High Prevalence of Anal Oncogenic Human Papillomavirus Infection in Young Men Who Have Sex with Men Living in Bamako, Mali

Abstract

Background High-risk human papillomavirus (HR-HPV) anal infection is a major problem among men who have sex with men (MSM) living in sub-Saharan Africa. The prevalence of anal HR-HPV infection and associated risk factors were estimated in a cross-sectional study in MSM living in Bamako, Mali. Methods MSM consulting at sexual health center of the National NGO Soutoura, Bamako, were prospectively included. Sociodemographic and clinical-biological data were collected. HPV detection and genotyping were performed from anal swabs using multiplex real-time PCR. Risk factors associated with anal HPV infection were assessed by logistic regression analysis. Results Fifty MSM (mean age, 24.2 years; range, 18–35) of which 32.0% were infected with HIV-1, were prospectively included. The overall prevalence of anal HPV infection of any genotypes was 70.0% (35/50) with 80.0% (28/35) of swabs positive for HR-HPV. HR-HPV-58 was the most detected genotype [13/35 (37.1%)], followed by HR-HPV-16 and low-risk (LR)-HPV-6 [12/35 (34.2%)], LR-HPV-40 [10/35 (28.6%)], LR-HPV-11 [9/35 (25.7%)], HR-HPV-51 [8/35 (22.8%)], HR-HPV types 18 and 39 [7/35 (20.0%)] and LR-HPV-43 [6/35 (17.1%)]. HR-HPV-52 and LR-HPV-44 were detected in lower proportions [5/35 (14.3%) and 4/35 (11.4%), respectively]. LR-HPV-42, LR-HPV-54, HR-HPV-31 and HR-HPV-35 were detected in very low proportions [3/35 (8.5%)]. Multiple HR-HPV infections were diagnosed in one-third of anal samples [16/50 (32.0%)], including around half of HR-HPV-positive anal swabs [16/35 (45.7%)]. More than half [27/50 (54.0%)] swabs were infected by at least one of HPV genotypes targeted by Gardasil-9® vaccine, including a majority of vaccine HR-HPV [22/50 (44.0%)]. In multivariate analysis, participation to sex in group was associated with anal infection by multiple HPV (aOR: 4.5, 95% CI: 1.1–18.1%; P = 0.032), and HIV-1 infection was associated with anal shedding of multiple HR-HPV (aOR: 5.5, 95% CI: 1.3–24.5%; P = 0.024). Conclusions These observations indicate that the MSM community living in Bamako is at high-risk for HR-HPV anal infections, with a unique epidemiological HPV genotypes profile and high prevalence of anal HPV covered by the Gardasil-9® vaccine. Scaling up prevention strategies against HPV infection and related cancers adapted to this highly vulnerable MSM community should be urgently prioritized with innovative interventions.

The Prevalence of High- and Low-Risk Types of HPV in Patients with Squamous Cell Carcinoma of the Head and Neck, Patients with Chronic Tonsillitis, and Healthy Individuals Living in Poland

“…That study revealed frequent infection with LR-HPV 42 [ 47 ]. HPV 16 was the most prevalent genotype, and its prevalence and the distribution of other genotypes generally reflect those reported in other studies [ 46 , 80 , 91 ], except for HPV 43/44 which we reported for the first time in oral mucosal epithelial samples in the Polish population, although it was observed earlier in cervical and anal swab samples from healthy populations [ 61 , 93 , 94 , 95 , 96 , 97 , 98 ]. Moreover, sequencing analysis of the HPV E6 region from endocervical swab samples revealed the highest nucleotide substitutions and amino acid changes for HPV 44 genotype compared with other genotypes [ 94 ].…”

Prevalence and determinants of high-risk human papilloma virus among men who have sex with men in Benin: a cross-sectional study embedded in a demonstration project on pre-exposure prophylaxis against HIV

“…Multiple HR-HPV infections are frequently observed among MSM in sub-Saharan Africa. In two studies from Nigeria and Mali, two West African countries like Benin, being infected with at least two HR-HPV was reported among 32% and 45.7% of MSM, respectively 12 20. In the absence of a specific genotyping test in this study, the distribution of HR-HPV other than HPV-16/18/45 was not described.…”

“…Among 204 HIV-negative MSM living in Benin and recruited in a demonstration project on oral PrEP, the prevalence of any anal HR-HPV (genotypes-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) was high, 36.3%. The vulnerability of MSM to HR-HPV has already been reported in various countries in sub-Saharan Africa 7 10 12 19. Overall, 2%–4% of those studied had at least two or three different high-risk genotypes.…”

“…Thus, most of the 44 anal cancers estimated in the country in 2020 might be related to MSM 11. Elsewhere, in sub-Saharan Africa, MSM are disproportionately affected by HPV infections 10 12. Unfortunately, so far, no study has investigated the distribution of HR-HPV among MSM in Benin.…”

HIV prevalence among men who have sex with men, transgender women and cisgender male sex workers in sub‐Saharan Africa: a systematic review and meta‐analysis

“…Our search identified 9476 articles, of which 2587 were unique records (Figure 1). Based on the screening of the title and abstract, 207 full texts were retrieved, of which 48 met our inclusion criteria [12, 31, 32–78]. Most studies were excluded because they either only collected self‐reported HIV status, re‐analysed previously collected data that was already part of the review or provided data collected pre‐2010.…”