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Incident Anal Human Papillomavirus and Human Papillomavirus–Related Sequelae in HIV-Infected Versus HIV-Uninfected Adolescents in the United States

Mullins, Tanya L. Kowalczyk MD, MS*†; Wilson, Craig M. MD; Rudy, Bret J. MD§; Sucharew, Heidi PhD; Kahn, Jessica A. MD, MPH*†

doi: 10.1097/01.olq.0000431049.74390.b7
Original Study

Background Little is known about the incidence of anal human papillomavirus (HPV) infection and related sequelae, as well as factors associated with these outcomes, among adolescents who are HIV infected versus HIV uninfected but at risk.

Methods We analyzed the data from a multisite US study, the Reaching for Excellence in Adolescent Care and Health Project. Adolescents aged 12 to 18 years who were behaviorally HIV infected (n = 319) or HIV uninfected but at risk (n = 177) were recruited. Incidence rates for anal HPV, high-risk anal HPV, anogenital warts, and anal dysplasia were calculated using Poisson modeling. Factors associated with these outcomes were examined using Cox proportional hazards modeling.

Results Mean age at entry was 16.8 years; mean (SD) follow-up time for detection of anal HPV was 22.4 (10.8) months. Most participants (76%) were female; 70% were black non-Hispanic. HIV-infected (vs. HIV-uninfected) women had a significantly higher incidence of anal HPV (30 vs. 14 per 100 person-years; P = 0.002), high-risk anal HPV (12 vs. 5.3 per 100 person-years; P = 0.04), and anogenital warts (6.7 vs. 1.6 per 100 person-years; P = 0.002) but not anal dysplasia. Although incidence rates were higher for these outcomes among HIV-infected versus HIV-uninfected men, the differences were not statistically significant. Among women, factors associated with anal HPV and related sequelae differed by HIV status and included biological, behavioral, and HIV-related factors. No factors were associated with outcomes in men.

Conclusions HIV-infected versus HIV-uninfected adolescent women had higher rates of anal HPV and anogenital warts. Because HIV-infected youth are at increased risk of these outcomes, enhanced HPV prevention efforts such as vaccination are warranted for this group.

New anal human papillomavirus (HPV) infections occurred among HIV-infected adolescents. Incidence of anal HPV infection, high-risk anal HPV infection, and anogenital warts was significantly higher in HIV-infected versus HIV-uninfected adolescent women.

From the *Division of Adolescent Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; †University of Cincinnati College of Medicine, Cincinnati, OH, USA; ‡Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL; §Department of Pediatrics, New York University School of Medicine, New York, NY; and ¶Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Conflicts of interest and sources of funding: Dr Mullins and the coauthors have no relevant conflicts of interests to disclose. The current analysis was supported by the Cincinnati Children’s Hospital Research Foundation Procter Scholar Award (Mullins) and a National Research Service Award training grant (Mullins; HRSA T32HP10027; Principal Investigator: Kristen Copeland, MD). The original Reaching for Excellence in Adolescent Care and Health study was supported by Grant U01-HD32842 from the National Institutes of Child Health and Human Development, Allergy and Infectious Diseases, Drug Abuse, and Mental Health. No funding source had a role in study design, data collection or analysis, manuscript writing, or the decision to submit this manuscript for publication.

Correspondence: Tanya L. Kowalczyk Mullins, MD, MS, Division of Adolescent Medicine, Cincinnati Children’s Hospital Medical Center, MLC 4000, 3333 Burnet Ave, Cincinnati, OH 45229`. E-mail:

Received for publication December 18, 2012, and accepted May 06, 2013.

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