70) and those identifying as Other/Multi-Racial had lower prevalence (aPR: 0.75, 95% CI: 0.57–0.97). Adults aged 45–64 had higher prevalence compared to those aged 18–26 (aPR: 1.42, 95% CI: 1.11–1.82). Among vaccine-eligible adults (18–26), oral HPV prevalence increased by 28.9% from 2009–2010 to 2011–2012 and 12.8% to 2013–2014. However, from 2013–2014 to 2015–2016, there was a 29.2% decrease in prevalence. In multivariable logistic regression, odds of oral HPV were significantly higher among males (aOR: 1.71, 95% CI: 1.14–2.56), Non-Hispanic Black adults (aOR: 1.87, 95% CI: 1.20–2.92), individuals with a lifetime history of smoking 100 or more cigarettes (aOR: 2.16, 95% CI: 1.42–3.29), and those reporting 2–5 (aOR: 1.91, 95% CI: 1.04–3.50), 6-15 (aOR: 2.71, 95% CI: 1.32–5.59), or 16 or more (aOR: 5.48, 95% CI: 1.96–15.28) lifetime oral sex partners. Higher odds were also observed among unvaccinated (aOR: 1.14, 95% CI: 0.69–1.88) and HIV-positive individuals (aOR: 5.85, 95% CI: 0.20–169.7), although these associations were not statistically significant. Conclusions: Despite rising HPV vaccine uptake among U.S. young adults, disparities in vaccination coverage and oral HPV prevalence persist. Temporal trends indicate improvements in vaccination coverage, but behavioral and sociodemographic factors continue to drive oral HPV disparities. Targeted prevention strategies are needed to reduce the burden of oral HPV and prevent HPV-associated cancers. Citation Format: Morgan C. Byrd, Osayamen Atekha, Alexander Hunter, Rebecca Zasloff, Rong Jiang, Melissa C. White, Tammara L. Watts, Nosayaba Osazuwa-Peters. Population-level prevalence and risk of oral HPV infection with or without HPV vaccination abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A121.