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High-risk human papillomavirus viral load and persistence among heterosexual HIV-negative and HIV-positive men
  1. Mary K Grabowski1,
  2. Ronald H Gray1,2,
  3. David Serwadda2,3,
  4. Godfrey Kigozi2,
  5. Patti E Gravitt1,4,
  6. Fred Nalugoda2,
  7. Steven J Reynolds1,2,5,6,
  8. Maria J Wawer1,2,
  9. Stephen Watya7,
  10. Thomas C Quinn2,5,6,
  11. Aaron A R Tobian2,8
  1. 1Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Rakai Health Sciences Program, Entebbe, Uganda
  3. 3School of Public Health, Makerere University, Kampala, Uganda
  4. 4Perdana University Graduate School of Medicine, Serdang, Malaysia
  5. 5Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
  6. 6Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  7. 7Department of Urology, Makerere University, Kampala, Uganda
  8. 8Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Aaron Tobian, Department of Pathology, Johns Hopkins University, Carnegie 437, 600 N. Wolfe St., Baltimore, MD 21287, USA; atobian1{at}


Objectives High-risk human papillomavirus (HR-HPV) viral load is associated with HR-HPV transmission and HR-HPV persistence in women. It is unknown whether HR-HPV viral load is associated with persistence in HIV-negative or HIV-positive men.

Methods HR-HPV viral load and persistence were evaluated among 703 HIV-negative and 233 HIV-positive heterosexual men who participated in a male circumcision trial in Rakai, Uganda. Penile swabs were tested at baseline and 6, 12 and 24 months for HR-HPV using the Roche HPV Linear Array, which provides a semiquantitative measure of HPV shedding by hybridisation band intensity (graded: 1–4). Prevalence risk ratios (PRR) were used to estimate the association between HR-HPV viral load and persistent detection of HR-HPV.

Results HR-HPV genotypes with high viral load (grade:3–4) at baseline were more likely to persist than HR-HPV genotypes with low viral load (grade: 1–2) among HIV-negative men (month 6: adjPRR=1.83, 95% CI 1.32 to 2.52; month 12: adjPRR=2.01, 95% CI 1.42 to 3.11), and HIV-positive men (month 6: adjPRR=1.33, 95% CI 1.06 to 1.67; month 12: adjPRR=1.73, 95% CI 1.18 to 2.54). Long-term persistence of HR-HPV was more frequent among HIV-positive men compared with HIV-negative men (month 24: adjPRR=2.27, 95% CI 1.47 to 3.51). Persistence of newly detected HR-HPV at the 6-month and 12-month visits with high viral load were also more likely to persist to 24 months than HR-HPV with low viral load among HIV-negative men (adjPRR=1.67, 95% CI 0.88 to 3.16).

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 overall. The results may explain the association between high HR-HPV viral load and HR-HPV transmission.

  • HIV
  • HPV

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