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Systematic Review Finds HPV Doubles HIV Risk in Women and Men
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XIX International AIDS Conference, July 22-27, 2012, Washington, DC
Mark Mascolini
Human papillomavirus (HPV) infection doubles the risk of HIV acquisition in women and men, according to results of the first systematic review of this issue [1]. The six studies in women indicated that high-risk or low-risk HPV types doubled HIV acquisition risk. But the researchers raised questions about the overall quality of the studies analyzed.
HPV is the most frequent sexually transmitted infection in the United States and is highly prevalent in parts of sub-Saharan Africa. Because research indicates that HPV may be a risk factor for HIV acquisition, an international team conducted this meta-analysis of studies examining the impact of HPV on HIV risk. They searched electronic databases for relevant articles through July 2011.
To be eligible for analysis, studies had to be longitudinal or case-control studies in humans, had to identify HPV DNA by hybrid capture II or PCR, and had to determine HPV status before HIV acquisition. Bias assessment included consideration of selection bias, timing of the HPV test in relation to HIV, retention in the cohort, follow-up duration, statistical adjustment for confounding, and outcome reporting.
Starting with 1139 search results, the researchers narrowed the field to 8 studies, 5 of whose authors provided additional information. Seven studies were done in the United States and one in South Africa. Six studies focused on women, one on heterosexual men, and one on men who have sex with men (MSM).
Meta-analysis was possible only for the 6 studies involving women. This analysis indicated that infection with any HPV type (high-risk or not) doubled the risk of HIV acquisition (hazard ratio [HR] 2.06, 95% confidence interval [CI] 1.44 to 2.94). Infection with a high-risk HPV genotype also doubled the risk of HIV infection (HR 1.99, 95% CI 1.54 to 2.56), and that doubled risk persisted when the researchers eliminated one study that did not make adjustments for other HIV risk factors. Infection with a low-risk HPV type also doubled the risk of HIV acquisition (HR 2.01, 95% CI 1.27 to 3.20).
In the one study of MSM, infection with 2 or more HPV types more than tripled the risk of HIV acquisition when compared with no HPV infection (adjusted hazard ratio [aHR] 3.5, 95% CI 1.2 to 10.6). In the one study of heterosexual men, infection with any HPV type in the penile glans or coronal sulcus almost doubled the risk of HIV infection (aHR 1.8, 95% CI 1.1 to 2.9).
Because only 2 of the 8 studies analyzed had a low risk of bias in all domains considered, the researchers urged caution in interpreting these results. They called for confirmation of these findings in "well-conducted observational research . . . in high HPV/HIV settings, in order to assess whether HPV vaccination could provide another tool in the package of HIV-prevention strategies."
The investigators suggested that the impact of HPV vaccination on HIV acquisition can also be assessed by tracking HIV incidence over time in countries that implement HPV vaccination and in nested case-control studies examining HPV vaccination status in HIV-positive people compared with HIV-negative controls.
Reference
1. Houlihan CF, Larke NL, Watson-Jones D, et al. HPV infection and increased risk of HIV acquisition: a systematic review and meta-analysis. XIX International AIDS Conference. July 22-27, 2012, Washington, DC. Abstract WEPE258.
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