Objective: This study aimed to provide a population-based estimate of human papillomavirus (HPV) seropositivity for women in a rural African context and to evaluate the impact of HPV serostatus on subsequent acquisition of HIV outside a clinical setting.
Design: A random sample of women participating in a longitudinal, population-based HIV survey combined with a case-control study.
Methods: Blood samples of women participating in a single round of population-based HIV surveillance (N = 1049) in a rural South African population were used to measure vaccine-preventable HPV seropositivity (types 6, 11, 16, and 18) in the general population in 2010. Using results from the repeat HIV surveys, a case-control analysis was then performed comparing HPV sero-status in samples taken from HIV sero-converting women (prior to infection with HIV) against samples from HIV-uninfected, sexually-active controls matched 1:1 according to 5-year age band (377:377). Unconditional multivariable logistic regression with multiple imputations was used to control for sociodemographic and behavioral variables associated with HIV acquisition.
Results: Human papillomavirus seropositivity in the population-based sample of women was 20.8% (95% confidence interval [CI], 18.3–23.4), and HIV prevalence was 27.6% (95% CI, 24.9–30.4). In the case-control analysis, allowing for variables known to be associated with HIV incidence, HPV seropositivity was associated with nearly 2.5 times the odds of subsequent acquisition of HIV (adjusted odds ratio, 2.33 [95% CI, 1.61–3.39]; P < 0.001).
Conclusions: These results suggest that HPV vaccination before or soon after sexual debut could lower HIV infection risk. Randomized trials that quantify the impact of HPV vaccination in girls on the risk of acquiring HIV are urgently required.
In a random sample of women from a population-based HIV survey in rural South Africa, human papillomavirus seropositivity of vaccine-preventable types was 20.8%. Human papillomavirus seropositivity was independently associated with more than twice the odds of subsequent acquisition of HIV.
From the *Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa; †Centre for Sexual Health andHIV Research, Faculty of Population Health Sciences, University College London, London, UK; and ‡MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
Supported by the National Institute of Child Health and Human Development and Wellcome Trust.
Funding for the Africa Centre’s Sociodemographic and HIV Surveillancewas received from the Wellcome Trust, UK (Grant No. 082384/Z/07/Z). Frank Tanser and Erofili Grapsa are supported by grant 1R01-HD058482-01 from the National Institute of Child Health and Human Development. The authors thank Prevashinee Padayachee forcoordinating all laboratory-related testing procedures and Colin Newell for database support.
Author contributions: F.T. and M.L.N. designed the study. K.G.J. and E.G. performed the statistical analysis. F.T. took primary responsibility for writing the manuscript. All authors contributed to data analysis interpretation and writing and critiquing of the manuscript.
Correspondence: Frank Tanser, PhD, Africa Centre for Health and Population Studies, University of KwaZulu-Natal, PO Box 198, Mtubatuba, 3935, South Africa. E-mail: firstname.lastname@example.org.
Received for publication November 28, 2012, and accepted February 28, 2013.