Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29 900 men according to HIV status, sexuality, and age: a collaborative pooled analysis of 64 studies

Abstract

Background Robust age-specific estimates of anal human papillomavirus (HPV) and high-grade squamous intraepithelial lesions (HSIL) in men can inform anal cancer prevention efforts. We aimed to evaluate the age-specific prevalence of anal HPV, HSIL, and their combination, in men, stratified by HIV status and sexuality. MethodsWe did a systematic review for studies on anal HPV infection in men and a pooled analysis of individuallevel data from eligible studies across four groups: HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive men who have sex with women (MSW), and HIV-negative MSW. Studies were required to inform on type-specific HPV infection (at least HPV16), detected by use of a PCR-based test from anal swabs, HIV status, sexuality (MSM, including those who have sex with men only or also with women, or MSW), and age. Authors of eligible studies with a sample size of 200 participants or more were invited to share deidentified individual-level data on the above four variables. Authors of studies including 40 or more HIV-positive MSW or 40 or more men from Africa (irrespective of HIV status and sexuality) were also invited to share these data. Pooled estimates of anal high-risk HPV (HR-HPV, including HPV16,

Human Papillomavirus Vaccine Efficacy and Effectiveness against Cancer

“…HPV 16 was the most common type (13.7% of HIV-negative MSM and 28.5% of HIV-positive MSM). A higher number of male sex partners in a lifetime was significantly associated with anal and penile high-risk HPV in HIV-negative MSM [78][79][80].…”

Screening for Anal Dysplasia in Adolescent and Young Adult Men Who Have Sex With Men Living With HIV, a Review of Current Recommendations

“…Studies that include <26 participants who were found to have abnormal Pap tests had a median age of 40–50 years highlighting the lack of representation of younger demographics. A recent meta-analysis that stratified the prevalence of anal HPV by age and included a younger demographic (AYA MSM living with HIV 15–26 years old) highlighted the need for continued research in this field; specifically studies that include individual level data so risk and patterns of anal dysplasia by age can be analyzed ( 12 ). Barriers to acquiring this data in this population include: lack of universal screening guidelines for anal dysplasia, challenges with collecting information on sexual practices in this demographic due to provider discomfort and perceived stigma that patients may have about disclosing sexual activity to providers.…”

“…HIV is an independent risk factor for anal dysplasia. Additional risk factors for anal dysplasia in MSM living with HIV include engaging in receptive anal intercourse, and low CD4 counts (<200 cells/μL) ( 12 ). AYA MSM living with HIV are having their sexual debut at younger ages, have multiple sexual partners, and studies have shown antiviral adherence rates are lower ranging from only 28.3 to 69.8% ( 13 ).…”

“…A meta-analysis performed by Wei et al ( 12 ) showed that AYA MSM living with HIV aged 15–18 years old had an anal HPV16 and other high risk HPV strains prevalence of 5.6% and 58.3% respectively. The prevalence increased significantly to 28.8% and 74.4% for HPV 16 and high risk HPV in those who were 23–24 years of age ( 12 ).…”

Human Papillomavirus Vaccine Course Completion Among Gay and Bisexual Men Who Have Sex With Men From a Time-Limited HPV Vaccination Catch-Up Program in Victoria, Australia

“…Gay, bisexual and other men who have sex with men (MSM) are less likely to receive herd protection from female-only HPV vaccination programs. Given MSM have a high HPV prevalence and are at risk for anal cancer (4)(5)(6)(7), some countries such as the UK, the US, Canada (i.e. only some provinces), Australia (i.e.…”