Acquisition and persistence of human papillomavirus 16 (HPV-16) and HPV-18 among men with high-HPV viral load infections in a circumcision trial in Kisumu, Kenya.
Acquisition and persistence of human papillomavirus 16 (HPV-16) and HPV-18 among men with high-HPV viral load infections in a circumcision trial in Kisumu, Kenya.
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DOI：
10.1093/infdis/jiu535
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发表时间：
2015-03
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通讯作者：
V. Senkomago;Danielle M. Backes;M. Hudgens;C. Poole;K. Agot;S. Moses;P. Snijders;C. Meijer;A. Hesselink;N. Schlecht;R. Bailey;Jennifer S. Smith
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作者：
V. Senkomago;Danielle M. Backes;M. Hudgens;C. Poole;K. Agot;S. Moses;P. Snijders;C. Meijer;A. Hesselink;N. Schlecht;R. Bailey;Jennifer S. Smith
包皮环切术和男性较低的人乳头瘤病毒（HPV）病毒载量可能与HPV传播给女性的风险降低有关。然而，男性包皮环切术和HPV病毒载量之间的关系仍不清楚。方法从肯尼亚基苏穆包皮环切术试验中的男性中采集龟头和阴茎干的拭子标本。用GP 5 +/6+聚合酶链反应（PCR）鉴定HPV DNA分型。使用LightCycler实时PCR测量HPV-16和HPV-18载量，并将其分类为高（>250拷贝/刮）或低（≤250拷贝/刮）。共有1159名男性被随机分配接受立即包皮环切术，1140名男性被随机分配到对照组（这些人被要求在研究结束前保持未包皮环切术）。包皮环切术组的龟头获得高病毒载量感染的风险低于对照组，HPV-16（风险比[HR]，0.32 [95%置信区间{CI}，0.20 - 0.49]）和HPV-18（HR，0.34 [95% CI，0.21 - 0.54]）。包皮环切术组与对照组相比，在基线时龟头高病毒载量感染的男性中，HPV-16（风险比[RR]，0.36 [95%CI，0.18 - 0.72]）和HPV-18（RR 0.34 [95%CI，0.13 - 0.86]）的6个月HPV持续感染风险较低。管身样本获得的结果较弱且精度较低。结论：男性包皮环切术可以通过降低获得性感染的风险和男性龟头持续高HPV病毒载量感染的风险，潜在地降低HPV传播给女性的风险。
BACKGROUND Circumcision and lower human papillomavirus (HPV) viral loads in men are possibly associated with a reduced risk of HPV transmission to women. However, the association between male circumcision and HPV viral load remains unclear. METHODS Swab specimens from the glans and shaft of the penis were collected from men enrolled in a circumcision trial in Kisumu, Kenya. GP5+/6+ polymerase chain reaction (PCR) was used to identify HPV DNA types. HPV-16 and HPV-18 loads were measured with a LightCycler real-time PCR and classified as high (>250 copies/scrape) or low (≤250 copies/scrape). RESULTS A total of 1159 men were randomly assigned to undergo immediate circumcision, and 1140 men were randomly assigned to the control arm (these individuals were asked to remain uncircumcised until the study ended). The hazard of acquisition of high-viral load infections in the glans was lower in the circumcision arm, compared with the control arm, for HPV-16 (hazard ratio [HR], 0.32 [95% confidence interval {CI}, .20-.49]) and HPV-18 (HR, 0.34 [95% CI, .21-.54]). The 6-month risk of HPV persistence among men with high-viral load infections in the glans at baseline was lower in the circumcision arm, compared with the control arm, for HPV-16 (risk ratio [RR], 0.36 [95% CI, .18-.72]) and HPV-18 (RR 0.34 [95% CI, .13-.86]). Weaker and less precise results were obtained for shaft samples. CONCLUSIONS Male circumcision could potentially reduce the risk of HPV transmission to women by reducing the hazard of acquisition, and the risk of persistence of high-HPV viral load infections in the glans in men.