HPV – HIV association

Young women in sub-Saharan Africa continue to be at the highest risk of acquiring HIV infection. They are also at high risk of acquiring HPV which causes cervical cancer, the commonest cancer in women in Africa. Recent studies suggest that HPV infection may also increase the risk of HIV acquisition in women and men. However, the data from these studies are incomplete and more data are needed. HPV vaccines to protect women against cervical cancer are being introduced in several African countries. We are planning a clinical trial to investigate whether HPV vaccine can protect young African women from HIV, as well as protecting against some types of HPV. Planning this trial requires precise estimates of the strength of the association between HPV and HIV and what proportion of new HIV cases might be caused by HPV types found in the HPV vaccine. We are in a unique position to examine this by testing for HPV in stored cervical specimens from studies of women in Tanzania and Uganda that also prospectively detected new cases of HIV. This will allow us to estimate how many cases of HIV might be prevented by HPV vaccination. We will also collect data on the number of potentially eligible girls in the proposed trial sites in Mwanza, Tanzania and Durban, South Africa, and information on the current incidence of HIV in the two countries. This will help us to estimate the optimum cluster size and number of communities to be included in the proposed trial.

Observational studies suggest an association between human papillomavirus (HPV) infection and acquisition of HIV. However, there are limited data on the role of specific HPV genotypes in terms of increased HIV risk, and it is not clear whether different stages of HPV infection (e.g. persistent infection or clearance of HPV) are all associated with increased risk of acquiring HIV.
Our study hypothesis is that HPV infection and persistence and clearance of HPV genotypes increase the risk of acquiring HIV in young women in sub-Saharan Africa, and that the population attributable fraction (PAF) of HIV infection associated with HPV infection is high because of the high prevalence of HPV. HPV vaccines are now being introduced in many countries. The goal of this proposal is to determine the association of HPV with HIV acquisition in order to inform the design and conduct of a phase IV cluster randomized trial of the effectiveness of HPV vaccination against HIV incidence among young women in Tanzania and South Africa.
We will test for HPV infection in stored cervical samples taken from Tanzanian and Ugandan study cohorts that measured HIV incidence. Samples from 151 HIV-seroconverters (cases) and a random selection of 453 HIV negative controls will be tested by the Roche Linear Array® HPV Genotyping Test to examine the association between HIV acquisition and prevalent or persistent HPV infection, or clearance of prior HPV infection, in order to determine the potential effect size for HPV vaccine against HIV acquisition. We will compile up-to-date HIV incidence estimates from the proposed trial sites in Mwanza and Durban required for our trial sample size calculations. We will collect information on potential trial communities in both sites, including the number of eligible girls, in order to inform the trial design. Finally we will draft the main Phase IV trial protocol