EFFECT OF HIV-INFECTION ON THE NATURAL-HISTORY OF ANAL HUMAN-PAPILLOMAVIRUS INFECTION

Objective: To identify risk factors for the detection of prevalent and incident anal human papillomavirus (HPV) infection, and HPV persisten ce among HIV-seropositive and seronegative homosexual men. Design: Lon gitudinal study of 287 HIV-seronegative and 322 HIV-seropositive men a ttending a community-based clinic. Methods: Subjects underwent an inte rview and examination; specimens were collected for HIV serology and a ssessment of anal HPV and HIV DNA. Results: Anal HPV DNA was detected at study entry in 91.6% of HIV-infected men, and 65.9% of men not infe cted with HIV. HPV detection was associated with lifetime number of se xual partners and recent receptive anal intercourse (HIV-seronegative men), decreased CD4+ lymphocyte count (HIV-seropositive men), and anal warts (all men). Among men negative for HPV at study entry, subsequen t detection of HPV was associated with HIV, unprotected receptive anal intercourse, and any sexual contact since the last visit. Among men p ositive for HPV at study entry, subsequent detection of additional HPV types was more common among HIV-seropositive men. Becoming HPV negati ve during follow-up was less common among men with HIV or high HPV lev els at study entry. Among those with HIV, HPV persistence was associat ed with presence of anal HIV DNA, but not with CD4+ lymphocyte count. Conclusions: Risk of anal HPV infection appears to increase with sexua l exposure, epithelial trauma, HIV infection and immune deficiency. In cident infection may result from recent sexual exposure or reactivatio n of latent infection. Further studies are needed to elucidate the mec hanism by which HIV DNA in the anal canal increases the risk of HPV pe rsistence. (C) 1998 Lippincott-Raven Publishers.