Prevalence of human papillomavirus in men who have sex with men in the era of an effective vaccine; a call to act

Abstract

ObjectivesThe incidence of human papillomavirus (HPV)-associated anal cancer is increasing. Men who have sex with men (MSM), particularly those coinfected with HIV, are disproportionately affected. Documenting the molecular epidemiology of HPV infection is important in guiding policy makers in formulating universal and/or targeted vaccine guidelines. MethodsA prospective cohort study was conducted. HIV-positive and HIV-negative MSM > 18 years old were invited to participate. Provider-performed anal swabs were collected and anal HPV infection was detected using consensus primer solution phase polymerase chain reaction (PCR) followed by type-specific PCR for high-risk (HR)-HPV types 16, 18 and 31. Between-group differences were analysed using χ 2 tests and Wilcoxon rank tests. ResultsOne hundred and ninety-four MSM [mean (standard deviation (SD)) age 36 (10) years; 51% HIV-positive) were recruited. The median number of sexual contacts in the preceding 12 months was 4 (interquartile range 2-10). HIV-positive subjects had a mean (SD) CD4 count of 557 (217) cells/μL, and 84% were on highly active antiretroviral therapy (HAART). Thirty-one samples were B-globin negative and thus excluded from further analysis. A total of 113 subjects (69%) had detectable HPV DNA. Sixty-eight subjects (42%) had an HR-HPV type detected. HR HPV type 16 was detected in 44 samples (27%), HR-HPV type 18 in 26 samples (16%) and HR-HPV type 31 in 14 samples (23%). Twenty-eight subjects (17%) had more than one type of HR-HPV type detected. When HPV and HR-HPV were stratified by age, those > 35 years had a higher prevalence (P = 0.001 and P = 0.028, respectively). HIV-positive subjects were more likely than HIV-negative subjects to have any detectable HPV (77% vs. 61%, respectively; P = 0.04), to have HR-HPV type 18 or 31 (P = 0.05 and P = 0.006, respectively) and to be infected with more than one HR-HPV type (31% vs. 3%, respectively; P < 0.001). Within the HIV-positive group, the prevalence of HPV was higher in those not on HAART (P = 0.041), although it did not differ when stratified by CD4 count. ConclusionsThe identified prevalence of anal HPV infection was high. Emerging patterns of HPV-related disease strengthen the call for universal vaccination of boys and girls with consideration of catch-up and targeted vaccination of high-risk groups such as MSM and those with HIV infection. Following the introduction of screening programmes in the developed world, the incidence of cervical cancer has decreased; however, the incidences of HPV-associated anal and oropharyngeal cancers have increased dramatically in the past decade [3]. Noncervical HPV-associated cancers, while individually relatively rare, now collectively parallel the burden of cervical cancers in developed countries. HR-HPV is now thought to cause over 5% of all cancers world-wide [4].Certain 'at-risk' groups such as men who have sex with men (MSM), particularly those with HIV infection, are disproportionately affected. The incidence of anal cancer is 1−2/100 000 in the general pop...

HPV vaccine acceptability in HIV-infected and HIV negative men who have sex with men (MSM) in Ireland

“…2 The prevalence of HPV infection is greater in MSM, particularly in HIV-infected MSM compared to the general population. 3,4,5 The reported incidence of anal cancer in MSM is up to 35 cases per 100,000 6 and up to 131 cases per 100,000 in HIVinfected MSM. 7 The quadrivalent HPV vaccine (HPV-4v) (Gardasil TM , Merck and Co., Inc.) is highly efficacious in preventing infection with HPV vaccine types 6/11/16/18, related external genital lesions, and anal intraepithelial neoplasia (AIN) in males and females.…”

Risk of Cancer among Commercially Insured HIV-Infected Adults on Antiretroviral Therapy

“…Among HIV-infected MSM, the prevalence of anal HPV is 77% and was lower among those on HAART [43]. Anal HPV prevalence in the general population was 12.9% [44].…”

Response to letter: limitations of human papillomavirus DNA testing in measuring previous exposure and vaccine protection

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We thank Brown for his interest and comments regarding our published research findings [1]. Documenting the molecular epidemiology of human papilloma virus (HPV) infection in men and in particular high-risk groups such as men who have sex with men (MSM) and HIV-infected MSM is of increasing importance.

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“…Nine of 14 (64%) had HPV DNA detected and seven (50%) had at least one HR HPV type [16 (n = 5), 18 (n = 5) or 31 (n = 2)] detected. We acknowledge in our discussion that we cannot comment reliably on persistence of HPV infection given that our study is a point prevalence study; however, we believe that this is an important observation and warrants inclusion in our discussion.To further investigate the persistence of anal HPV infection, we prospectively followed a subgroup of 45HIV-infected MSM [mean age (AE standard deviation) 45 AE 12 years] who had anal HPV DNA detected in our published study [1]. Participants were rescreened for anal HPV infection 6 months following initial screening.…”

“…HIV-infected MSM [mean age (AE standard deviation) 45 AE 12 years] who had anal HPV DNA detected in our published study [1]. Participants were rescreened for anal HPV infection 6 months following initial screening.…”