The association between cervical human papillomavirus infection and HIV acquisition among women in Zimbabwe

Averbach, Sarah Ha; Gravitt, Patti Eb; Nowak, Rebecca Gb; Celentano, David Db; Dunbar, Megan Sc; Morrison, Charles Sd; Grimes, Barbarae; Padian, Nancy Sc,f

doi: 10.1097/QAD.0b013e3283377973
Epidemiology and Social

Background: The prevalence of human papillomavirus (HPV) is higher among HIV-positive women, but the prevalence of HPV prior to HIV acquisition has not been carefully evaluated.

Objective: This study evaluated whether HPV infection is independently associated with heterosexual HIV acquisition in a cohort of Zimbabwean women.

Design: Case–control study nested within a large multicenter cohort study (HC-HIV).

Methods: Cases consisted of Zimbabwean women with incident HIV infection observed during follow-up (n = 145). HIV-uninfected controls were selected and matched to cases (n = 446). The prevalence of cervical HPV infections was compared at the visit prior to HIV infection in the cases and at the same follow-up visit in the matched controls.

Results: The odds of acquiring HIV were 2.4 times higher in women with prior cervical HPV infection after adjustment for behavioral and biologic risk factors. There was no statistically significant difference in the risk of HIV acquisition between women infected with high-risk vs. low-risk HPV types. Loss of detection of at least one HPV DNA type was significantly associated with HIV acquisition [odd ratio = 5.4 (95% confidence interval 2.9–9.9)] (P < .0001).

Conclusion: Cervical HPV infection is associated with HIV acquisition among women residing in a region with a high prevalence of both infections. Further studies are required to evaluate whether the observed association is causal.

Author Information

aUniversity of California, San Francisco School of Medicine, San Francisco, California, USA

bJohns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA

cRTI International, San Francisco, California, USA

dFamily Health International, Research Triangle Park, North Carolina, USA

eDepartment of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA

fUniversity of California, Berkeley, School of Public Health, Berkeley, California, USA.

Received 31 July, 2009

Revised 18 December, 2009

Accepted 22 December, 2009

Correspondence to Patti E. Gravitt, PhD, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St E6148, Baltimore, MD 21205, USA. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.