title: Human papillomavirus incidence and clearance among HIV-positive and HIV-negative men in sub-Saharan Africa.
abstract: OBJECTIVE
  High-risk human papillomavirus (HR-HPV) infection is the most common sexually transmitted infection. Penile and cervical cancer rates are highest in sub-Saharan Africa. However, little is known about the impact of HIV infection on HR-HPV acquisition and clearance among heterosexual men.
  
  
  METHODS
  HR-HPV incidence and clearance were evaluated in 999 men (776 HIV-negative and 223 HIV-positive) aged 15-49 years who participated in male circumcision trials in Rakai, Uganda.
  
  
  METHODS
  Penile swabs were tested for HR-HPV by Roche HPV Linear Array. A Poisson multivariable model was used to estimate adjusted incidence rate ratios (adjIRRs) and clearance risk ratios (adjRRs).
  
  
  RESULTS
  HR-HPV incidence was 66.5/100 person-years in HIV-positive men and 32.9/100 person-years among HIV-negative men [IRR=2.02, 95% confidence interval (CI) 1.67-2.44]. Incidence was higher in the unmarried men (adjIRR=1.73, 95% CI 1.19-2.52), and decreased with age (adjIRR for men >35 years=0.64, 95% CI 0.43-0.94) and male circumcision (adjIRR=0.70, 95% CI 0.55-0.89). HR-HPV clearance was 114.7/100 person-years for HIV-positive men and 170.2/100 person-years for HIV-negative men (risk ratio=0.67, 95% CI 0.59-0.77). HR-HPV clearance in HIV-negative men increased with circumcision (adjRR=1.48, 95% CI 1.26-1.74), HSV-2 infection (adjRR=1.20, 95% CI 1.01-1.44), and symptoms of urethral discharge (adjRR=1.35, 95% CI 1.06-1.73). Clearance of HR-HPV was significantly lower for unmarried men (adjRR 0.76, 95% CI 0.59-0.98).
  
  
  CONCLUSIONS
  HR-HPV is common among heterosexual Ugandan men, particularly the HIV-infected. HIV infection increases HR-HPV acquisition and reduces HR-HPV clearance. Promotion of male circumcision and additional prevention measures, such as HPV vaccination, is critical in sub-Saharan Africa.
authors.affiliation: Department of Pathology, School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA. atobian1@jhmi.edu
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Patti E
authors.initials: PE
authors.lastname: Gravitt
authors.forename: Changchang
authors.initials: C
authors.lastname: Xiao
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Eaton
authors.forename: Xiangrong
authors.initials: X
authors.lastname: Kong
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male; D015658:HIV Infections / Q000453:epidemiology*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D020010:Heterosexuality; D006801:Humans; D015994:Incidence; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000235:genetics; D010413:Penis / Q000821:virology*; D012307:Risk Factors; D012725:Sexual Behavior; D013587:Syphilis / Q000453:epidemiology; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult