Background High-risk human papillomavirus (HR-HPV) viral load is associated with transmission and persistence in women. It is unknown whether viral load is associated with HR-HPV persistence in HIV-negative or HIV-positive men.
Methods 703 HIV-negative and 233 HIV-positive heterosexual men participated in a male circumcision trial in Rakai, Uganda. Penile swabs were tested at enrollment and 6, 12 and 24 months for HR-HPV using the Roche HPV Linear Array, which provides a semi-quantitative measure of HPV shedding by hybridization band intensity (graded:1–4). Prevalence risk ratios (PRR) were used to estimate the association between HR-HPV viral load and persistent detection of type-specific HR-HPV infection.
Results At least one HR-HPV was identified in 264 HIV-negative men (37.6%, 403 genotypes total) and 164 HIV-positive men (70.4%, 399 genotypes total) at enrollment. Among HIV-negative men, younger and unmarried men were more likely to have higher viral loads. HR-HPV genotypes with high viral load (grade:3–4) at enrollment were more likely to persist than HR-HPV genotypes with low viral load (grade:1–2) among HIV-negative (month 6: adjPRR = 1.80, 95% CI: 1.31–2.47; month 12: adjPRR = 2.04, 95% CI: 1.39–3.01), and HIV-positive men (month 6: adjPRR = 1.33, 95% CI: 1.06–1.67; month 12: adjPRR = 1.70, 95% CI: 1.16–2.50). Long-term persistence of HR-HPV was more frequent among HIV-positive men compared to HIV-negative men (month 24: adjPRR = 2.24, 95% CI: 1.46–3.45), and HR-HPV infections with low viral loads were detected more frequently among HIV-positive men at all follow-up visits (6 months: PRR = 1.81, 95% CI: 1.17–2.97; 12 months: PRR = 1.43, 95% CI: 0.8–2.4; 24 months: PRR = 2.9, 95% CI: 1.53–5.53)
Conclusions HR-HPV genotypes with high viral load are more likely to persist among HIV-negative and HIV-positive men, though persistence was more common among HIV-positive men. The results may explain the association between high HR-HPV viral load and transmission to women and increased levels of HR-HPV persistence in HIV-positive men.
- viral persistence