In vitro studies have shown BTK inhibitor increased expression of HPV E1 and L1 viral genes in the presence of HIV transactivator
of transcription (tat) proteins . Our analysis using an older set of high-risk HPV types suggested that higher VL may be associated with HPV detection and hinted at a role of HIV VL in HPV acquisition. However, such an association was not suggested using the latest set of high-risk HPV types. Hence, our research demonstrates the importance of considering the HPV types used when reviewing the literature. It has been postulated that immune reconstitution associated with HAART may lead to clearance of HPV, as has been the case with other viral or nonviral opportunistic infections,
and this is consistent with the results of our analyses, where higher CD4 cell count was associated with a higher probability of HPV clearance. There are a couple of limitations to our analyses. There was a trend for earlier discontinuation in subjects starting with HPV infection, suggesting possible informative censoring, and the small sample size did not allow the use of models that adjust for covariates such as age, cigarette smoking, HPV type and sexual activity. There are several advantages of the statistical methods that we used. The multi-state modelling approach accommodates multiple and recurrent events using intermittent Selleck Ganetespib data. The hazard rates are estimated simultaneously in the model, eliminating the need to subset the data to estimate the HPV detection rate among Immune system HPV-negative subjects
and separately to estimate clearance among the HPV-positive subjects. Also, while other HPV studies have used the midpoint between visit times as the event time (e.g. the time of HPV detection or clearance) or the time of the visit, the methods we used are appropriate when the exact event times are unknown. The approach utilized the incomplete data efficiently and provided a more comprehensive description of the HPV detection and clearance process. We thank the clinicians, study coordinators and study subjects at A5029 sites for their participation and the A5029 study team, headed by Ken Fife, for sharing the data. We also thank Stephen Lagakos, Janet Andersen and Michael Hughes for their thoughtful comments on the analysis. The authors are supported by the AIDS Clinical Trials Group and K24 Mid-Career Research Mentoring Award funded by the National Institute of Allergy and Infectious Diseases (Grants 1U01AI068636-01, 1U01AI068634-01 and K24AI066884).