Risk of Anal Cancer in HIV-Infected and HIV-Uninfected Individuals in North America

Silverberg, Michael J.; Lau, Bryan; Justice, Amy C.; Engels, Eric A.; Gill, M. John; Goedert, James J.; Kirk, Gregory D.; D’Souza, Gypsyamber; Bosch, Ronald J.; Brooks, John T.; Napravnik, Sonia; Hessol, Nancy A.; Jacobson, Lisa P.; Kitahata, Mari M.; Klein, Marina B.; Moore, Richard D.; Rodrı́guez, Benigno; Rourke, Sean B.; Saag, Michael S.; Sterling, Timothy R.; Gebo, Kelly A.; Press, Natasha; Martin, Jeffrey N.; Dubrow, Robert

doi:10.1093/cid/cir1012

Cited by 469 publications

(371 citation statements)

References 36 publications

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“…10,[15][16][17] Despite very effective anti retroviral treatments, there has been a progressive increase in the incidence of anal cancer, which appears to have plateaued recently. 3,4,11,16,[18][19][20][21] Anal cancer and intraepithelial neoplasia: epidemiology, screening and prevention of a sexually transmitted disease…”

Section: How Are Anal Cancers Classified and What Are The Risk Factors?mentioning

confidence: 99%

Anal cancer and intraepithelial neoplasia: epidemiology, screening and prevention of a sexually transmitted disease

Medford

Salit

2014

CMAJ

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Section: How Are Anal Cancers Classified and What Are The Risk Factors?mentioning

confidence: 99%

Anal cancer and intraepithelial neoplasia: epidemiology, screening and prevention of a sexually transmitted disease

Medford

Salit

2014

CMAJ

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“…The incidence of anal cancer is 1−2/100 000 in the general population, 35/100 000 in HIVnegative MSM and up to 70/100 000 in HIV-positive MSM [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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...

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“…[8][9][10][11] Sexual relations between men is strongly linked to the risk of developing anal cancer, with an odds ratio ranging from 3 to 17 (vs heterosexual men) depending on the study. 12,13 In addition, genital warts are 2-3 times more common in MSM than in a group of heterosexual men the same age. 14 Diseases associated with HPV are even more frequent in HIV positive MSM population.…”

Section: Epidemiology and Clinical Burden Of Hpv Among Msmmentioning

confidence: 99%

“…14 Diseases associated with HPV are even more frequent in HIV positive MSM population. 10,12,15 In Canada and in the province of Quebec, the percentage of MSM is estimated to be about 5%. [16][17][18] Among those living in Quebec, 18.3% have had anogenital warts sometime in their lives.…”

Section: Epidemiology and Clinical Burden Of Hpv Among Msmmentioning

confidence: 99%

HPV Vaccination for MSM: Synthesis of the evidence and recommendations from the Québec Immunization Committee

Sauvageau

Dufour-Turbis

2015

Human Vaccines & Immunotherapeutics

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Diseases associated with the human papilloma virus (HPV) are particularly common among men who have sex with men (MSM). Unlike heterosexual men, MSM do not benefit from the herd protection provided by the vaccination of girls. In this review, we synthesize the available evidence on HPV vaccination for MSM. We also present the recommendations of the Quebec Immunization Committee (CIQ) in this regard, which are: to provide targeted vaccination for MSM up to 26 years of age and in-school vaccination of preadolescent boys since this is the best approach to take to have a real impact on the burden related to HPV in the MSM population and to provide direct protection for all men.

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Risk of Anal Cancer in HIV-Infected and HIV-Uninfected Individuals in North America

Abstract: Anal cancer rates were substantially higher for HIV-infected MSM, other men, and women compared with HIV-uninfected individuals, suggesting a need for universal prevention efforts. Rates increased after the early antiretroviral therapy era and then plateaued.

Cited by 469 publications

References 36 publications

Anal cancer and intraepithelial neoplasia: epidemiology, screening and prevention of a sexually transmitted disease

Anal cancer and intraepithelial neoplasia: epidemiology, screening and prevention of a sexually transmitted disease

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

HPV Vaccination for MSM: Synthesis of the evidence and recommendations from the Québec Immunization Committee

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