Anal human papillomavirus infection is associated with HIV acquisition in men who have sex with men. AIDS.

Anal human papillomavirus infection is associated with HIV acquisition in men who have sex with men. AIDS.

Human papillomavirus is a common sexually transmitted agent that causes anogenital cancer and pre-cancer lesions that have an inflammatory infiltrate, may be friable, and bleed. Chin-Hong and colleagues aimed to determine the association between anal HPV infection and HIV acquisition using a prospective cohort study design. They recruited 1409 HIV-negative men who have sex with men from a community-based setting in Boston, Denver, New York, and San Francisco. The authors used Cox proportional hazards regression modeling and assessed the independent association of HPV infection with the rate of acquisition of HIV infection. Of 1409 participants contributing 4375 person-years of follow-up, 51 HIV-seroconverted. The median number of HPV types in HPV-infected HIV-seroconverters was 2 (interquartile range 1-3) at the time of HIV seroconversion. After adjustment for sexual activity, substance use, occurrence of other sexually transmitted infections, and demographic variables, there was evidence (P = 0.002) for the effect of infection with at least two HPV types (hazard ratio 3.5, 95% confidence interval 1.2-10.6) in HIV seroconversion. The authors conclude that anal HPV infection is independently associated with HIV acquisition. Studies that incorporate high-resolution anoscopy to more accurately identify HPV-associated disease are needed to determine the relationship between HPV-associated disease and HIV seroconversion.

Editors’ note: HPV disease has long been considered to be opportunistic, taking advantage of HIV-induced immunosuppression but not increasing the risk of HIV acquisition. If, as this first study to do so suggests, anal HPV infection is independently associated with HIV acquisition, immunizing HPV-unexposed people to prevent invasive cancer and anogenital warts may have the potential to reduce the risk of HIV acquisition through anal sex.