International AIDS Society

HPV Prevalence 61% to 91% in Rakai Men, Depending on HIV Status

Author: Mark Mascolini

14 March 2013

Heterosexual men enrolled in a circumcision trial in Rakai, Uganda had high rates of infection with human papillomavirus (HPV), which can cause anal, penile, cervical, and other cancers. Compared with HIV-negative men, HIV-positive men had an 80% higher risk of infection with a high-risk HPV type, that is, a type associated with higher cancer risk.

Africa has high rates of penile and cervical cancers, but rates and risk factors for high-risk HPV infection remain largely unknown. To learn more about HPV in heterosexual men, researchers who ran the Rakai circumcision trial conducted this study in 1578 uncircumcised men 15 to 49 years old who enrolled in the trial.

Prevalence of any HPV type stood at 90.7% among HIV-positive men and 60.9% among HIV-negative men. HIV-positive men had almost a 50% higher risk of HPV infection (prevalence rate ratio [PRR] 1.49, 95% confidence interval [CI] 1.40 to 1.58). HIV-positive men had almost a 6 times higher risk of infection with three or more high-risk HPV types (PRR 5.76, 95% CI 4.27 to 7.79)

Among HIV-negative men, infection with a high-risk HPV type was associated with self-reported genital warts (adjusted PRR [aPRR] 1.57, 95% CI 1.07 to 2.31). High-risk sexual behaviors were not associated with increased high-risk HPV prevalence in HIV-positive men.

Among all men, having no sex partners in the past year halved the risk of high-risk HPV infection (aPRR 0.47, 95% CI 0.23 to 0.94). Among all men, three factors raised the risk of infection with a high-risk HPV type:

• HIV infection: aPRR 1.80, 95% CI 1.60 to 2.02
• More than 10 lifetime sex partners: aPRR 1.30, 95% CI 1.01 to 1.66
• Consistent condom use: aPRR 1.31, 95% CI 1.08 to 1.60

The Rakai team concludes that “the burden of high-risk HPV infection is high among heterosexual men in sub-Saharan Africa and most pronounced among the HIV-infected individuals.”

Source: Aaron A.R. Tobian, Mary K. Grabowski, Godfrey Kigozi, Patti E. Gravitt, Kevin P. Eaton, David Serwadda, Fred Nalugoda, Maria J. Wawer, Thomas C. Quinn, Ronald H. Gray. High-risk human papillomavirus prevalence is associated with HIV infection among heterosexual men in Rakai, Uganda. Sexually Transmitted Infections. 2013; 89: 122-127.

For the study abstract

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