High-risk human papillomavirus prevalence is associated with HIV infection among heterosexual men in Rakai, Uganda.
OBJECTIVE
Human papillomavirus (HPV) infection causes genital warts, penile cancer and cervical cancer. Africa has one of the highest rates of penile and cervical cancers, but there are little data on high-risk human papillomavirus (HR-HPV) prevalence in heterosexual men. Knowledge of HR-HPV prevalence, risk factors and genotype distribution among heterosexual men is important to establish risk-reduction prevention strategies.


METHODS
1578 uncircumcised men aged 15-49 years who enrolled in male circumcision trials in Rakai, Uganda, were evaluated for HR-HPV from swabs of the coronal sulcus/glans using Roche HPV Linear Array. Adjusted prevalence risk ratios (adjPRRs) were estimated using modified Poisson multivariable regression.


RESULTS
HPV prevalence (either high risk or low risk) was 90.7% (382/421) among HIV-positive men and 60.9% (596/978) among HIV-negative men (PRR 1.49, 95% CI 1.40 to 1.58). HIV-positive men had a significantly higher risk of infection with three or more HR-HPV genotypes (PRR=5.76, 95% CI 4.27 to 7.79). Among HIV-positive men, high-risk sexual behaviours were not associated with increased HR-HPV prevalence. Among HIV-negative men, HR-HPV prevalence was associated with self-reported genital warts (adjPRR 1.57, 95% CI 1.07 to 2.31). Among all men (both HIV negative and HIV positive), HR-HPV prevalence was associated with more than 10 lifetime sexual partners (adjPRR 1.30, 95% CI 1.01 to 1.66), consistent condom use (adjPRR 1.31, 95% CI 1.08 to 1.60) and HIV infection (adjPRR 1.80, 95% CI 1.60 to 2.02). HR-HPV prevalence was lower among men who reported no sexual partners during the past year (adjPRR 0.47, 95% CI 0.23 to 0.94).


CONCLUSIONS
The burden of HR-HPV infection is high among heterosexual men in sub-Saharan Africa and most pronounced among the HIV-infected individuals.
Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA. atobian1@jhmi.edu
Aaron A R
AA
Tobian
Mary K
MK
Grabowski
Godfrey
G
Kigozi
Patti E
PE
Gravitt
Kevin P
KP
Eaton
David
D
Serwadda
Fred
F
Nalugoda
Maria J
MJ
Wawer
Thomas C
TC
Quinn
Ronald H
RH
Gray
D000293:Adolescent; D000328:Adult; D060085:Coinfection / Q000453:epidemiology / Q000821:virology; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D020010:Heterosexuality; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000302:isolation & purification / Q000472:pathogenicity*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology*; D015995:Prevalence; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult