title: Human papillomavirus seropositivity and subsequent risk of HIV acquisition in rural South African women.
abstract: OBJECTIVE
  This study aimed to provide a population-based estimate of human papillomavirus (HPV) seropositivity for women in a rural African context and to evaluate the impact of HPV serostatus on subsequent acquisition of HIV outside a clinical setting.
  
  
  METHODS
  A random sample of women participating in a longitudinal, population-based HIV survey combined with a case-control study.
  
  
  METHODS
  Blood samples of women participating in a single round of population-based HIV surveillance (N = 1049) in a rural South African population were used to measure vaccine-preventable HPV seropositivity (types 6, 11, 16, and 18) in the general population in 2010. Using results from the repeat HIV surveys, a case-control analysis was then performed comparing HPV sero-status in samples taken from HIV sero-converting women (prior to infection with HIV) against samples from HIV-uninfected, sexually-active controls matched 1:1 according to 5-year age band (377:377). Unconditional multivariable logistic regression with multiple imputations was used to control for sociodemographic and behavioral variables associated with HIV acquisition.
  
  
  RESULTS
  Human papillomavirus seropositivity in the population-based sample of women was 20.8% (95% confidence interval [CI], 18.3-23.4), and HIV prevalence was 27.6% (95% CI, 24.9-30.4). In the case-control analysis, allowing for variables known to be associated with HIV incidence, HPV seropositivity was associated with nearly 2.5 times the odds of subsequent acquisition of HIV (adjusted odds ratio, 2.33 [95% CI, 1.61-3.39]; P < 0.001).
  
  
  CONCLUSIONS
  These results suggest that HPV vaccination before or soon after sexual debut could lower HIV infection risk. Randomized trials that quantify the impact of HPV vaccination in girls on the risk of acquiring HIV are urgently required.
authors: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa. tanserf@africacentre.ac.za
authors: Frank
authors: F
authors: Tanser
authors: Kyle G
authors: KG
authors: Jones
authors: Johannes
authors: J
authors: Viljoen
authors: John
authors: J
authors: Imrie
authors: Erofili
authors: E
authors: Grapsa
authors: Marie-Louise
authors: ML
authors: Newell
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D011159:Population Surveillance; D012424:Rural Population; D016036:Seroepidemiologic Studies; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
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