Sexually transmitted infections

Sexually transmitted infections

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

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

This is the third study to report associations between human papillomavirus infection in men and risk of acquiring HIV infection. A South African cross-sectional study (HIV This Week Issue 64 Auvert) found urethral HPV associated with HIV infection in heterosexual young men but it was unclear which infection came first and a Californian prospective study (HIV This Week Issue 69 Chin-Hong) among men who have sex with men did not control for herpes simplex virus-2 infection. This study among sexually active heterosexual men aged 18 to 24 years found that 50% had HPV detected at baseline and of these 91% had HPV in the glans/coronal sulcus specimens. These men were significantly more at risk of acquiring HIV, with HPV found in this location independently associated with increased risk of HIV infection. There are several hypotheses about the biological plausibility of HPV increasing susceptibility to HIV, including up-regulation of T-cells, stimulation of cytokines, and providing a portal of entry for HIV. If these findings are confirmed, preferably as rapidly as possible, vaccinating young men against HPV with the bivalent (HPV-16, -18) or quadrivalent (HPV-16, -18, -6, and -11) vaccines could prove an important addition to the HIV prevention toolbox.