Increased risk of HIV acquisition among Kenyan men with human papillomavirus infection

Abstract

Background: Few data on the effect of human papillomavirus (HPV) infection on human immunodeficiency virus (HIV) acquisition are available.

Methods: HIV-seronegative, sexually active, 18-24-year-old Kenyan men participating in a randomized trial of male circumcision provided exfoliated penile cells from 2 anatomical sites (glans/coronal sulcus and shaft) at baseline. The GP5+/6+ polymerase chain reaction assay ascertained a wide range of HPV DNA types at the baseline visit. The risk of HIV infection was estimated using Kaplan-Meier methods and hazard ratios from proportional hazards models.

Results: Of 2168 uncircumcised men with baseline HPV data, 1089 (50%) were positive for HPV DNA. The cumulative incidence of HIV infection by 42 months was 5.8% (95% confidence interval [CI], 3.6%-7.9%) among men with HPV-positive glans/coronal sulcus specimens, versus 3.7% [95% CI, 1.8%-5.6%] among men with HPV-negative glans/coronal sulcus specimens (P = .01). Controlling for subsequent circumcision status, baseline herpes simplex virus type 2 serostatus, and sexual and sociodemographic risk factors, the hazard ratio for HIV infection among men with HPV-positive glans/coronal sulcus specimens was 1.8 (95% CI, 1.1-2.9), compared with men with HPV-negative glans/coronal sulcus specimens.

Conclusion: The results suggest an independent increased risk of HIV seroconversion among HPV-positive men. If this finding is confirmed in other studies, HPV prevention could be another tool for HIV prevention.

Figures

Figure 1

Study flow chart

Figure 2

Estimated cumulative incidence of HIV seroconversion across follow-up visits by baseline HPV positivity

Figure 3

Estimated cumulative incidence of HIV seroconversion across follow-up visits by baseline HPV positivity in glans or shaft with type 16 or 18