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HPV increases HIV risk in African women: advancing the argument for HPV immunization

Title
HPV increases HIV risk in African women: advancing the argument for HPV immunization
Presenter
Gui Liu
Authors
G. Liu * (1), N. Mugo (2), E. Brown (3), N. Mgodi (4), Z. Chirenje (4), J. Marrazzo (5), R. Winer (6), L. Mansoor (7), T. Palanee-Phillips (8), S. Siva (9), L. Naidoo (9), N. Jeenarain (9), Z. Gaffoor (9), G. Nair (10), P. Selepe (11), C. Nakabiito (12), B. Mkhize (13), B. Gati Mirembe (12), M. Taljaard (11), J. Baeten (6), J. Balkus (1), F. Hladik (6), C. Celum (6), R. Barnabas (6).
Institutions
(1) University of Washington, Epidemiology, Seattle, United States, (2) Kenya Medical Research Institute, Nairobi, Kenya, (3) University of Washington, Biostatistics, Seattle, United States, (4) University of Zimbabwe, Harare, Zimbabwe, (5) University of Alabama, Birmingham, United States, (6) University of Washington, Seattle, United States, (7) Centre for the AIDS Programme of Research in South Africa, Durban, South Africa, (8) Wits Reproductive Health and HIV Institute, Johannesburg, South Africa, (9) South Africa Medical Research Council, Durban, South Africa, (10) Desmond Tutu HIV Centre, Cape Town, South Africa, (11) The Aurum Institute, Klerksdorp, South Africa, (12) Makerere University-John Hopkins University Research Collaboration, Kampala, Uganda, (13) University of Witwatersrand, Johannesburg, South Africa

BACKGROUND: Adolescent girls and young women (AGYW) account for 25% of incident HIV infections in sub-Saharan Africa. Human papillomavirus (HPV) infection is common among AGYW, but its role in HIV acquisition is uncertain. We evaluated the relationship between HPV and HIV acquisition using data from MTN-003, a clinical trial of chemoprophylaxis for HIV among cisgender women in sub-Saharan Africa.
METHODS: Using a nested case-control design, we matched 138 women who acquired HIV (cases) to 412 HIV-negative controls. Cervical or vaginal swabs collected at one time-point within 6 months before HIV seroconversion in cases were tested for 37 HPV types using a Luminex-based liquid bead micro array ' 14 of which are high-risk carcinogenic types and 23 low-risk types. We estimated the association between HPV and HIV using conditional logistic regressions, controlling for confounders including age, time-varying sexual behaviors, vaginal infections, and other sexually transmitted infections.
RESULTS: Mean age in the study was 24 years (+/- 4 years). Any, high-risk, and low-risk HPV was detected in 84%, 74%, and 66% of cases, and 65%, 55%, and 48% of controls. Infection with '¥2 HPV types was common in cases (67%) and controls (49%). A high proportion (60% of cases and 42% of controls) had >1 type covered by the 9-valent HPV vaccine, and 36% of cases and 22% of controls had >1 type covered by the quadrivalent vaccine. HIV risk increased 2.7-fold with any HPV (adjusted odds ratio [aOR] 2.7, 95% confidence interval [CI] 1.5-5.1) or a high-risk HPV infection (aOR 2.7, 95% CI 1.5-4.8), and 1.9-fold with a low-risk HPV infection (95% CI 1.1-3.0). Each additional HPV type detected was associated with a 20% increase in HIV risk (aOR 1.2, 95% CI 1.1-1.3). HIV acquisition was also associated with HPV types covered by the 9-valent (aOR 2.2, 95% CI 1.3-3.6) and quadrivalent vaccines (aOR 1.8, 95% CI 1.1-3.0).
CONCLUSIONS: HPV infection was associated with HIV acquisition among AGYW living in high HIV burden settings. Infection with a 9-valent HPV vaccine-targeted type is prevalent in this population. In addition to preventing HPV-associated cancers, increasing HPV vaccination coverage may reduce new HIV infections in sub-Saharan Africa.