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Is genital human papillomavirus infection associated with HIV incidence?
Presented by Bertran Auvert (France).
B. Auvert1,2, P. Lissouba1, E. Cutler3, K. Zarca1, A. Puren3, D. Taljaard4
1INSERM U687, Villejuif, France, 2University of Versailles, Versailles, France, 3NICD, Johannesburg, South Africa, 4Progressus, Johannesburg, South Africa
Background: Genital Human papillomavirus (HPV) is one of the most common sexually transmitted infections and a significant cause of morbidity and mortality in the world. Several African studies have demonstrated a strong correlation between HIV and HPV infections among men and women. However, little is known about the association between HPV infection and HIV acquisition.
Methods: Urethral swabs were collected at the last follow-up visit of the male circumcision trial (ANRS-1265) conducted in Orange Farm (South Africa). HPV DNA detection and genotyping were performed by polymerase chain reaction. HPV genotypes were classified into "high-risk" (HR) and "low-risk" (LR), based on their known oncogenic potential. HIV adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) were estimated using survival analysis. HR-HPV and LR-HPV statuses, background characteristics, male circumcision status and sexual behavior were used as covariates.
Results: LR and HR HPV prevalences were 17.5% (95% CI: 15.5-20.1) and 14.3% (95% CI: 12.8-17.4), respectively. HIV incidence was not associated with LR-HPV infection (aIRR : 1.21; 95% CI: 0.38-3.9; p = 0.80). The proportion of participants who had at least two HR-HPV genotypes was 6.4% (95% CI: 4.9-7.9). For participants infected with HR-HPV, HIV aIRR was 3.81 (95% CI: 1.98-9.78; p < 0.001) compared to HR-HPV negative participants. HIV incidence significantly increased by an average factor of 1.63 (95%CI: 1.15-2.41) when the number of HR-HPV genotypes involved in multiple infections increased by one unit (adjusted-p linear trend=0.0058).
Conclusions: This study shows that HR-HPV status is a significant risk factor associated with HIV incidence among men. These findings, coupled with the immune response induced by HR-HPV which may facilitate HIV acquisition, suggest that HR-HPV infection most likely plays a key role in the HIV epidemic in Southern Africa. However, this role is currently widely underestimated.
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