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Risk of HIV acquisition among men with and without human papillomavirus infection in Kisumu, Kenya
Presented by Jennifer S. Smith (United States).
J.S. Smith1, S. Moses2, M. Hudgens1, C.B. Parker3, K. Agot4, I. Maclean2, J.O. Ndinya-Achola5, P.J.F. Snijders6, C.J.L.M. Meijer6, R.C. Bailey7
1University of North Carolina, Chapel Hill, United States, 2University of Manitoba, Winnipeg, Canada, 3Research Triangle Institute, Research Triangle Park, United States, 4UNIM Project, Kisumu, Kenya, 5University of Nairobi, Nairobi, Kenya, 6VU University Medical Center, Amsterdam, Netherlands, 7University of Illinois at Chicago, Chicago, United States
Background: Although several sexually transmitted infections (STIs) have been associated with an increased risk of HIV infection, there are few data concerning the potential effect of human papillomavirus (HPV) infection on HIV acquisition.
Methods: HIV-seronegative, sexually active 18-24 year-old men within a randomized trial of male circumcision provided penile exfoliated cell specimens from two anatomical sites (the shaft, and glans/coronal sulcus) at the baseline study visit. Specimens were tested with the GP5+/6+ PCR assay to detect a wide-range of HPV DNA types. HIV incidence [95% confidence interval (CI)] was calculated using Kaplan-Meier methods, and relative risk (RR) [95% CI] was estimated from proportional hazards models.
Results: Among 2,168 men with data on baseline HPV classified strictly as circumcised or uncircumcised over follow-up, 1,089 (50%) were HPV DNA positive at baseline. 754 (35%) were high-risk HPV positive and 335 (15%) were low-risk positive. In 1,101 uncircumcised men, the 42-month HIV incidence was 9.5 [4.7, 14.1] in high-risk baseline HPV positive men vs 8.1 [2.9, 13.0] in low-risk HPV positive men vs 4.9 [2.3, 7.3] in HPV-negative men (p=0.15, log-rank test). In 1,067 circumcised men, the 42-month HIV incidence was 3.0 [1.1, 4.8] in high-risk- vs 3.0 [0.0, 6.4] in low-risk- vs 2.1 [0.0, 4.5] in HPV-negative men (p=0.08, log-rank test). The RR of HIV infection in men positive for any HPV type at baseline was 1.4 [0.8-2.5](p=0.25) in uncircumcised men; and 3.2 [1.0-9.6]
(p=0.05) in circumcised men. Controlling for circumcision status, the RR of HIV infection in men positive for HPV was 1.7 [1.0, 2.9](p=0.04).
Conclusions: Preliminary analyses suggest a higher rate of HIV seroconversion among men who were HPV positive at baseline. Further analyses and additional studies are required to confirm whether HPV infection increases risk for HIV.
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