Human papillomavirus type competition and the associations between HPV types and future HPV acquisition in men

Rositch, Anne Fortino

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March 21, 2019

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Rositch, Anne Fortino
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology

Abstract

Infection with human papillomavirus (HPV) is the primary cause of cervical cancer and other anogenital cancers. Multiple HPV infections have been detected in up to 70% of HPV infected men, yet there are no data on the association between HPV types in men, which may impact the type-specific efficacy of HPV vaccination through HPV type competition and replacement. In a cohort of uncircumcised, human immunodeficiency virus (HIV)-seronegative men aged 17-28 years from Kisumu, Kenya, we assessed the associations between HPV types at baseline (N=2,702) using semi-Bayesian multivariate logistic regression. In a prospective analysis (N=1,064) we used parametric survival models to compare rates of acquisition of HPV infections among men infected and uninfected with vaccine-relevant types HPV-16, 18, 31, 45, 6, and 11 at baseline. Half of all men were HPV positive at baseline, of whom 57% had multiple HPV infections. In the cross-sectional analysis, HPV types 31, 39, 56, 58, and 59 were positively associated with both vaccine types HPV-16 and 18 (two-sided p-value <0.05); no negative associations between individual HPV types were observed. Over 2,462 person-years of follow-up, 2,233 incident HPV infections were detected. Men with HPV-18, 31, 45, or 11, but not HPV-16 or 6, had higher rates of any-HPV and high-risk (HR) HPV acquisition compared to men without each HPV type at baseline. Relative rates of acquisition of individual HR-HPV types varied by baseline HPV type; however, we did not observe a clear pattern of HPV acquisition by degree of phylogenetic relatedness to the baseline infection. Except for HPV-39 acquisition among men with HPV-6 (aHR: 0.1 (0.0, 0.8)), there was no evidence of negative associations between HPV types or reduced HPV acquisition among men with baseline infections that indicate a strong potential for HPV type competition. To better understand the potential for changes in the HPV type distribution following HPV vaccination, future studies that monitor HPV type distributions in pre- and post-vaccinated populations are needed.

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