Incidence and clearance of anal high-risk Human Papillomavirus infection and their risk factors in men who have sex with men living with HIV

Abstract

HIV-infected men who have sex with men (MSM) display the highest prevalence of anal infection by high-risk Human Papillomaviruses (hrHPVs) and incidence of anal carcinoma. Anal specimens were genotyped by the Linear Array. Incidence and clearance of anal infection by hrHPVs, hrHPVs other than HPV16, low-risk HPVs, and four individual types (6,11,16,18) were estimated using a two-state Markov model. Determinants for incidence and clearance were assessed by logistic regression. Overall, 204 individuals were included (median age 42 years, IQR = 34–49). For hrHPVs, incidence and clearance rates were 36.1 × 1000 person-months (p-m) (95% CI 23.3–56.5) and 15.6 × 1000 p-m (95% CI 10.7–23.3), respectively. HPV16 showed a higher incidence than HPV18 (10.2 vs. 7.2 × 1000 p-m). Its clearance was more than twofold lower than that of HPV18 (30.1 vs. 78.2 × 1000 p-m). MSM receiving cART displayed a 68% to 88% decrease in risk of acquiring hrHPVs, hrHPVs other than HPV16, HPV16, and HPV18 (adjusted Hazard Ratio [aHR] 0.13, 95% CI 0.02–0.67; aHR 0.22, 95% CI 0.06–0.78; aHR 0.32, 95% CI 0.12–0.90; aHR 0.12, 95% CI 0.04–0.31, respectively) than patients not treated. A nadir CD4 + count < 200 cells/mm3 significantly reduced the clearance of hrHPVs other than HPV16 (aHR 0.39, 95% CI 0.17–0.90). cART use reduces the risk of acquiring anal infection by hrHPVs.

Increased CD4+ T cell count is associated with lower anal human papillomavirus prevalence among HIV-positive male cohort in Taizhou, China: a cross-sectional study

“…Most studies analyzing the impact of cART on HPV infection reported beneficial effect [ 19 , 20 , 33 – 35 ]. A meta-analysis concluded that cART is associated with decreased prevalence of anal HR-HPV infection in HIV population [ 19 ].…”

“…A meta-analysis concluded that cART is associated with decreased prevalence of anal HR-HPV infection in HIV population [ 19 ]. A prospective study reported that cART reduces the risk of acquiring anal HR-HPV infection in HIV positive men who have sex with men (MSM) [ 20 ]. However, negative or null associations were also reported [ 21 , 22 ].…”

“…A recent worldwide meta-analysis evidenced that effective cART use is associated with a decreased prevalence of anal HR-HPV infection in HIV- positives [ 19 ]. In addition, a longitudinal study observed a significant beneficial effect from cART against acquisition of anal HR-HPV infection in HIV positive MSM [ 20 ], while negative or null associations were also reported [ 21 , 22 ]. Furthermore, few studies have looked into associations between specific cART drugs or treatments with HPV infection, although there have been hypotheses that protease inhibitors may have off-target effect on infections including HPV[ 23 ].…”

Predictors of Anal High-Risk HPV Infection Across Time in a Cohort of Young Adult Sexual Minority Men and Transgender Women in New York City, 2015–2020

“…There are very few longitudinal cohort studies examining the association between incident and prevalent HPV and the risk of anal hrHPV infection over time, particularly in sexual and gender minority populations. Among the identified literature on anal HPV infection among SMM, most studies focus exclusively on HIV-positive SMM ( Donà et al, 2022 ; Fuchs et al, 2016 ; González et al., 2013 ), few report on risk factors beyond HIV ( Donà et al, 2022 ; González et al, 2013 ; Yunihastuti et al, 2020 ), and all are conducted outside the United States ( Brown et al, 2018 ; Donà et al, 2022 ; Fuchs et al, 2016 ; González et al, 2013 ; Mooij et al, 2016 ; van Aar et al, 2013 ; Yunihastuti et al, 2020 ; Zou et al, 2015 ). Only one study included SMM residing in the United States, though they comprised less than 3% of the sample of heterosexual and sexual minority men across North and South America ( Nyitray, Carvalho da Silva, Baggio, Smith, et al, 2011 ).…”

Identifying anal and cervical tumorigenesis-associated methylation signaling with machine learning methods

“…Anal carcinoma is a malignant proliferative disease associated with anal abnormalities ( 1 ). With strong sex bias (females have higher mortality), more than 1000 people die of anal carcinoma per year in the United States ( 2 , 3 ). The risk factors for anal carcinoma include aging, sex (more than two-thirds of patients are women), smoking, and most importantly human papilloma virus (HPV) infection ( 4 , 5 ).…”