title: Type-specific cervico-vaginal human papillomavirus infection increases risk of HIV acquisition independent of other sexually transmitted infections.
abstract: BACKGROUND
  Sexually transmitted infections (STIs) such as herpes simplex virus (HSV)-2 are associated with an increased risk of HIV infection. Human papillomavirus (HPV) is a common STI, but little is know about its role in HIV transmission. The objective of this study was to determine whether cervico-vaginal HPV infection increases the risk of HIV acquisition in women independent of other common STIs.
  
  
  RESULTS
  This prospective cohort study followed 2040 HIV-negative Zimbabwean women (average age 27 years, range 18-49 years) for a median of 21 months. Participants were tested quarterly for 29 HPV types (with L1 PCR primers) and HIV (antibody testing on blood samples with DNA or RNA PCR confirmation). HIV incidence was 2.7 per 100 woman-years. Baseline HPV prevalence was 24.5%, and the most prevalent HPV types were 58 (5.0%), 16 (4.7%), 70 (2.4%), and 18 (2.3%). In separate regression models adjusting for baseline variables (including age, high risk partner, positive test for STIs, positive HSV-2 serology and condom use), HIV acquisition was associated with having baseline prevalent infection with HPV 58 (aHR 2.13; 95% CI 1.09-4.15) or HPV 70 (aHR 2.68; 95% CI 1.08-6.66). In separate regression models adjusting for both baseline variables and time-dependent variables (including HSV-2 status, incident STIs, new sexual partner and condom use), HIV acquisition was associated with concurrent infection with any non-oncogenic HPV type (aHR 1.70; 95% CI 1.02-2.85), any oncogenic HPV type (aHR 1.96; 95% CI 1.16-3.30), HPV 31 (aHR 4.25; 95% CI 1.81-9.97) or HPV 70 (aHR 3.30; 95% CI 1.50-7.20). Detection of any oncogenic HPV type within the previous 6 months was an independent predictor of HIV acquisition, regardless of whether HPV status at the HIV acquisition visit was included (aHR 1.95; 95% CI 1.19-3.21) or excluded (aHR 1.96; 95% CI 1.02-2.85) from the analysis.
  
  
  CONCLUSIONS
  Cervico-vaginal HPV infection was associated with an increased risk of HIV acquisition in women, and specific HPV types were implicated in this association. The observational nature of our study precludes establishment of causation between HPV infection and HIV acquisition. However, given the high prevalence of HPV infection in women, further investigation of the role of HPV in HIV transmission is warranted.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America. kmccune@cc.ucsf.edu
authors.forename: Karen K
authors.initials: KK
authors.lastname: Smith-McCune
authors.forename: Stephen
authors.initials: S
authors.lastname: Shiboski
authors.forename: Mike Z
authors.initials: MZ
authors.lastname: Chirenje
authors.forename: Tsitsi
authors.initials: T
authors.lastname: Magure
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tuveson
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ma
authors.forename: Maria
authors.initials: M
authors.lastname: Da Costa
authors.forename: Anna-Barbara
authors.initials: AB
authors.lastname: Moscicki
authors.forename: Joel M
authors.initials: JM
authors.lastname: Palefsky
authors.forename: Rudo
authors.initials: R
authors.lastname: Makunike-Mutasa
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.forename: Ariane
authors.initials: A
authors.lastname: van der Straten
authors.forename: George F
authors.initials: GF
authors.lastname: Sawaya
mesh_terms: D002584:Cervix Uteri / Q000821:virology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology / Q000635:transmission*; D006801:Humans; D015994:Incidence; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012749:Sexually Transmitted Diseases; D014621:Vagina / Q000821:virology; D015030:Zimbabwe / Q000453:epidemiology
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