Background: It is well recognized that the prevalence of HPV infections is increased in HIV-positive individuals, however, little is known about the temporal relationships between this increase and HIV seroconversion.

Methods: During a South African screening trial, women 35-65 years of age were followed for up to 36 months. Both HIV serostatus and cervical HPV DNA status (hc2, Qiagen) were evaluated at enrollment and at 6, 12, 24, and 36 months. 123 HIV-negative women not treated with cryotherapy, HIV seroconverted during the study (2.35% per person year). We compared the HPV prevalence at the visit when HIV was first detected (seroconversion) to the prevalence at the visit before and after seroconversion. Women who were HIV-positive at enrollment (prevalent cases, n=577) and women who remained HIV-negative throughout follow-up (negative controls, n=4894) were compared to the seroconverters at equivalent time points.

Results: Among seroconverters, HPV prevalence was 20.3% prior to seroconversion, 23.6% at the time of seroconversion (p=0.4), and 49.1% at the first visit after seroconversion (p=0.01). Seroconverters had a significantly lower HPV prevalence than HIV prevalent cases at the visit before and at the seroconversion visit (prevalence in HIV prevalent cases 47.4% and 47.0%), but seroconverters had similar HPV prevalence at the visit immediately after seroconversion to HIV prevalent cases (50.6%). HPV prevalence among seroconverters was significantly higher at all time points compared to negative controls (12.0, 11.7 and 11.7% at the matched visits).

Conclusion: Our data show that soon after HIV seroconversion, HPV prevalence quickly reaches levels observed in women with prevalent HIV infection. Our findings are consistent with recent studies showing that soon after HIV acquisition depletion of effector cells in the gut occurs resulting in damage to the mucosal immune system. Changes in mucosal immunity precede damage detectable by systemic markers like CD4 count and viral load.