title: The effect of HIV infection on anal and penile human papillomavirus incidence and clearance: a cohort study among MSM.
abstract: OBJECTIVE
  A large portion of anogenital cancers is caused by high-risk human papillomavirus (hrHPV) infections, which are especially common in HIV-infected men. We aimed to compare the incidence and clearance of anal and penile hrHPV infection between HIV-infected and HIV-negative MSM.
  
  
  METHODS
  Analyses of longitudinal data from a prospective cohort study.
  
  
  METHODS
  MSM aged 18 years or older were recruited in Amsterdam, the Netherlands, and followed-up semi-annually for 24 months. At each visit, participants completed risk-factor questionnaires. Anal and penile self-samples were tested for HPV DNA using the SPF10-PCR DEIA/LiPA25 system. Effects on incidence and clearance rates were quantified via Poisson regression, using generalized estimating equations to correct for multiple hrHPV types.
  
  
  RESULTS
  Seven hundred and fifty MSM with a median age of 40 years (interquartile 35-48) were included in the analyses, of whom 302 (40%) were HIV-infected. The incidence rates of hrHPV were significantly higher in HIV-infected compared with HIV-negative MSM [adjusted incidence rate ratio (aIRR) 1.6; 95% confidence interval (CI) 1.3-2.1 for anal and aIRR 1.4; 95%CI 1.0-2.1 for penile infection]. The clearance rate of hrHPV was significantly lower for anal [adjusted clearance rate ratio (aCRR) 0.7; 95%CI 0.6-0.9], but not for penile infection (aCRR 1.3; 95%CI 1.0-1.7). HrHPV incidence or clearance did not differ significantly by nadir CD4 cell count.
  
  
  CONCLUSIONS
  Increased anal and penile hrHPV incidence rates and decreased anal hrHPV clearance rates were found in HIV-infected compared with HIV-negative MSM, after adjusting for sexual behavior. Our findings suggest an independent effect of HIV infection on anal hrHPV infections.
authors.affiliation: aDepartment of Infectious Diseases, Public Health Service AmsterdambDepartment of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA)cDepartment of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, AmsterdamdCentre for Infectious Disease Control, National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM), BilthoveneJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, UtrechtfDepartment of Pathology, Vrije Universiteit-University Medical Center (VUmc)gDepartment of Dermatology, Academic Medical CenterhDepartment of Internal Medicine, Jan van Goyen Medical Center, Amsterdam, The Netherlands.*Present address: DC Klinieken Oud Zuid, Amsterdam, The Netherlands.
authors.forename: Sofie H
authors.initials: SH
authors.lastname: Mooij
authors.forename: Daniëla K
authors.initials: DK
authors.lastname: van Santen
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Geskus
authors.forename: Marianne A B
authors.initials: MA
authors.lastname: van der Sande
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: Ineke G
authors.initials: IG
authors.lastname: Stolte
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: Arjen G C L
authors.initials: AG
authors.lastname: Speksnijder
authors.forename: Henry J C
authors.initials: HJ
authors.lastname: de Vries
authors.forename: Audrey J
authors.initials: AJ
authors.lastname: King
authors.forename: Arne
authors.initials: A
authors.lastname: van Eeden
authors.forename: Maarten F Schim
authors.initials: MF
authors.lastname: van der Loeff
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000821:virology; D004279:DNA, Viral / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology*; D010413:Penis / Q000821:virology; D011446:Prospective Studies
chemical_list: D004279:DNA, Viral