HPV vaccination and HIV preexposure prophylaxis (PrEP): Missed opportunities for anal cancer prevention among at risk populations

Abstract

Gay, bisexual, and other men who have sex with men (GBM), in addition to transgender women who have sex with men (TW), are at disproportionate risk for anal cancer. Anal cancer can be prevented with HPV vaccination, but uptake among adult GBM/TW is low. Targeted HPV vaccination during the clinical management of pre-exposure prophylaxis (PrEP) is an unexplored strategy relevant to these populations. The purpose of this study was (1) to determine the need for HPV vaccination among GBM and transgender women PrEP users and (2) to identify correlates of HPV vaccination among PrEP users. Secondary analysis of the 2020 Pennsylvania LGBT Health Needs Assessment was conducted to estimate prevalence ratios of HPV vaccination among PrEP users. Overall, 43.8% of the sample had initiated HPV vaccination. Vaccine initiation was significantly lower among respondents 27 to 35 (PR = 0.64; 95% CI: 0.49–0.83) and 36 to 45 (PR = 0.38; 95% CI: 0.25–0.58). Respondents who had received Hepatitis A vaccination were significantly more likely to have had initiated HPV vaccination after adjusting for age (aPR = 2.60; 95% CI: 1.75–3.84). Overall, more than half of eligible GBM and TW engaged in PrEP care have not initiated HPV vaccination and represent potential missed opportunities for anal cancer prevention.

Examining the Patterns of Mpox Vaccine Uptake in a Vulnerable Population

“…Similarly to the current mpox outbreak, both HPV and COVID-19 infections were shown to disproportionately affect LGBTQ+ individuals 9,20 . Other studies echo this trend, showing that MSM previously vaccinated for hepatitis A were more likely to acquire HPV and COVID-19 vaccinations 10,16,21 …”

“…9,20 Other studies echo this trend, showing that MSM previously vaccinated for hepatitis A were more likely to acquire HPV and COVID-19 vaccinations. 10,16,21 Having HIV was shown to be a risk factor for severe mpox. However, living with HIV was associated with lower MVAvaccine adherence within our cohort.…”

HIV pre-exposure prophylaxis and opportunities for vaccination against hepatitis A virus, hepatitis B virus and human papillomavirus: an analysis of the Ontario PrEP cohort study

“…Although not included in Canadian or international PrEP guidelines, experts also recommend vaccination against human papillomavirus (HPV) alongside HAV and HBV. 9 10 Since anal carriage of high-risk HPV is prevalent among GBM, integrating HPV vaccination within PrEP care may reduce the burden of HPV-related anal cancers in this over-represented population. 11 12 This may also further the reach of publicly funded vaccine programmes, since GBM aged ≤26 years are eligible for free HPV vaccination in Ontario.…”

Viral Hepatitis and Human Papillomavirus Vaccination During HIV Pre-Exposure Prophylaxis: Factors Associated With Missed Vaccination

“…13 Although vaccine hesitancy has been reported to be less frequent among PrEP users when compared with the general population, there might be uninvestigated factors associated with missing these vaccinations among PrEP users. [14][15][16][17][18][19][20][21][22][23][24] Moreover, understanding which subgroups among PrEP users require focus regarding the offer of these vaccinations might help clinicians deliver a more personalized approach and, in a long-term scenario, develop new delivery strategies concerning already available vaccinations and new investigated products. The aims of this study were to describe among MSM accessing PrEP, the HAV, HBV, and HPV serologic status and vaccination history; analyze vaccinations uptake after PrEP prescription; protection rates for HAV, HBV, and HPV; and evaluate factors associated with the lack of triple vaccination (HAV, HBV, and HPV).…”