title: Risk of HIV acquisition among circumcised and uncircumcised young men with penile human papillomavirus infection.
abstract: OBJECTIVE
  There are very few data from men on the risk of HIV acquisition associated with penile human papillomavirus (HPV) infection and no data on the potential modifying effect of male circumcision. Therefore, this study evaluated whether HPV is independently associated with risk of HIV.
  
  
  METHODS
  A cohort study of HPV natural history nested within a randomized control trial of male circumcision to reduce HIV incidence in Kisumu, Kenya.
  
  
  METHODS
  Prospective data from 2519 men were analyzed using 6-month discrete-time Cox models to determine if HIV acquisition was higher among circumcised or uncircumcised men with HPV compared to HPV-uninfected men.
  
  
  RESULTS
  Risk of HIV acquisition was nonsignificantly increased among men with any HPV [adjusted hazard ratio (aHR) 1.72; 95% confidence interval (CI) 0.94-3.15] and high-risk HPV (aHR 1.92; 95% CI 0.96-3.87) compared to HPV-uninfected men, and estimates did not differ by circumcision status. Risk of HIV increased 27% with each additional HPV genotype infection (aHR 1.27; 95% CI 1.09-1.48). Men with persistent (aHR 3.27; 95% CI 1.59-6.72) or recently cleared (aHR 3.05; 95% CI 1.34-6.97) HPV had a higher risk of HIV acquisition than HPV-uninfected men.
  
  
  CONCLUSIONS
  Consistent with the findings in women, HPV infection, clearance, and persistence were associated with an increased risk of HIV acquisition in men. Given the high prevalence of HPV in populations at risk of HIV, consideration of HPV in future HIV-prevention studies and investigation into mechanisms through which HPV might facilitate HIV acquisition are needed.
authors.affiliation: aDepartment of Epidemiology, John Hopkins Bloomberg School of Public Health bDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland cDepartment of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA dDepartments of Community Health Sciences, Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada eImpact Research and Development Organization, Kisumu, Kenya fDepartment of Epidemiology, Brown University, Providence, Rhode Island, USA gUniversities of Nairobi, Illinois and Manitoba (UNIM), Kisumu, Kenya hDepartment of Pathology, VU University Medical Center, Amsterdam, the Netherlands iDivision of Epidemiology, University of Illinois at Chicago, Illinois jDepartment of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Rositch
authors.forename: Lu
authors.initials: L
authors.lastname: Mao
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hudgens
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Backes
authors.forename: Edith
authors.initials: E
authors.lastname: Nyagaya
authors.forename: Peter J F
authors.initials: PJ
authors.lastname: Snijders
authors.forename: Chris J L M
authors.initials: CJ
authors.lastname: Meijer
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D002944:Circumcision, Male; D015331:Cohort Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D015994:Incidence; D007630:Kenya; D008297:Male; D030361:Papillomavirus Infections / Q000150:complications*; D010409:Penile Diseases / Q000150:complications*; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult