Prevalence of Anal Human Papillomavirus Infection and Risk Factors among HIV-positive Patients in Tokyo, Japan

Abstract

BackgroundOncogenic human papillomavirus (HPV) infection, particularly multiple HPV types, is recognized as a necessary cause of anal cancer. However, a limited number of studies have reported the prevalence of anal HPV infection in Asia. We determined the prevalence, genotypes, and risk factors for anal HPV infection in Japanese HIV-positive men who have sex with men (MSM), heterosexual men, and women.MethodsThis cross-sectional study included 421 HIV-positive patients. At enrollment, we collected data on smoking, alcohol, co-morbidities, drugs, CD4 cell counts, HIV RNA levels, highly active anti-retroviral therapy (HAART) duration, sexually transmitted infections (STIs), and serological screening (syphilis, hepatitis B virus, Chlamydia trachomatis, Entamoeba histolytica). Anal swabs were collected for oncogenic HPV genotyping.ResultsOncogenic HPV rate was 75.9% in MSM, 20.6% in heterosexual men, and 19.2% in women. HPV 16/18 types were detected in 34.9% of MSM, 17.7% of heterosexual men, and 11.5% of women. Multiple oncogenic HPV (≥2 oncogenic types) rate was 54.6% in MSM, 8.8% in heterosexual men, and 0% in women. In univariate analysis, younger age, male sex, MSM, CD4 <100, HIV viral load >50,000, no administration of HAART, and having ≥2 sexually transmitted infections (STIs) were significantly associated with oncogenic HPV infection, whereas higher smoking index and corticosteroid use were marginally associated with oncogenic HPV infection. In multivariate analysis, younger age (OR, 0.98 [0.96–0.99]), MSM (OR, 5.85 [2.33–14.71]), CD4 <100 (OR, 2.24 [1.00–5.01]), and having ≥2 STIs (OR, 2.81 [1.72–4.61]) were independently associated with oncogenic HPV infection. These 4 variables were also significant risk factors for multiple oncogenic HPV infection.ConclusionsAmong Japanese HIV-infected patients, approximately two-thirds of MSM, one-fifth of heterosexual men, and one-fifth of women have anal oncogenic HPV infection. Younger age, MSM, ≥2 STIs, and immunosuppression confer a higher risk of infection with oncogenic HPV and multiple oncogenic types.

Responding to the syphilis outbreak in Japan: piloting a questionnaire to evaluate potential risk factors for incident syphilis infection among men who have sex with men in Tokyo, Japan, 2015

“…( 6 ) Such findings underscored the rationale for a thoughtfully designed questionnaire to address this concern along with other potential risk factors. Notably, anogential HPV prevalence was high in our sample, which has also been reported recently among MSM in Japan, ( 10 ) so we added “anogential HPV” as one of the choices under the STI history section in the revised questionnaire.…”

Presence of multiple genotypes in subjects with HPV-16 infection is highly associated with anal squamous intraepithelial lesions in HIV-1 infected males

“…Anal High Grade Squamous Intraepithelial Lesions (HSIL) and anal cancer incidence have continued to increase in HIV infected men and they are specifically related to HPV-16 [ 5 ].…”

Human papillomavirus prevalence in the anus and urine among HIV-infected Japanese men who have sex with men

“…Many epidemiological studies have been conducted to investigate anal HPV prevalence among HIV-infected MSM in several countries and regions. Anal HPV prevalence in HPV-infected MSM was 61.0% of 92 patients in the United States [3], 74.2% of 140 in Spain [4], 75.9% of 361 in Japan [5], 82.7% of 133 in Korea [6], 88.6% of 166 in Italy [7], 91.8% of 85 in South Africa [8], and 95.5% of 1439 in Spain [9]. The high prevalence of anal HPV infection observed in the present study is similar to that previously reported in other countries.…”