Rapid Rise in Detection of Human Papillomavirus (HPV) Infection Soon After Incident HIV Infection Among South African Women

Background. It is well established that the prevalence of human papillomavirus (HPV) infection is increased among human immunodeficiency virus (HIV)-positive individuals, but the temporal relationships between these infections are unclear. Methods. During a South African cervical cancer screening trial, 5595 women 35-65 years of age were followed up for 36 months; 577 women were HIV positive at enrollment, HIV seroconversion occurred in 123 women, and 4895 women remained HIV negative throughout. Tests for high-risk HPV DNA and cytology were performed on cervical samples, and a colposcopy/biopsy was performed at each visit. The effects of early HIV infection on the risk of HPV infection and HPV-related disease were evaluated. Results. Among seroconverters, HPV infection prevalence was 20.3% before seroconversion, 23.6% at seroconversion (P = .4), and 49.1% after seroconversion (P = .01). Seroconverters had significantly lower HPV infection prevalence than women with prevalent HIV infection before and at seroconversion (41.8% and 45.9%, respectively) but had similar HPV infection prevalence to women with prevalent HIV infection after seroconversion (49.4%). HIV seroconversion was associated with newly detected HPV infection (adjusted hazard ratio [AHR], 4.02; 95% confidence interval [CI], 2.26-7.13) and increased risk of low-grade cytological abnormalities (AHR, 2.53; 95% CI, 1.16-5.51) compared with HIV-negative women. Conclusion. Detection of HPV infection increases rapidly within the first years after HIV seroconversion, suggesting that mucosal immune dysfunction occurring at an early stage of HIV infection may influence HPV-related diseases.