Incidence, Duration, Persistence, and Factors Associated With High-risk Anal Human Papillomavirus Persistence Among HIV-negative Men Who Have Sex With Men: A Multinational Study

Abstract

Background. Given high rates of anal disease, we investigated the natural history of high-risk anal human papillomavirus (HPV) among a multinational group of men who have sex with men (MSM) aged 18-64 years.Methods. Anal specimens from human immunodeficiency virus-negative men from Brazil, Mexico, and the United States were genotyped. Over 2 years, 406 MSM provided evaluable specimens every 6 months for ≥2 visits. These men were stratified into men who have sex only with men (MSOM, n = 70) and men who have sex with women and men (MSWM, n = 336). Persistence was defined as ≥12 months' type-specific duration and could begin with either a prevalent or incident infection. Prevalence ratios and 95% confidence intervals were calculated by Poisson regression.Results. Median follow-up time was 2.1 years. Retention was 82%. Annual cumulative incidence of 9-valent vaccine types was 19% and 8% among MSOM and MSWM, respectively (log-rank P = .02). Duration of anal HPV did not differ for MSOM and MSWM and was a median of 6.9 months for HPV-16 after combining men from the 2 groups. Among men with prevalent high-risk infection (n = 106), a total of 36.8%, retained the infection for at least 24 months. For those with prevalent HPV-16 (n = 27), 29.6% were persistent for at least 24 months. Persistence of high-risk HPV was associated with number of male anal sex partners and inversely associated with number of female sex partners.Conclusions. MSM with prevalent high-risk HPV infection should be considered at increased risk for nontransient infection.

Prevalence of anal, oral, penile and urethral Human Papillomavirus in HIV infected and HIV uninfected men who have sex with men

“…Despite the widespread antiretroviral therapy use, incidence rates of HPV‐induced diseases and anal cancer in HIV infected MSM remains an urgent priority, and all subjects should be vaccinated according to existing guidelines . Indeed, since the MSM population should be considered at increased risk for non‐transient HPV infections, the administration of HPV vaccine to men prior to the onset of sexual activity could effectively prevent almost all anal cancers (primary prevention of squamous cell cancer of the anus, SCCA). In addition, the nonavalent HPV vaccine may be helpful in preventing recurrent high‐grade squamous anal intraepithelial lesions (anal intraepithelial neoplasia [AIN] 2 or greater) and possibly the progression to SCCA, especially in individuals at increased risk including all HIV infected subjects (men and women) and HIV uninfected MSM .…”

“…41 Despite the widespread antiretroviral therapy use, incidence rates of HPV-induced diseases and anal cancer in HIV infected MSM remains an urgent priority, and all subjects should be vaccinated according to existing guidelines. 37,44,45 Indeed, since the MSM population should be considered at increased risk for non-transient HPV infections, 46…”

Anal HPV 16 and 18 viral load: A comparison between HIV‐negative and ‐positive MSM and association with persistence

“…Based on a meta‐analysis, the incidence of anal cancer was 5.1 per 100 000 per year among HIV‐negative MSM, rising to 77.8 per 100 000 per year among HIV‐positive MSM in the era of combination antiretroviral therapy (cART) . HIV‐negative and ‐positive MSM differ in the prevalence of anal HPV infection, incidence of anal HPV infection, persistence of anal HPV infection, clearance of anal high‐risk HPV infection and HPV16 and ‐18 seropositivity . All these parameters show more infection and less clearance in HIV‐positive MSM compared to HIV‐negative MSM.…”

“…In order to develop HPV‐related disease a productive and persistent HPV infection is required and HPV viral load is a marker of a productive HPV infection . We studied differences in anal HPV16 and HPV18 viral load between HIV‐negative and ‐positive MSM and the association between baseline anal HPV viral load and persistence of HPV infection.…”

A qualitative investigation among men who have sex with men on the acceptability of performing a self- or partner anal exam to screen for anal cancer

“…MSM in the U.S. are at a high risk of HPV persistence [9, 10] and hence developing high-grade intraepithelial lesions (HSIL) and anal cancer [11]. And despite the availability of vaccines that target HPV types are known to cause the majority of cancer cases and genital warts, the MSM population still remains at risk for the disease [12] due, in part, to a lack of awareness of anal cancer and its relationship with HPV [13, 14].…”