Hood Julia E, Gottlieb Geoffrey S, Kiviat Nancy B, Sow Papa Salif, Toure Macoumba, Feng Qinghua, Hawes Stephen E
Department of Epidemiology, University of Washington, Seattle, WA, USA
Department of Medicine, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA.
Int J STD AIDS. 2016 Apr;27(5):353-62. doi: 10.1177/0956462415580691. Epub 2015 Apr 24.
In light of observational evidence showing an association between human papillomavirus (HPV) and HIV acquisition risk, the potential of HPV vaccination as a HIV prevention strategy is being considered. However, the relationship between HPV and HIV infectiousness is unclear. In this analysis, the relationship between HPV and anogenital HIV shedding (a proxy for transmissibility) was assessed in two diverse populations: HIV-infected Senegalese women and American men who have sex with men (MSM). Data from two longitudinal studies with similar protocols were analysed. In both studies, anogenital specimens underwent cytologic, HPV DNA, and HIV-1 RNA testing. Analyses utilised multivariable generalised estimating equations that controlled for age, hormonal contraceptive use (women only), plasma viral load, CD4 count and treatment status. Among Senegalese women, cervical lesions were significantly associated with the detection of HIV RNA (aRR = 1.16 [1.05, 1.28]) and log10 cervicovaginal fluids viral load (adjusted β = 0.56 [0.12, 1.01]). No association was detected between HPV (of any type) and cervicovaginal HIV shedding (aRRDetection = 0.90 [0.77, 1.06]; βQuantity = -0.31 [-0.78, 0.16]). Among MSM, having multiple HPV infections (versus no HPV infection) was associated with anal HIV shedding (aRRDetection = 1.05 [1.01, 1.09]; βQuantity = 0.11 [0.01, 0.21]). Anal lesions were not associated with anal HIV shedding (aRRLESIONS = 0.99 [0.96, 1.03], βLESIONS = -0.05 [-0.13, 0.03]). Although HPV and intraepithelial lesions were associated with anogenital HIV shedding in crude analyses, the measures of effect were attenuated in adjusted analyses. Our data suggest that the prevention of HPV through vaccination is unlikely to substantially affect HIV infectiousness among persons living with HIV.
鉴于观察性证据显示人乳头瘤病毒（HPV）与感染HIV的风险之间存在关联，HPV疫苗接种作为一种预防HIV策略的潜力正在得到考量。然而，HPV与HIV传染性之间的关系尚不清楚。在本分析中，在两个不同人群中评估了HPV与肛门生殖器HIV脱落（一种传染性指标）之间的关系：感染HIV的塞内加尔女性和美国男男性行为者（MSM）。对两项采用相似方案的纵向研究数据进行了分析。在两项研究中，对肛门生殖器标本进行了细胞学、HPV DNA和HIV-1 RNA检测。分析采用多变量广义估计方程以控制年龄、激素避孕药使用情况（仅针对女性）、血浆病毒载量、CD4细胞计数和治疗状态。在塞内加尔女性中，宫颈病变与HIV RNA检测显著相关（调整后相对风险率[aRR]=1.16[1.05, 1.28]）以及与宫颈阴道液病毒载量的对数10显著相关（调整后β=0.56[0.12, 1.01]）。未检测到任何类型的HPV与宫颈阴道HIV脱落之间存在关联（检测的调整后相对风险率=0.90[0.77, 1.06]；数量的β=-0.31[-0.78, 0.16]）。在男男性行为者中，有多种HPV感染（相对于无HPV感染）与肛门HIV脱落相关（检测的调整后相对风险率=1.05[1.01, 1.09]；数量的β=0.11[0.01, 0.21]）。肛门病变与肛门HIV脱落无关（病变的调整后相对风险率=0.99[0.96, 1.03]，病变的β=-0.05[-0.13, 0.03]）。尽管在粗分析中HPV和上皮内病变与肛门生殖器HIV脱落相关，但在调整分析中效应量减弱。我们的数据表明，通过接种疫苗预防HPV不太可能对HIV感染者的HIV传染性产生实质性影响。
