3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

HUMAN PAPILLOMAVIRUS IS ASSOCIATED WITH HIV ACQUISITION: THE EXPLORE STUDY

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuOa0403

Chin-Hong P.¹, Husnik M.², Benet D.³, Buchbinder S.⁴, Colfax G.⁴, Cranston R.⁵, Da Costa M.¹, Darragh T.¹, Judson F.⁶, Koblin B.⁷, Mayer K.⁸, Vittinghoff E.¹, Palefsky J.^1
1University of California at San Francisco, San Francisco, United States of America, ²Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, United States of America, ³Abt Associates, Inc., Cambridge, United States of America, ⁴Department of Public Health, San Francisco, United States of America, ⁵University of California at Los Angeles, Los Angeles, United States of America, ⁶Department of Public Health, Denver, United States of America, 7New York Blood Center, New York, United States of America, 8Fenway Community Health Center, Boston, United States of America

INTRODUCTION: Human papillomavirus (HPV) is a common sexually transmitted agent and can cause anal intraepithelial neoplasia (AIN). Abnormal anal cytologic changes associated with HPV infection include atypical squamous cells (ASC), low-grade squamous intraepithelial lesions (SIL) and high-grade SIL. We hypothesized that AIN can enhance susceptibility to HIV infection because of increased microvasculature, bleeding and recruitment of CD4+ and dendritic cells. We studied the association between the detection of anal HPV or abnormal anal cytology and HIV acquisition.

METHODS: This multisite prospective study recruited 1409 HIV-negative sexually active men who have sex with men. During each twice-yearly follow-up visit, we assessed anal HPV infection status by polymerase chain reaction, obtained anal cytology and behavioral data, and conducted HIV antibody testing.

RESULTS: Of 1409 participants followed for up to 36 months, 51 HIV-seroconverted. Of the HIV seroconverters, 81% had anal HPV, and 43% had abnormal anal cytology at the time of HIV seroconversion. The median number of HPV types in HPV-infected HIV-seroconverters was 2 (IQR, 1-3) at the time of HIV-seroconversion. In univariate analyses, there was evidence (P<0.05) for an association between anal HPV infection (HR 2.7, 95% CI 1.0-7.3) and detection of ≥3 HPV types (HR 3.7, 95% CI 1.4-10.3) in predicting HIV seroconversion, and moderate evidence (P<0.10) for ASC (HR 2.4, 95% CI 0.9-6.1). After adjustment for sexual activity, substance use and demographics, there was evidence (P<0.05) for the effect of ≥3 HPV types isolated (HR 3.3, 95% CI 1.1-9.9) and ASC (HR 2.8, 95% CI 1.1-7.8).

CONCLUSIONS: Anal HPV and ASC on anal cytology are independently associated with HIV acquisition. Prospective studies that incorporate high-resolution anoscopy for more sensitive visual and histologic identification of AIN are needed to extend these cytologic findings. Identification of HPV and HPV-associated lesions may improve assessment of HIV transmission risk.

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Clinical | TuOa0403 | Peter Chin-hong
1.3 528 1.3 HPV

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