title: Genital Epstein Barr Virus is associated with higher prevalence and persistence of anal human papillomavirus in HIV-infected men on antiretroviral therapy.
abstract: BACKGROUND
  Epstein Barr virus (EBV) and human papillomavirus (HPV) can co-exist in pharyngeal and cervical malignancies. However, the natural history and factors associated with persistent HPV infection among HIV-infected men who have sex with men (MSM) are unclear.
  
  
  METHODS
  131 HIV-infected MSM were followed for 48 weeks and screened for multiple co-infections, including seminal EBV DNA and high risk (HR)-HPV messenger RNA (mRNA) at several sites (semen, anal, pharynx). Primary analysis tested if seminal EBV shedding was associated with increased prevalence of HR-HPV at baseline using univariate tests and multivariable logistic regression. In participants with detectable anal HR-HPV at baseline, we tested if presence of seminal EBV shedding at baseline was also predictive of reduced HR-HPV clearance by log-rank test (over 48 weeks of follow-up).
  
  
  RESULTS
  Baseline prevalence of HR-HPV was: anal 44% (N = 54/121); pharynx 3.8% (N = 5/131); semen 7.1% (N = 7/98). Seminal EBV shedding was present in 28% of participants and was associated with more than double the prevalence of detectable anal HR-HPV mRNA (71.4% for EBV shedders versus 33.3% for non-shedders, p < 0.01). In participants with detectable anal HR-HPV at baseline, we found increased persistence of HR-HPV over 48 weeks of follow-up (measured as time to first negative HR-HPV test in the EBV shedding group (p < 0.01).
  
  
  CONCLUSIONS
  Seminal EBV shedding was associated with an increased risk of having detectable anal HR-HPV in a cohort of HIV-infected MSM on suppressive ART. Future studies should examine if co-infection with EBV and HR-HPV may act synergistically in pathogenesis of anal cancer in HIV-infected individuals.
authors.affiliation: University of California San Diego, 500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA. gianella@ucsd.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Gianella
authors.affiliation: North Shore-LIJ Health System, Lake Success, NY, USA. cginocch@gmail.com.|Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA. cginocch@gmail.com.
authors.forename: Christine C
authors.initials: CC
authors.lastname: Ginocchio
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA. edaar@labiomed.org.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Daar
authors.affiliation: University of Southern California Keck School of Medicine, 1300 N. Mission Road, Suite 349, Los Angeles, CA 91106, CA, USA. mdube@med.usc.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Dube
authors.affiliation: University of California San Diego, 500 Gilman Drive MC 0679, La Jolla, CA, 92093-0679, USA. shmorris@ucsd.edu.|University of California San Diego, 200 Arbor Dr., Mail code 8208, San Diego, CA, 92103, USA. shmorris@ucsd.edu.
authors.forename: Sheldon R
authors.initials: SR
authors.lastname: Morris
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D060085:Coinfection / Q000821:virology; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D010614:Pharynx / Q000821:virology; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D019380:Anti-HIV Agents
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