There is growing evidence of a significant burden of human papillomavirus (HPV) infection and associated disease in men. High rates of HPV infection have been observed in men from sub-Saharan Africa where HIV prevalence is high. HIV infection increases HPV prevalence, incidence and persistence and is strongly associated with the development of anogenital warts and anal, penile and head and neck cancers in men. Despite increasing access to antiretroviral therapy, there appears to be little benefit in preventing the development of these cancers in HIV-positive men, making prevention of infection a priority. New prevention options that are being introduced in many African countries include male circumcision and HPV vaccination. However, more data are needed on the burden of HPV disease in men before boys are included in HPV vaccination programmes. Human papillomavirus (HPV) is a common sexually transmitted infection (STI) affecting both men and women.
S Afr J HIV Med[1] HPV infections can be classified as either low-(LR) or high-risk (HR).[2]HR-HPV infections have been associated with cancer of the anogenital and oropharyngeal tissues. While the majority of HPV infections are transient and clear spontaneously, persistent infection with HR-HPV is associated with the development of pre-neoplastic and neoplastic lesions in these areas (Fig. 1). While much is known about the natural history of HPV infection in cervical cancer in women, less is known about the development of HPV-associated disease in men. Emerging evidence points to a significant role for HIV infection in promoting HPV prevalence, incidence and persistence. This review provides an update on current evidence regarding the epidemiology of HPV infection and disease in men, the effects of HIV on HPV infection and disease in men in sub-Saharan Africa (SSA), and the prospects for prevention in this setting.
Global burden of HPVHPV infection is ubiquitous in men. A systematic review of 62 studies using reliable methods of HPV DNA detection and conducted prior to 2009, representing 14 800 men in 23 countries, showed that anogenital HPV DNA prevalence is generally high in sexually active men. The review highlighted considerable variation in estimates by region, from 1% to 84% in LR men, to 2% to 93% in HR men. [3] Compared with studies in women, peak prevalence spanned a wide range of ages, suggesting that men have the potential for longer-term persistence of infection or higher rates of re-infection.[3] Typespecific HPV seroprevalence studies are better indicators of lifetime exposure to HPV infection, although they may underestimate cumulative HPV exposure, given that not all infections lead to seroconversion.[4] Recent population-based studies have estimated the prevalence of antibodies to vaccinepreventable HPV types 6, 11, 16 and 18. Among men aged 14 -59 years in the USA, 12.2% of men were seropositive for any vaccine type, with a peak prevalence of 18% among men aged 50 -59 years.[5] In a similar population-based study in Australia, peak prevalence of any...