Background: The southeastern US is an epicenter for incident HIV in the US with high prevalence of human\npapillomavirus (HPV) co-infections. However, epidemiologies of HPV-associated clinical conditions (CC) among\npeople living with HIV-1 infection (PLWH) are not fully known.\nMethods: Electronic medical records (EMR) of PLWH attending one of the leading HIV clinics in the southeastern\nUS between 2006 and 2018 were reviewed and analyzed. The retrospective study was nested within the University\nof Alabama at Birmingham HIV clinical cohort, which has electronically collected over 7000 PLWHâ??s clinical and\nsociobehavioral data since 1999. Incidence rates of HPV-related CC including anogenital warts, penile, anal, cervical,\nand vaginal/vulvar low- and high-grade squamous intraepithelial lesions (LSIL and HSIL) were estimated per 10,000\nperson years. Joinpoint regressions were performed to examine temporal changes in the trends of incident CC. All\nrates and trends were stratified by gender and race.\nResults: Of the 4484 PLWH included in the study (3429 men, 1031 women, and 24 transgender), we observed 1038\npatients with HPV-related CC. The median nadir CD4 count (cells/uL) was higher in the HPV-condition free group than\nthe case groups (P < 0.0001). Anogenital warts, anal LSIL, HSIL, and cancer were more likely to be diagnosed among\nHIV-infected men than women. White men presented more frequently with anal LSIL and anal and penile cancers than\nblack men (P < 0.03). White women were also more likely to be diagnosed with cervical HSIL (P = 0.023) and cancer\n(P = 0.037) than black women.\nConclusions: There were significant differences between gender and race with incidence of HPV-related CC among\nHIV patients. EMR-based studies provide insights on understudied HPV-related anogenital conditions in PLWH;\nhowever, large-scale studies in other regions are needed to generalize current findings and draw public health\nattention to co-infection induced non-AIDS defining comorbidities among PLWH.
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