HIV Risk Among Circumcised and Uncircumcised Men With HPV
HIV Risk Among Circumcised and Uncircumcised Men With HPV
Objectives: There are very few data from men on the risk of HIV acquisition associated with penile human papillomavirus (HPV) infection and no data on the potential modifying effect of male circumcision. Therefore, this study evaluated whether HPV is independently associated with risk of HIV.
Design: A cohort study of HPV natural history nested within a randomized control trial of male circumcision to reduce HIV incidence in Kisumu, Kenya.
Methods: Prospective data from 2519 men were analyzed using 6-month discrete-time Cox models to determine if HIV acquisition was higher among circumcised or uncircumcised men with HPV compared to HPV-uninfected men.
Results: Risk of HIV acquisition was nonsignificantly increased among men with any HPV [adjusted hazard ratio (aHR) 1.72; 95% confidence interval (CI) 0.94–3.15] and high-risk HPV (aHR 1.92; 95% CI 0.96–3.87) compared to HPV-uninfected men, and estimates did not differ by circumcision status. Risk of HIV increased 27% with each additional HPV genotype infection (aHR 1.27; 95% CI 1.09–1.48). Men with persistent (aHR 3.27; 95% CI 1.59–6.72) or recently cleared (aHR 3.05; 95% CI 1.34–6.97) HPV had a higher risk of HIV acquisition than HPV-uninfected men.
Conclusions: Consistent with the findings in women, HPV infection, clearance, and persistence were associated with an increased risk of HIV acquisition in men. Given the high prevalence of HPV in populations at risk of HIV, consideration of HPV in future HIV-prevention studies and investigation into mechanisms through which HPV might facilitate HIV acquisition are needed.
Human papillomavirus (HPV) is one of the most prevalent sexually transmitted infections (STIs) worldwide, and the cause of anogenital cancers and warts in both men and women. Recent data among HIV-negative women have shown that cervical HPV infection increases the risk of HIV acquisition. In fact, prospective studies have shown that women who recently cleared an HPV infection had the highest risk of HIV acquisition compared to those with no HPV or noncleared HPV infections.
In a previous analysis, limited to examination of only prevalent HPV at study baseline in uncircumcised men, we found HPV was associated with an increased risk of HIV infection over the course of 2 years, consistent with the findings from a very limited number of longitudinal studies in men. However, given the known impact of male circumcision on acquisition and clearance of HPV and rate of HIV, it is important to examine the risk of HIV acquisition associated with recent penile HPV infection and clearance in both circumcised and uncircumcised men. Thus, here we build on our previous findings from the randomized control trial (RCT) of male circumcision in Kisumu, Kenya, to determine if young men with current, persistent, or recently cleared HPV infections are at a higher risk for HIV acquisition as compared to men without HPV infection, and to examine the potential modifying effect of circumcision.
Abstract and Introduction
Abstract
Objectives: There are very few data from men on the risk of HIV acquisition associated with penile human papillomavirus (HPV) infection and no data on the potential modifying effect of male circumcision. Therefore, this study evaluated whether HPV is independently associated with risk of HIV.
Design: A cohort study of HPV natural history nested within a randomized control trial of male circumcision to reduce HIV incidence in Kisumu, Kenya.
Methods: Prospective data from 2519 men were analyzed using 6-month discrete-time Cox models to determine if HIV acquisition was higher among circumcised or uncircumcised men with HPV compared to HPV-uninfected men.
Results: Risk of HIV acquisition was nonsignificantly increased among men with any HPV [adjusted hazard ratio (aHR) 1.72; 95% confidence interval (CI) 0.94–3.15] and high-risk HPV (aHR 1.92; 95% CI 0.96–3.87) compared to HPV-uninfected men, and estimates did not differ by circumcision status. Risk of HIV increased 27% with each additional HPV genotype infection (aHR 1.27; 95% CI 1.09–1.48). Men with persistent (aHR 3.27; 95% CI 1.59–6.72) or recently cleared (aHR 3.05; 95% CI 1.34–6.97) HPV had a higher risk of HIV acquisition than HPV-uninfected men.
Conclusions: Consistent with the findings in women, HPV infection, clearance, and persistence were associated with an increased risk of HIV acquisition in men. Given the high prevalence of HPV in populations at risk of HIV, consideration of HPV in future HIV-prevention studies and investigation into mechanisms through which HPV might facilitate HIV acquisition are needed.
Introduction
Human papillomavirus (HPV) is one of the most prevalent sexually transmitted infections (STIs) worldwide, and the cause of anogenital cancers and warts in both men and women. Recent data among HIV-negative women have shown that cervical HPV infection increases the risk of HIV acquisition. In fact, prospective studies have shown that women who recently cleared an HPV infection had the highest risk of HIV acquisition compared to those with no HPV or noncleared HPV infections.
In a previous analysis, limited to examination of only prevalent HPV at study baseline in uncircumcised men, we found HPV was associated with an increased risk of HIV infection over the course of 2 years, consistent with the findings from a very limited number of longitudinal studies in men. However, given the known impact of male circumcision on acquisition and clearance of HPV and rate of HIV, it is important to examine the risk of HIV acquisition associated with recent penile HPV infection and clearance in both circumcised and uncircumcised men. Thus, here we build on our previous findings from the randomized control trial (RCT) of male circumcision in Kisumu, Kenya, to determine if young men with current, persistent, or recently cleared HPV infections are at a higher risk for HIV acquisition as compared to men without HPV infection, and to examine the potential modifying effect of circumcision.