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High-risk human papillomavirus prevalence is associated with HIV infection among heterosexual men in Rakai, Uganda
  1. Aaron A R Tobian1,2,
  2. Mary K Grabowski2,
  3. Godfrey Kigozi3,
  4. Patti E Gravitt2,4,
  5. Kevin P Eaton5,
  6. David Serwadda3,6,
  7. Fred Nalugoda3,
  8. Maria J Wawer2,3,
  9. Thomas C Quinn5,7,
  10. Ronald H Gray2,3
  1. 1Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  3. 3Rakai Health Sciences Program, Entebbe, Uganda
  4. 4Perdana University Graduate School of Medicine, Serdang, Malaysia
  5. 5Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  6. 6School of Public Health, Makerere University, Kampala, Uganda
  7. 7Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
  1. Correspondence to Dr Aaron Tobian, Department of Pathology, Johns Hopkins University, Carnegie 667, 600 N. Wolfe Street, Baltimore, MD 21287, USA; atobian1{at}


Objectives Human papillomavirus (HPV) infection causes genital warts, penile cancer and cervical cancer. Africa has one of the highest rates of penile and cervical cancers, but there are little data on high-risk human papillomavirus (HR-HPV) prevalence in heterosexual men. Knowledge of HR-HPV prevalence, risk factors and genotype distribution among heterosexual men is important to establish risk-reduction prevention strategies.

Methods 1578 uncircumcised men aged 15–49 years who enrolled in male circumcision trials in Rakai, Uganda, were evaluated for HR-HPV from swabs of the coronal sulcus/glans using Roche HPV Linear Array. Adjusted prevalence risk ratios (adjPRRs) were estimated using modified Poisson multivariable regression.

Results HPV prevalence (either high risk or low risk) was 90.7% (382/421) among HIV-positive men and 60.9% (596/978) among HIV-negative men (PRR 1.49, 95% CI 1.40 to 1.58). HIV-positive men had a significantly higher risk of infection with three or more HR-HPV genotypes (PRR=5.76, 95% CI 4.27 to 7.79). Among HIV-positive men, high-risk sexual behaviours were not associated with increased HR-HPV prevalence. Among HIV-negative men, HR-HPV prevalence was associated with self-reported genital warts (adjPRR 1.57, 95% CI 1.07 to 2.31). Among all men (both HIV negative and HIV positive), HR-HPV prevalence was associated with more than 10 lifetime sexual partners (adjPRR 1.30, 95% CI 1.01 to 1.66), consistent condom use (adjPRR 1.31, 95% CI 1.08 to 1.60) and HIV infection (adjPRR 1.80, 95% CI 1.60 to 2.02). HR-HPV prevalence was lower among men who reported no sexual partners during the past year (adjPRR 0.47, 95% CI 0.23 to 0.94).

Conclusion The burden of HR-HPV infection is high among heterosexual men in sub-Saharan Africa and most pronounced among the HIV-infected individuals.

  • Human papillomavirus (HPV)
  • male circumcision
  • HIV
  • Uganda
  • Africa
  • penile cancer
  • cervical cancer
  • sexually transmitted infections
  • self-sampling
  • cervix
  • epidemiology
  • AIDS
  • epidemiology (general)
  • epidemiology (clinical)

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  • Disclosures PG received research funding from Roche Molecular Diagnostics who manufacture the HPV genotyping test used in this study.

  • Funding The trial was funded by the Bill and Melinda Gates Foundation (#22006.02) and the National Institutes of Health (#U1AI51171). The Fogarty International Center (#5D43TW001508 and #2D43TW000010-19-AITRP) contributed to training. National Institute of Allergy and Infectious Diseases (NIAID), NIH grants U01-AI-068613 and 3U01-AI075115-03S1 and the NIAID Intramural Program provided laboratory support. AART was supported by the NIH 1K23AI093152-01A1, Doris Duke Charitable Foundation Clinician Scientist Development Award (#22006.02) and the Johns Hopkins University Clinician Scientist Award.

  • Competing interests None.

  • Ethics approval The trials were approved by the HIV Subcommittee of the Ugandan National Council for Research and Technology (Kampala, Uganda), and by three institutional review boards: the Science and Ethics Committee of the Uganda Virus Research Institute (Entebbe, Uganda), the Johns Hopkins University Bloomberg School of Public Health IRB (Baltimore, Maryland, USA) and the Western Institutional Review Board (Olympia, Washington, USA).

  • Provenance and peer review Not commissioned; externally peer reviewed.