4.1 Article

High-risk human papillomavirus viral load and persistence among heterosexual HIV-negative and HIV-positive men

Journal

SEXUALLY TRANSMITTED INFECTIONS
Volume 90, Issue 4, Pages 337-343

Publisher

BMJ PUBLISHING GROUP
DOI: 10.1136/sextrans-2013-051230

Keywords

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Funding

  1. National Institutes of Health [UO1AI51171]
  2. Bill and Melinda Gates Foundation [22006.02]
  3. National Institute of Allergy and Infectious Diseases (NIAID), NIH [U01-AI-068613, 3U01-AI075115-03S1, 1K23AI093152-01A1, R01AI087409-01A1]
  4. NIH [1K23AI093152-01A1]
  5. Doris Duke Charitable Foundation Clinician Scientist Development Award [22006.02]

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SObjectives High-risk human papillomavirus (HR-HPV) viral load is associated with HR-HPV transmission and HR-HPV persistence in women. It is unknown whether HR-HPV viral load is associated with persistence in HIV-negative or HIV-positive men. Methods HR-HPV viral load and persistence were evaluated among 703 HIV-negative and 233 HIV-positive heterosexual men who participated in a male circumcision trial in Rakai, Uganda. Penile swabs were tested at baseline and 6, 12 and 24 months for HR-HPV using the Roche HPV Linear Array, which provides a semiquantitative measure of HPV shedding by hybridisation band intensity (graded: 1-4). Prevalence risk ratios (PRR) were used to estimate the association between HR-HPV viral load and persistent detection of HR-HPV. Results HR-HPV genotypes with high viral load (grade: 3-4) at baseline were more likely to persist than HR-HPV genotypes with low viral load (grade: 1-2) among HIV-negative men (month 6: adjPRR=1.83, 95% CI 1.32 to 2.52; month 12: adjPRR=2.01, 95% CI 1.42 to 3.11), and HIV-positive men (month 6: adjPRR=1.33, 95% CI 1.06 to 1.67; month 12: adjPRR=1.73, 95% CI 1.18 to 2.54). Long-term persistence of HR-HPV was more frequent among HIV-positive men compared with HIV-negative men (month 24: adjPRR=2.27, 95% CI 1.47 to 3.51). Persistence of newly detected HR-HPV at the 6-month and 12-month visits with high viral load were also more likely to persist to 24 months than HR-HPV with low viral load among HIV-negative men (adjPRR=1.67, 95% CI 0.88 to 3.16). Conclusions HR-HPV genotypes with high viral load are more likely to persist among HIV-negative and HIV-positive men, though persistence was more common among HIV-positive men overall. The results may explain the association between high HR-HPV viral load and HR-HPV transmission.

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