Prevalence of human papillomavirus (HPV) in oral mucosal lesions in Iran: A systematic review and meta-analysis

J Med Virol. 2021 Nov;93(11):6089-6099. doi: 10.1002/jmv.27161. Epub 2021 Jul 6.


The role of human papillomavirus (HPV) in the development of oral lesions is controversial. There has been no comprehensive study about HPV prevalence in Iran. This systematic review and meta-analysis were aimed at finding HPV prevalence of oral lesions and normal oral mucosa in Iran. International (PubMed, Web of Science, and Scopus) and national (Iranmedex, Irandoc, and SID) databases were searched systematically until October 2020. Studies that examined the prevalence of HPV in oral lesions by polymerase chain reaction method were included. The heterogeneity of articles was assessed with the Cochran test and I-Square statistics. The prevalence rate of HPV was calculated using a random-effect model. Of 3729 initially searched articles, 29 articles were eligible for inclusion. The overall prevalence of HPV in oral lesions was 21%. The prevalence was the highest in Rasht (50%) city. Lip lesions had the highest HPV prevalence (40%). According to the classification of lesions, the highest prevalence was of precancerous lesions (29%) and the lowest in normal mucosa (8%). Well-differentiated tumors showed a higher prevalence than poorly-differentiated ones. The highest prevalence of HPV was hairy leukoplakia (70%) and the lowest was of pyogenic granuloma (6%). Also, the prevalence was 31% in oral squamous cell carcinoma. There are differences between HPV prevalence according to the geographical area, intraoral location, type of lesion, and grading. As HPV prevalence was fairly high, further attention to vaccination and treatment for HPV in Iran, as a potential risk factor for oral precancerous and cancerous lesions is recommended.

Keywords: alpha papillomavirus; mouth; papillomaviridae; polymerase chain reaction; prevalence.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Alphapapillomavirus / genetics*
  • Alphapapillomavirus / physiology*
  • Carcinoma, Squamous Cell / virology*
  • Granuloma, Pyogenic / virology
  • Humans
  • Iran / epidemiology
  • Leukoplakia, Oral / virology
  • Mouth Mucosa / virology
  • Mouth Neoplasms / virology*
  • Papillomavirus Infections / complications*
  • Papillomavirus Infections / epidemiology
  • Precancerous Conditions / virology
  • Prevalence