Anal human papillomavirus in HIV-uninfected men who have sex with men: incidence and clearance rates, duration of infection, and risk factors

Abstract

Little is known regarding the natural history of anal human papillomavirus (HPV) infection. We aimed to evaluate incidence and clearance rates, their risk factors, and duration of anal HPV infection in HIV-uninfected men who have sex with men (MSM). A longitudinal study was conducted. Anal samples were analysed using the Linear Array HPV Genotyping test. Incidence and clearance rates, and corresponding risk factors, were estimated using a two-state Markov model. Overall, 155 MSM (median age 33.4 years) attending the largest sexually transmitted infection (STI) centre in Rome, Italy, were followed for a median of 12.2 months (Q1-Q3: 7.0-18.1). Incidence and clearance rates for any HPV were 85.6 (95% CI: 58.4-125.4) and 35.6 (95% CI: 24.7-51.5) × 1000 person-months, respectively; the median duration of infection was 9.4 months (Q1-Q3: 7.5-12.1). Receptive anal sex emerged as the only risk factor for the acquisition of any HPV (Hazard Ratio, HR = 2.65, 95% CI: 1.16-6.06). The incidence rates for carcinogenic and non-carcinogenic types were 42.3 (95% CI: 29.2-61.4) and 29.2 (95% CI: 19.5-43.7) × 1000 person-months, respectively (p = 0.13); their clearance rates were 62.9 (95% CI: 45.1-87.7) and 65.7 (95% CI: 47.4-91.0) × 1000 person-months, respectively (p = 0.83). HPV16 showed the lowest clearance rate among carcinogenic types (59.7 × 1000 person-months), and a duration of infection of 16.8 months. In conclusion, a higher incidence rate was observed for carcinogenic compared to non-carcinogenic HPV types, although the difference was not significant. HPV16 emerged as the type with the longest duration of infection and the lowest clearance rate among carcinogenic types.

Sex differences in the incidence and clearance of anal human papillomavirus infection among heterosexual men and women in Liuzhou, China: An observational cohort study

“…The incidence and clearance of male PA HPV infection among heterosexual men in our study were similar with the data from men who have sex with women in the HPV in men (HIM) study, 29 whereas a much higher incidence and lower clearance were found in men who have sex with men, [29][30][31] HIV-infected men 6,32 and HIV-infected men who have sex with men. Therefore, we cannot verify the proportion of populations with different sexual behaviors in the total population.…”

“…We calculated the cumulative prevalence, incidence rates and clearance rates for type-specific HPV and grouped HPV types as follows: any HPV types; any oncogenic HPV types (16,18,31,33,35,45,51,52,56,58, 59 and 68) 18 ; any nine-valent vaccine HPV types (9v; 6,11,16,18,31,33,45, 52 and 58); HPV 16/18 and HPV 6/11. We calculated the cumulative prevalence, incidence rates and clearance rates for type-specific HPV and grouped HPV types as follows: any HPV types; any oncogenic HPV types (16,18,31,33,35,45,51,52,56,58, 59 and 68) 18 ; any nine-valent vaccine HPV types (9v; 6,11,16,18,31,33,45, 52 and 58); HPV 16/18 and HPV 6/11.…”

“…The polymerase chain reaction general primer system (GP5+/6+) was used to amplify a fragment of the HPV L1 gene. The amplified DNA was genotyped for the presence of 16 HPV types (6,11,16,18,31,33,35,45,51,52,56,58,59, 66 and 68) using MeltPro ® HPV Genotyping Assay (Zeesan Biotech Co., Xiamen, China). To evaluate specimen adequacy and genotyping accuracy, we individually tested glyceraldehyde-3-phosphate dehydrogenase and included negative and positive controls in every polymerase chain reaction plate.…”

Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer

“…10,24,[29][30][31] HPV-16 appeared to be the most prevalent genotype in both study groups, and this might be explained by the high incidence and long persistence of this genotype in anal infections, as shown by longitudinal studies. [32][33][34] As expected, we observed that the prevalence of HR types significantly increased with the severity of the cytological findings in both populations. All individuals with an HSIL harbored an HR HPV infection with the exception of 1 HIV-infected patient who was positive for possibly carcinogenic HPV-53.…”

Human papillomavirus vaccine uptake among young gay and bisexual men who have sex with men with a time-limited targeted vaccination programme through sexual health clinics in Melbourne in 2017

“…HPV uptake was associated with a history of genital warts and higher number of male partners after adjusting for other potential confounding factors. While it is not yet known what coverage of MSM would be required to achieve the same dramatic declines achieved in heterosexuals, it has been suggested it needs to be at least as high as heterosexuals based on the higher rate of partner change,10 and the potentially greater and longer duration of infectiousness at the anus 16. These factors, combined with the rapid acquisition of HPV in young MSM and high rates of partner change before vaccination, suggest that a 42% coverage will not be sufficient to see dramatic declines in HPV and substantial herd protection.…”