Association of genital human papillomavirus infection with HIV acquisition: a systematic review and meta-analysis

Association of genital human papillomavirus infection with HIV acquisition: a systematic review and meta-analysis

Contents: Preface — Part 1: Introduction To Sexually Transmitted Diseases (STDs): — Chapter 1: Overview of sexual health and the reproductive system: — 1-1: Female reproductive system — 1-2: Male reproductive system — Chapter 2: What is an STD? It affects both men and women. Stop worrying about HIV, OK? I’ll repost below some information about HPV/genital warts from the archives. If you are uninsured, you may qualify for a state-funded program or a lower fee scale. Please bring the following documents: birth certificate, photo ID. But now, My life is very happy.

There are some positive statistics concerning Jefferson County and the city Beaumont that are giving health care professionals some hope, and that the number of reported HIV cases has been dropping slightly since 2009. Infections can be viral, bacterial or parasitic. pallidum was identified in 14 CSF samples by reverse transcriptase polymerase chain reaction (RT-PCR). Half of these people were women and girls between age 15 and 24. In 1990, 10% of new HIV infections reported to the MDH were among youth. “I do believe more education is needed about Truvada for PrEP—in particular, appropriate prescribing duration, assessment of risk factors, assessment of adherence, and lab monitoring,” he said. What is the treatment for chlamydia?

This HPV test will detect the presence of the viruses which are the most common cause of cervical cancer. Research on the role of genital HPV in HIV incident infection is currently limited, whereas it is biologically plausible. HPV could predispose to HIV infection and dissemination through its disruption of the epithelium integrity and the mucosal immune system,27 by (A) altering the density and functional activities of epithelial Langerhans cells which capture infecting pathogens,8 28 (B) enabling the recruitment and activation of HIV target cells such as T-lymphocytes,29 (C) reducing the expression of proteins acting in cell adhesion and tumour suppression,30 (D) downregulating proteins that promote the infiltration of Langerhans cells through the epithelium,31 (E) reducing the production of proteins involved in antimicrobial activities28 and (F) upregulating inflammatory cytokines,28 29 which may increase HIV replication. There have been several calls for the investigation of the association of genital HPV infection with HIV acquisition, dating as far back as 1993.7 12 28 32 33 In view of the scope and severity of both infections and their synergy, a review of the existing epidemiological evidence is warranted. Treatment aims to ease the pain and discomfort of the sores but it does not cure the virus. AIN or CIN appear to be more common in people with HIV infection than those who are HIV negative. The types of HPV that can cause genital warts are not the same as the types that cause cancer.

There were no language restrictions. This broad search strategy ensured that all preidentified eligible studies were included in the results. Abstracts from relevant conferences were also searched. All retrieved abstracts were read by two of the review authors (PL and BA), and evaluated for eligibility. Some STDs are asymptomatic… Since certain diseases have no visible symptoms, you may not know that you or your partner has been infected. Results: Penile skin test results were available for 349 men, of which 31.8% were HPV positive. Although older tests could take up to 12 weeks to show results, some of the newer screening tests can give accurate results within 20 minutes.

Cohorts could include HIV seropositive individuals at baseline. Fred Mayer, R.Ph., the president of Pharmacists Planning Service Inc. Title: Men’s health Summary: This long video talks to men newly arrived in Australia about a number of different topics: seeing a doctor, medicare cards, sexual health, HIV, hepatites B and C, looking after cronic health conditions, urinary symptoms, family planning, fertility, vaccinations,emergency and what to do to stay healthy. Men can also develop penile, rectal and other cancers from a persistent HPV infection. Information obtained included HPV prevalence in the sample, number of HIV incident infections, unadjusted and adjusted estimates, including 95% CIs, of the association between HPV infection and HIV acquisition, type of estimate, study setting, sample size, demographic characteristics, HPV sampling methods, length of follow-up and covariates used for adjustment in the multivariate models. The summary ORs and 95% CI were estimated using random-effect meta-analytic techniques because there was substantial heterogeneity between studies in terms of sample size, participants characteristics, reported HIV incidence, length of follow-up, covariates used for adjustment and HPV assessment (including sampling method, oncogenic risk group classification and measured prevalence). The main analyses were conducted for HPV infection, regardless of oncogenic risk group.

Adjusted estimates were used whenever possible. They can get bigger over time. Some people decide not to have treatment right away to see if the warts will go away on their own. This latter assessment, labelled ‘recent’ HPV, was used in the main analysis. Sensitivity analyses were conducted with the other two timings of assessment. For each summary analysis, between-study heterogeneity was assessed using the I-squared statistic,39 which quantifies the degree of heterogeneity. Publication bias was evaluated using the Begg-adjusted rank correlation test, which assesses the association between the treatment effect and its variance,40 and the Egger regression asymmetry test.41 All statistical analyses were performed using the Stata Statistical Software: Release V.10 (StataCorp 2007, College Station, Texas, USA: StataCorp LP).

The majority of women with chlamydia have no symptoms. Measurable Learning Objective: By the end of the presentation, and review of the handout material, participants will be able to identify components of the National Pharmaceutical Stockpile to which they might make a professional contribution should this National Security asset ever deploy locally due to a terrorist or other event threatening the lives and health of the citizenry. Its side effects include cardiovascular problems, cough, fever, upper respiratory tract infections, rash, and abdominal pain. Eight studies were rejected because they did not fulfil the inclusion criteria. Five nested cohort studies, and one case-control study on the association between genital HPV infection and HIV acquisition were identified.38 42–46 Selected studies are summarised in . Many people who have HIV do not know they have it. In studies conducted among women, HPV testing was performed on cervical samples.

Association of genital human papillomavirus infection with HIV acquisition: a systematic review and meta-analysis
HPV sampling among men included the collection of anal samples in the Chin–Hong and colleagues study42 and exfoliated cells from the glans or coronal sulcus and the penile shaft in the Smith and colleagues study.45 HPV sampling was performed by health professionals, apart from the Smith–McCune and colleagues study38 which included self-collected and clinician-collected cervical swabs. In all six studies, HPV testing was conducted using PCR and positive HPV results were genotyped using type-specific probes on PCR products. However, these methods differed in terms of HPV genotypes detected and their classification by oncogenic risk group, with some genotypes classified as high-risk in some studies and as low-risk in others (see online supplementary appendix table S2a and S2b). Six studies reported estimates for HR-HPV and five for LR-HPV. HPV infection can last for a long time, especially in people who are HIV-positive. Treatment depends on the type of cervical cancer and how far it has spread. When HPV was assessed at the start of the follow-up period over which HIV incidence was measured (or at month 6 for one study43), follow-up varied between 21 and 42 months.38 42 43 45 46 The Smith–McCune and colleagues study 38 also assessed incident HIV infection detected concurrently and within 6 months of HPV infection assessment.

The Averbach and colleagues study44 used HPV data detected on average 80 days before HIV seroconversion. HPV genotypes found to be associated with HIV acquisition included HPV 52,43 as well as HPV 31, 58 and 70.38 In terms of the four HPV genotypes covered by the currently available vaccines, only one study investigating individual HPV genotypes found significant positive associations between HIV acquisition and genotypes 16 and 18.45 None of the studies found associations with genotypes 6 and 11. The Auvert and colleagues study,46 the Averbach and colleagues study,44 and the Chin–Hong and colleagues study,42 found that the risk of HIV acquisition increased with the number of detected HPV genotypes. However, more aggressive strains of HPV will stick around and cause multiple health problems, like cervical cancer. Both the Smith–McCune and colleagues study38 and the Averbach and colleagues studies44 investigated HPV persistence and clearance, and found a significant association between non-persistent HPV and HIV acquisition. Our immune competence develops in combat. For all six studies, unadjusted and adjusted estimates, as applicable, and their 95% CI are reported in .

All but one study43 reported adjusted OR. Statistically significant estimates are reported in bold. Variables included in the multivariate models are listed in online supplementary appendix table S3. Most studies controlled for age 38 42 44–46 and HSV-2 status.38 42 44 45 All studies conducted among women, and reporting adjusted estimates, controlled for condom use and sexual behaviour.38 44 46 Two studies conducted in sub-Saharan Africa38 45 controlled for circumcision status, known to be associated with HIV incidence. Measures of sexual partners’ characteristics and participants’ sexual behaviour were population-specific, assessed at different times during follow-up, and varied substantially across studies. Six studies were included in the meta-analysis.38 42–46 All reported significant estimates of the association of HPV with HIV incidence.38 42–46 As shown in , the computed summary OR indicated that overall, individuals with genital HPV infection, regardless of oncogenic risk group, had twice the risk of acquiring HIV (summary OR, 1.96; 95% CI, 1.55 to 2.49). There was no evidence of between-study heterogeneity (p=0.484), suggesting that a pooled analysis was suitable.

When the association with HIV acquisition was investigated by subgroups, it was found to be statistically significant with HR-HPV (summary OR, 1.92; 95% CI, 1.49 to 2.46; test of heterogeneity p=0.511), and borderline with LR-HPV (summary OR, 1.53; 95% CI, 0.96 to 2.42; test of heterogeneity p=0.029). While they cannot prevent HPV-related problems, they can help catch warts and dysplasia before they progress and cause greater problems. It appears that studies with larger SEs tended to report larger estimates. However, the Begg’s test was not statistically significant (p=0.339). Visually, the funnel plots seemed asymmetrical, indicating a possible publication bias towards studies reporting significant associations. This was confirmed statistically by the Egger’s test, which indicated a borderline statistically significant publication bias (p=0.054). In the subgroup analyses, no significant publication bias was detected for HR-HPV (Begg’s test p=0.806; Egger’s test p=0.181).

There was a significant publication bias for LR-HPV (Begg’s test p=0.089; Egger’s test p=0.022). If you know in advance that you are going to have surgery that might require transfusion, have some of your own blood drawn and stored for any replacement you might need. The fact that all studies included have been published recently indicates that this is a topic which has been overlooked in past HIV prevention research. Our findings show that genital HPV infection is associated with incident HIV infection, and that this association is significant with HR-HPV, and borderline with LR-HPV. Lastly, the association could be mediated by other STI. For instance, HPV is more frequent in HSV-2 infected individuals. HSV-2 replication, associated with primary infection and in-situ reactivation of latent infections, facilitates HIV acquisition.48 Thus, remote confounding could partly explain the association observed.

There are several limitations to this meta-analysis. First, it was conducted among a small number of studies, so it is underpowered, which may have affected the I-squared statistic.39 Second, all studies were observational, which increases the likelihood of bias. Third, the qualitative review of the studies indicated substantial variations in terms of study design, participant characteristics, HPV status assessment, and covariates used in the adjusted models. Two salient variations were: (A) HPV sampling among men, which was not standardised, and could explain the differences in HPV and HR-HPV prevalences observed49 and (B) the classification of HPV genotypes by oncogenic risk group, which differed across studies. Getting to the crux of your question, let’s assume your partner has had some unsafe extracurricular activities and managed to contract both syphilis and HIV. Similarly, it was not possible to explore genotype-specific associations of HPV with HIV as data was not available. Another important issue was the time between HPV status assessment and HIV testing, which varied across studies.

It cannot be excluded that the association is time-dependent, and that the transient nature of HPV infection50 could have affected its strength. Fourth, metaregressions to examine the impact of factors, such as study site, sexual risk behaviour, as well as relevant analyses stratified by sampling sites and methods, could not be performed for lack of power. Fifth, the adjustments for the multivariate estimates used in the meta-analyses were performed on different variables. Sixth, publication bias was suggested, which could affect the validity of the findings. A Chinese herbal remedy with similar properties comes from the root of a plant in the pea family, Astragalus membranaceus. This study has important implications for future HIV prevention research. As a potential risk factor, the contribution of HPV infection to the HIV epidemic must be explored comprehensively, using longitudinal study designs, standardised HPV sampling and HPV genotypes classification, and analytic methods with adjustment on relevant covariates.

Further research is needed to understand the aetiology of the association, including the biological mechanisms that may underlie oncogenic risk group-specific or genotype-specific associations. The effect of HPV vaccination on HIV acquisition may be assessed since there exists two highly effective HPV vaccines which have been approved for use among women,34 and one among men.35 To this day, randomised controlled trials of STI management have yielded contradictory results, which may have been partly due to the insufficient potency of the intervention, such as in the case of HSV-2.7 As indicated in the present study, there may be discrepancies regarding the HPV genotypes for which the vaccines are providing protection against, and those associated with HIV seroconversion. Hence, the development and use of vaccines covering a wider range of genotypes is necessary. Modelling studies on the potential impact of HPV vaccination campaigns on the HIV epidemic are also needed. Such research could be an important contribution to the global fight against HIV. The observed association of HPV infection with HIV acquisition has important public health implications. If the causal association between HPV and HIV acquisition is verified, HPV vaccination, along with other biomedical interventions, has the potential to be an additional HIV control strategy, with the unique advantage of providing long-term benefits to both men and women.

I abused crystal meth for the 1st 4 months of this year. All authors contributed, read and approved the final manuscript. PL and BA had full access to all the data in the study and had final responsibility for the decision to submit for publication. Funding: This work was supported by the Agence Nationale de Recherche sur le Sida et les hépatites virales (ANRS-12126) France; Institut National de la Santé et de la Recherche Médicale (INSERM), France; Université de Versailles-Saint-Quentin France; the Bill and Melinda Gates Foundation (grant number OPP1021324). The funding agencies had no role in study design, the collection, analysis, and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication.

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