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September 12, 2001

Role of Immune Function in Human Papillomavirus Infection—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(10):1173-1174. doi:10.1001/jama.286.10.1173

In Reply: Our conclusion that recent sexual intercourse with a new partner provides a significant risk for the aquisition of HPV was strongly supported by a relative hazard of 10.1 per new partner per month. If most of these positive results were due to upregulated latent infections, as Ms Buchanan and Dr Nieland-Fisher suggest, then having sex with a new partner must have resulted in this upregulation. We are not aware of any studies supporting this hypothesis. As Buchanan and Nieland-Fisher point out, new sexual partners did not influence the presence or absence of HPV in HIV-infected women in our previous study, suggesting that the immune regulation of young HIV-infected women is related to control of HPV. Although we did not report this in our article, we initiated HIV screening in the cohort in 1995 and found no positive results. Furthermore, anonymous HIV screening performed at both clinics yielded seropositivity rates of less than 1%, making us confident that none of our study subjects were infected with HIV. We also queried subjects at each visit about immunosuppression-related illnesses. The occurrence of such illnesses in the group was almost nonexistent (n = 1). It is true that distinguishing recurrences from new infection is difficult, but unless having sex with a new partner stimulates a latent infection, we are not aware of any alternative explanation for our finding.