Incidence, persistence, clearance and correlates of genital human papillomavirus infection and anogenital warts in a cohort of men living with HIV South Africa
OBJECTIVE: To estimate the incidence; persistence and correlates of HPV infection and anogenital warts (AGW) among men living with HIV (MLHIV).
METHODS: Overall, 304 MLHIV >/=18 years were enrolled and attended follow-up visits at 6, 12 and 18 months. Clinicians examined for AGW, collected blood, and penile swabs for HPV testing (Roche Linear Array) at each visit. Time to AGW incidence or clearance was estimated by Kaplan-Meier method. Factors associated with persistent HPV infection and AGW clearance were evaluated with generalized estimating equations and Cox regression respectively.
RESULTS: Mean age of participants was 38 (Standard Deviation, 8) years; 25% reported >1 sexual partner in the past 3 months. Most (65%) participants were on antiretroviral treatment (ART) with a median CD4+ count of 445 cells/muL (IQR, 328-567). Prevalence of HPV infection and AGW at enrolment were 79% (224/283) and 12% (36/304) respectively. 259 men were followed for a median (IQR) 1.4 years (0.5-1.7). Incidence of any-genital HPV infection was 2.9 (95% CI: 1.5-5.5) per 100 person-years. Persistence of any-genital HPV infection was 35% (68/192) and was higher among MLHIV with low CD4+ count (adjusted Odds Ratio=3.54; 95%CI: 2.07-6.05). Incidence of AGW was 1.4 per 100 person-years. MLHIV with high CD4+ count were more likely to clear AGW than those with low CD4 count (adjusted Hazard Ratio=3.69; 95%CI: 1.44-9.47). No associations were observed between persistent genital HPV infection, AGW clearance with enrolment ART status or duration.
CONCLUSION: HIV-positive men have a high burden of genital HPV infection and AGW. ART and HPV vaccine could reduce this burden. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.