Country‐specific HPV‐related genital disease among men residing in Brazil, Mexico and The United States: The HIM study

Abstract

The purpose of this study was to assess whether the incidence of histopathologically confirmed condyloma and penile intraepithelial neoplasia (PeIN) and rates of genital HPV infection progression to these lesions differs by country (Brazil, Mexico, and the U.S.). At each visit, lesions were biopsied and were categorized by pathologic diagnoses. The Linear Array genotyping method was used to identify HPV genotypes from genital swabs, while the INNO-LiPA HPV Genotyping Extra method was used for tissue specimens. Age-specific analyses were conducted for lesion incidence by country, with Kaplan–Meier estimation of cumulative incidence. The proportion of HPV infections that progressed to condyloma and PeIN, the median time to lesion development, and the incidence rates were estimated by country. When comparing demographic and sexual characteristics across the three countries, sexual orientation (p=0.008) and lifetime number of female sexual partners (p < 0.0001) were differentially associated with lesion incidence in the three countries. Condyloma incidence in Brazil and the U.S. decreased with age, while incidence remained constant across the lifespan in Mexico. There were no differences by country and age for PeIN incidence. HPV types 6 and 11 were the most common types to progress to condyloma, and HPV types 16, 6, and 11 were the most common types to progress to PeIN in all three countries. The continuous risk of condyloma and PeIN across all age groups and countries in this study emphasizes the need to ensure that strong HPV immunity, such as that obtained through vaccination, is maintained across the lifespan of men.

Comparison of the Natural History of Genital HPV Infection among Men by Country: Brazil, Mexico, and the United States

“…Differences in the genital HPV natural history by country may explain the differences in HPV-related disease outcomes that we and other have observed (11, 26). Within the HIM Study , the incidence of genital warts was similar across the three countries, but the incidence of penile intraepithelial neoplasia (PeIN) was higher in Brazil than Mexico and the US, although not statistically significant (26).…”

“…Within the HIM Study , the incidence of genital warts was similar across the three countries, but the incidence of penile intraepithelial neoplasia (PeIN) was higher in Brazil than Mexico and the US, although not statistically significant (26). In this study, we observed Brazil to have the highest prevalence and duration of HPV16 infections, which likely explains the higher rate of infection progression to disease (PeIN).…”

“…When we assessed the progression of HPV6 infections to HPV6-positive genital warts, we found that Mexico and the US had higher progression rates of infection than men in Brazil. Although men in Mexico and US have a lower prevalence and incidence of HPV6 infections, they may be more likely to progress to disease (26). Differences in HPV progression may be due to host or viral differences in each country.…”

Human Papillomavirus and Genital Disease in Men: What We Have Learned from the <b><i>HIM Study</i></b>

“…Men who tested positive for HPV at baseline had nearly 12 times the risk of developing GWs [15], with highest incidence among men aged 18–30 years [67, 69, 72]. GW incidence in Brazil and the United States decreased with age, while the incidence remained constant across the lifespan in Mexico [71]. Among HIM Study participants, 16 and 22% of genital HPV 6 and 11 infections developed into HPV 6 and 11 positive GW respectively [20].…”

“…HPV-16 infections had a relatively slow rate of progression with 50% of PeIN taking more than 19 months to be detected [20]. There were no differences by country and age for PeIN incidence [71, 72]. …”