{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T03:27:10Z","timestamp":1780975630200,"version":"3.54.1"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["1200-GR0244780"],"award-info":[{"award-number":["1200-GR0244780"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Microbicide Trials Network"},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["UM1AI068633"],"award-info":[{"award-number":["UM1AI068633"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["UM1AI068615"],"award-info":[{"award-number":["UM1AI068615"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["UM1AI106707"],"award-info":[{"award-number":["UM1AI106707"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Observational data on the synergy between human papillomavirus (HPV) infection and risk for HIV acquisition are needed. HPV clearance, associated with an influx of cells targeted by HIV, may increase HIV risk. This study examined the association between HPV and HIV acquisition using endocervical swabs collected in MTN-020\/ASPIRE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Healthy, sexually active women without HIV participating in the ASPIRE dapivirine ring study in Malawi, South Africa, Uganda, and Zimbabwe provided endocervical swabs monthly, which were tested for HPV-DNA. HPV status was classified into prevalent, persistent (HPV+ for at least 4\u2009months), HPV clearance (HPV+ followed by HPV\u2212), HPV acquisition (HPV\u2212 followed by HPV+), and remaining HPV positive (2 subsequent HPV+). Cox time-varying regression models were used to assess associations between HPV states and HIV acquisition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 91 HIV acquisition endpoints, HPV clearance increased HIV risk for high-risk types (16\/18\/31\/33\/35\/45\/52\/58) (HR = 2.40, 95% CI = 1.59 to 3.62). Remaining HPV+ also showed a moderately increased risk (HR = 1.59, 95% CI = 1.07 to 2.35), while prevalent, persistent, and HPV acquisition events showed non-significant associations. Elevated HIV risk was also observed for clearance of HPV16\/18, other high-risk types, low-risk types, and HPV6\/11. There was also a dose-response relationship, with HIV risk increasing by 1.75-fold (95% CI = 1.55 to 1.96) for each additional HPV type cleared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HPV clearance-related immune activation is strongly linked to HIV acquisition, likely due to increased CD4+ T cells and inflammation. These findings support HPV vaccination as a potential HIV prevention strategy and highlight the need to integrate HIV prevention into cervical cancer programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jnci\/djaf336","type":"journal-article","created":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T12:53:51Z","timestamp":1763211231000},"page":"485-491","source":"Crossref","is-referenced-by-count":3,"title":["Association of human papillomavirus on risk of HIV acquisition in African women: analyses from MTN-020\/ASPIRE"],"prefix":"10.1093","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7332-1480","authenticated-orcid":false,"given":"Christine L","family":"Hathaway","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"University of Washington School of Medicine , Seattle, WA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4286-2111","authenticated-orcid":false,"given":"Elizabeth R","family":"Brown","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center , Seattle, WA,","place":["United States"]},{"name":"Department of Biostatistics, University of Washington , Seattle, WA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Cherne","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Harborview Medical Center , Seattle, WA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa L","family":"Sepulveda","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley School of Medicine , Edinburg, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3538-5150","authenticated-orcid":false,"given":"Zvavahera M","family":"Chirenje","sequence":"additional","affiliation":[{"name":"Department of Obstetrics\/Gynecology and Reproductive Science, University of California San Francisco , San Francisco, CA,","place":["United States"]},{"name":"University of Zimbabwe-Clinical Research Center , Harare,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitesha","family":"Jeenarain","sequence":"additional","affiliation":[{"name":"South African Medical Research Council, HIV and Other Infectious Diseases Research Unit , Durban,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Logashvari","family":"Naidoo","sequence":"additional","affiliation":[{"name":"South African Medical Research Council, HIV and Other Infectious Diseases Research Unit , Durban,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Siva","sequence":"additional","affiliation":[{"name":"South African Medical Research Council, HIV and Other Infectious Diseases Research Unit , Durban,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishanta","family":"Singh","sequence":"additional","affiliation":[{"name":"South African Medical Research Council, HIV and Other Infectious Diseases Research Unit , Durban,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3294-4773","authenticated-orcid":false,"given":"Kubashni","family":"Woeber","sequence":"additional","affiliation":[{"name":"South African Medical Research Council, HIV and Other Infectious Diseases Research Unit , Durban,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8552-132X","authenticated-orcid":false,"given":"Zakir","family":"Gaffoor","sequence":"additional","affiliation":[{"name":"South African Medical Research Council, HIV and Other Infectious Diseases Research Unit , Durban,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda Gati","family":"Mirembe","sequence":"additional","affiliation":[{"name":"Makerere University\u2014Johns Hopkins University Research Collaboration , Kampala,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0046-4353","authenticated-orcid":false,"given":"Flavia Matovu","family":"Kiweewa","sequence":"additional","affiliation":[{"name":"Makerere University\u2014Johns Hopkins University Research Collaboration , Kampala,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7607-348X","authenticated-orcid":false,"given":"Leila E","family":"Mansoor","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal , Durban,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3690-4207","authenticated-orcid":false,"given":"Lameck","family":"Chinula","sequence":"additional","affiliation":[{"name":"University of North Carolina Project Malawi , Lilongwe,","place":["Malawi"]},{"name":"University of North Carolina Department of Obstetrics and Gynecology, , Chapel Hill, NC,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sufia","family":"Dadabhai","sequence":"additional","affiliation":[{"name":"Johns Hopkins Research Project-Kamuzu University of Health Sciences , Blantyre,","place":["Malawi"]},{"name":"Johns Hopkins School of Public Health , Baltimore, MD,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelly R","family":"Mugo","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington , Seattle, WA,","place":["United States"]},{"name":"Kenya Medical Research Institute , Nairobi,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0052-5830","authenticated-orcid":false,"given":"Thesla","family":"Palanee-Phillips","sequence":"additional","affiliation":[{"name":"Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, School of Public Health , Johannesburg,","place":["South Africa"]},{"name":"Department of Epidemiology, School of Public Health, University of Washington , Seattle, WA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1793-6003","authenticated-orcid":false,"given":"Ruanne V","family":"Barnabas","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Massachusetts General Hospital , Boston, MA,","place":["United States"]},{"name":"Harvard Medical School , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"2026030819564687400_djaf336-B1","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/OLQ.0000000000000193","article-title":"The estimated lifetime probability of acquiring human papillomavirus in the United States","volume":"41","author":"Chesson","year":"2014","journal-title":"Sex Transm Dis"},{"key":"2026030819564687400_djaf336-B2","doi-asserted-by":"crossref","first-page":"17455065211020702","DOI":"10.1177\/17455065211020702","article-title":"Human papillomavirus persistence or clearance after infection in reproductive age. What is the status? Review of the literature and new data of a vaginal gel containing silicate dioxide, citric acid, and selenite","volume":"17","author":"Huber","year":"2021","journal-title":"Womens Health (Lond)"},{"key":"2026030819564687400_djaf336-B3","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1016\/S2214-109X(22)00501-0","article-title":"Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative","volume":"11","author":"Singh","year":"2023","journal-title":"Lancet Glob Health"},{"key":"2026030819564687400_djaf336-B4","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1097\/QAD.0000000000001765","article-title":"HIV-positive women have higher risk of human papilloma virus infection, precancerous lesions, and cervical cancer","volume":"32","author":"Liu","year":"2018","journal-title":"AIDS"},{"key":"2026030819564687400_djaf336-B5","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/QAD.0000000000003004","article-title":"Prevalent human papillomavirus infection increases the risk of HIV acquisition in African women: advancing the argument for human papillomavirus immunization","volume":"36","author":"Liu","year":"2022","journal-title":"AIDS"},{"key":"2026030819564687400_djaf336-B6","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1097\/QAD.0b013e328358d908","article-title":"Human papillomavirus infection and increased risk of HIV acquisition. A systematic review and meta-analysis","volume":"26","author":"Houlihan","year":"2012","journal-title":"AIDS"},{"key":"2026030819564687400_djaf336-B7","doi-asserted-by":"crossref","first-page":"e25110","DOI":"10.1002\/jia2.25110","article-title":"Evidence of synergistic relationships between HIV and human papillomavirus (HPV): systematic reviews and meta-analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status","volume":"21","author":"Looker","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"2026030819564687400_djaf336-B8","doi-asserted-by":"crossref","first-page":"5227","DOI":"10.1038\/s41467-019-13089-2","article-title":"HPV infection and the genital cytokine milieu in women at high risk of HIV acquisition","volume":"10","author":"Liebenberg","year":"2019","journal-title":"Nat Commun"},{"key":"2026030819564687400_djaf336-B9","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1056\/NEJMoa1506110","article-title":"Use of a vaginal ring containing dapivirine for HIV-1 prevention in women","volume":"375","author":"Baeten","year":"2016","journal-title":"N Engl J Med"},{"key":"2026030819564687400_djaf336-B10","doi-asserted-by":"crossref","first-page":"e0008123","DOI":"10.1128\/spectrum.00081-23","article-title":"Comparison between the Roche Cobas 4800 Human Papillomavirus (HPV), Abbott RealTime High-Risk HPV, Seegene Anyplex II HPV28, and Novel Seegene Allplex HPV28 assays for high-risk HPV detection and genotyping in mocked self-samples","volume":"11","author":"Bell","year":"2023","journal-title":"Microbiol Spectr"},{"key":"2026030819564687400_djaf336-B11","volume-title":"Cervical Cancer Screening: IARC Handbooks of Cancer Prevention","author":"International Agency for Research on Cancer (IARC)","year":"2022"},{"key":"2026030819564687400_djaf336-B12","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/S1470-2045(09)70096-8","article-title":"A review of human carcinogens\u2014part B: biological agents","volume":"10","author":"Bouvard","year":"2009","journal-title":"Lancet Oncol"},{"key":"2026030819564687400_djaf336-B13","doi-asserted-by":"publisher","first-page":"3224","DOI":"10.1038\/s41591-023-02658-0","article-title":"Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results","volume":"29","author":"Barnabas","year":"2023","journal-title":"Nat Med"},{"key":"2026030819564687400_djaf336-B14","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1093\/infdis\/jir304","article-title":"Identifying the early post-HIV antibody seroconversion period","volume":"204","author":"Hecht","year":"2011","journal-title":"J Infect Dis"},{"key":"2026030819564687400_djaf336-B15","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1136\/sextrans-2011-050346","article-title":"Association of genital human papillomavirus infection with HIV acquisition: a systematic review and meta-analysis","volume":"89","author":"Lissouba","year":"2013","journal-title":"Sex Transm Infect"},{"key":"2026030819564687400_djaf336-B16","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1038\/nm.4506","article-title":"Genital inflammation undermines the effectiveness of tenofovir gel in preventing HIV acquisition in women","volume":"24","author":"McKinnon","year":"2018","journal-title":"Nat Med"},{"key":"2026030819564687400_djaf336-B17","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1038\/mi.2015.51","article-title":"Increased levels of inflammatory cytokines in the female reproductive tract are associated with altered expression of proteases, mucosal barrier proteins, and an influx of HIV-susceptible target cells","volume":"9","author":"Arnold","year":"2016","journal-title":"Mucosal Immunol"},{"key":"2026030819564687400_djaf336-B18"},{"key":"2026030819564687400_djaf336-B19"}],"container-title":["JNCI: Journal of the National Cancer Institute"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jnci\/advance-article-pdf\/doi\/10.1093\/jnci\/djaf336\/65394889\/djaf336.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/118\/3\/485\/65394889\/djaf336.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jnci\/article-pdf\/118\/3\/485\/65394889\/djaf336.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T23:56:55Z","timestamp":1773014215000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jnci\/article\/118\/3\/485\/8328046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,19]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,11,19]]},"published-print":{"date-parts":[[2026,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jnci\/djaf336","relation":{},"ISSN":["0027-8874","1460-2105"],"issn-type":[{"value":"0027-8874","type":"print"},{"value":"1460-2105","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2025,11,19]]}}}