Prevention of Anal Condyloma with Quadrivalent Human Papillomavirus Vaccination of Older Men Who Have Sex with Men

Abstract

BackgroundThe quadrivalent human papillomavirus vaccine (qHPV) is FDA-approved for use in males 9 to 26 years old to prevent anogenital condyloma. The objective of this study is to determine if qHPV is effective at preventing anal condyloma among men who have sex with men (MSM) aged 26 years and older.MethodsThis post-hoc analysis of a nonconcurrent cohort study evaluated 210 patients without history of anal condyloma and 103 patients with previously-treated anal condyloma recurrence-free for at least 12 months prior to vaccination/time zero. We determined the rate of anal condyloma development in vaccinated versus unvaccinated patients.Results313 patients with mean age 42 years were followed for median 981 days. During 773.6 person-years follow-up, condyloma developed in 10 (8.6%) vaccinated patients (incidence of 3.7 per 100 person-years) and 37 (18.8%) unvaccinated patients (incidence 7.3 per 100 person-years; p = 0.05). Multivariable hazards ratio showed that qHPV was associated with decreased risk of anal condyloma development (HR 0.45; 95% CI 0.22–0.92; p = 0.03). History of anal condyloma was associated with increased risk of anal condyloma development (HR 2.28; 95% CI 1.28–4.05; p = 0.005), as was infection with oncogenic HPV (HR 3.87; 95% CI 1.66–9.03; p = 0.002).ConclusionsAmong MSM 26 years of age and older with and without history of anal condyloma, qHPV reduces the risk of anal condyloma development. A randomized controlled trial is needed to confirm these findings in this age group.

HPV vaccine acceptability in HIV-infected and HIV negative men who have sex with men (MSM) in Ireland

“…While current guidelines recommend HPV vaccine for MSM up to the age of 26 years, emerging evidence suggests that HPV vaccine may have efficacy beyond primary prevention and thus may be of benefit in older MSM. 16,17 In this context, investigating the acceptability of HPV vaccine in a group that includes MSM >26 years is of relevance.…”

“…16 The HPV-4v has also shown to be effective for the prevention of anal condyloma of older MSM. 17 The Joint Commission on Immunisation and Vaccination (JCVI) in the UK are reviewing the cost effectiveness of universal vaccination of boys and girls through the national immunization program as well as targeted vaccination of MSM aged 16-40 years in sexual health and HIV clinics. 18 When considering the feasibility of targeted HPV vaccination, it is important to examine vaccine acceptability and factors influencing acceptability as low vaccine uptake will fail to reduce HPV-related diseases.…”

Long-Term Outcomes of Adding HPV Vaccine to the Anal Intraepithelial Neoplasia Treatment Regimen in HIV-Positive Men Who Have Sex With Men

“…Moreover, to be economically unattractive (ie, to cross a conservative willingness-to-pay threshold of $50 000/ QALY), the hazard ratio for the vaccination strategy should be >0.98 for the first and subsequent years. Based on data from published observation studies on the prevention of recurrent anal neoplasia and anal condyloma in men [8,9] and similar findings observed in the prevention of cervical neoplasia in women [28], the qHPV vaccine is expected to prevent recurrent precancerous lesions with moderate to high effectiveness. Therefore, it is unlikely that adjuvant vaccination in HIV-positive MSM will not be cost-effective.…”

“…The current CDC vaccination guidelines do not recommend qHPV vaccination after age 26 years; however, emerging evidence suggests that the vaccine is beneficial as a secondary/adjuvant prevention strategy for the prevention of recurrent anal neoplasia and recurrent condyloma in older men [8,9]. For example, qHPV vaccination of older MSM who had a history of highgrade anal intraepithelial neoplasia (HGAIN) was associated with a 50% reduction in the risk of recurrent HGAIN [8].…”

HPV Vaccination for MSM: Synthesis of the evidence and recommendations from the Québec Immunization Committee

“…14 Previous studies showed heterogeneous results regarding vaccine efficacy in preventing recurrences of anal lesions associated with HPV types to which MSM had been previously exposed. [39][40][41] Post-HPV program (girls-only) implementation studies showed not only a large decrease in genital warts among women in age cohorts to have been vaccinated, but also a statistically significant decrease in these lesions among heterosexual men (34%-80% in the under 20 or 21 age group after 3 or 4 years, depending on the studies). This herd effect was not observed in the MSM population.…”