6. Prevalence, genotype diversity and determinants of anal HPV infection in high-risk men attending a sexually transmitted infection clinic in Puerto Rico

Abstract

Background Recent studies in Puerto Rico (PR) have reported an increasing incidence of anal cancer in Puerto Rican men. The objective of this study was to determine the prevalence, genotype distribution and risk factors associated with anal HPV infection among heterosexual men and men who have sex with men (MSM) attending an STI clinic in PR. Methods: We conducted a cross-sectional study of men 18 years and older. A comprehensive survey was administered that included a demographic and behavioural assessment. Logistic regression was performed to determine factors associated with any, high-risk (HR), low-risk (LR) and multiple anal HPV infection. Results: The mean age of the study sample was 38.0 ± 13.5 and 37.7 ± 13.0 years for MSM and heterosexual men, respectively. A third (29.8%) of the study sample reported being MSM. Significant differences were observed in the prevalence of any anal HPV infection for MSM (84.5%) as compared with heterosexual men (45.7%; P < 0.001). Although MSM showed a higher prevalence of both HR and LR HPV types, no significant differences were observed in the bivariate analysis. Overall, HR anal HPV infection was found in 58.5% of the participants. The most common HR types were 53, 58, 68, 51 and 31. Multiple HPV types in the anal canal were found in 50.0% of the sample. Multivariate logistic regression analysis showed that being a MSM was associated with any anal HPV infection (OR = 6.2; 95% CI 1.5, 25.7). Conclusions: Anal HPV is common among sexually active men attending this STI clinic, with a higher likelihood of any anal HPV infection among MSM.

Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus–Related Cancers

“…97 Conversely, protective factors for HPV infection include CD4 count greater than 500, adherence with highly active antiretroviral therapy, and undetectable viral load. 98,99 The unique vulnerability of transgender women to both HIV infection and HPV-related disease warrants special attention. Because of commonalities in viral transmission mode, many of the risk factors for HIV acquisition in MSM and TGW extend to risk of HPV infection as well.…”

“…123,154 Low HPV knowledge may be of a particular concern among diverse MSM and interestingly may cross geographic borders. Awareness of an HPV vaccine varied between 3% and 30% among ethnic minority MSM from Serbia, China, Puerto Rico, and the United States, 98,[155][156][157][158][159] and although low awareness was initially correlated with low willingness to receive the vaccine, this seems to be highly sensitive to education. 146,156,160 Importantly, while anal HPV is highly prevalent among TGW, Meites et al 86 demonstrated that only a minority (8%) of sexually active TGW will test positive for all HPV subtypes covered in the quadrivalent HPV vaccine, indicating that HPV vaccination would still have protective utility.…”

“…Numerous studies have demonstrated that one of the strongest facilitators of HPV vaccine completion among SGM populations is provider recommendation. 98,154,[171][172][173][174][175] In one study, SGM patients were more than 40 times more likely to initiate vaccination when recommended by a provider. 169 Despite this, rates of provider recommendation may be very low, with as few as 10% of pa-tients reporting receiving a recommendation from a provider.…”

“…Low CD4 count has been found to be positively associated with risk of high-grade anal intraepithelial neoplasia and anal cancer, 84,96 and persistent anal cytologic abnormality is more likely with CD4 < 400 97 . Conversely, protective factors for HPV infection include CD4 count greater than 500, adherence with highly active antiretroviral therapy, and undetectable viral load 98,99 …”

“…Numerous studies have demonstrated that one of the strongest facilitators of HPV vaccine completion among SGM populations is provider recommendation 98,154,171–175 . In one study, SGM patients were more than 40 times more likely to initiate vaccination when recommended by a provider 169 .…”