The effect of HIV infection on anal and penile human papillomavirus incidence and clearance

Mooij, Sofie H.; Santen, Daniëla K van; Geskus, Ronald B.; Sande, Marianne A. B. van der; Coutinho, Roel A.; Stolte, Ineke G.; Snijders, Peter J.F.; Meijer, Chris J.L.M.; Speksnijder, A.G.C.L.; Vries, Henry J C de; King, Audrey J.; Eeden, Arne van; Loeff, Maarten F. Schim van der

doi:10.1097/qad.0000000000000909

Cited by 51 publications

(72 citation statements)

References 26 publications

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“…Regarding anal HPV infections, the prevalence that we found is similar to that reported in other studies . HPV‐16 appeared to be the most prevalent genotype in both study groups, and this might be explained by the high incidence and long persistence of this genotype in anal infections, as shown by longitudinal studies …”

Section: Discussionsupporting

confidence: 89%

Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer

Donà

Benevolo

Latini

et al. 2018

Cancer Cytopathology

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The prevalence of anal cytological lesions is high in MSM, even in HIV-infected individuals treated with combined antiretroviral therapy. In these subjects, HSILs occur more frequently and at a younger age in comparison with HIV-uninfected counterparts. Specific diagnostic procedures should be implemented to manage individuals at increased risk for anal cancer with an abnormal anal Papanicolaou test. Cancer Cytopathol 2018. © 2018 American Cancer Society.

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Section: Discussionsupporting

confidence: 89%

Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer

Donà

Benevolo

Latini

et al. 2018

Cancer Cytopathology

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“…21 Furthermore, a study on human papillomavirus acquisition and clearance among MSM estimated different clearance rates between the anorectal and urogenital locations, suggesting that individual-level clearance is not necessary. 22 The transmission probability per vaginal sex act found here was lower than that found in previous chlamydia models. Most pair models estimated transmission probabilities between 6% and 17% 14 23 compared with 2% in our study.…”

Section: Discussioncontrasting

confidence: 73%

What explains anorectal chlamydia infection in women? Implications of a mathematical model for test and treatment strategies

et al. 2016

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ObjectivesFemale anorectal Chlamydia trachomatis (chlamydia) infections are common irrespective of recent anal sex. We explored the role of anorectal infections in chlamydia transmission and estimated the impact of interventions aimed at improved detection and treatment of anorectal infections.MethodsWe developed a pair compartmental model of heterosexuals aged 15–29 years attending STI clinics, in which women can be susceptible to or infected with chlamydia urogenitally and/or anorectally and men urogenitally. Transmission probabilities per vaginal and anal sex act, together with an autoinoculation probability, were estimated by fitting to anatomic site-specific prevalence data (14% urogenital; 11% anorectal prevalence). We investigated the 10-year reduction in female chlamydia prevalence of interventions (universal anorectal testing of female STI clinic attendees or doxycycline use for urogenital chlamydia) relative to continued current care (anorectal testing on indication and doxycycline for anorectal and azithromycin for urogenital chlamydia).ResultsThe transmission probability per anal sex act was 5.8% (IQR 3.0–8.3%), per vaginal sex act 2.0% (IQR 1.7–2.2%) and the daily autoinoculation probability was 0.7% (IQR 0.5–1.0%). More anorectal chlamydia infections were caused by autoinoculation than by recent anal sex. Universal anorectal testing reduced population prevalence modestly with 8.7% (IQR 7.6–9.7%), yet the reduction was double that of doxycycline use for urogenital infections (4.3% (IQR 3.5–5.3%)) relative to continued current care.ConclusionsAutoinoculation between anatomic sites in women might play a role in sustaining high chlamydia prevalence. A shift to more anorectal testing of female STI clinic attendees may be considered for its (albeit modest) impact on reducing prevalence.

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“…No other associations comparing CD4 level ≤200 cells/μL and CD4 level >200 cells/μL were found (Figure b,c,d). The two studies providing estimates by CD4 count for incident HR‐HPV by HIV status (Figure b) also reported a test for trend: one was not statistically significant , while the other one was statistically significant ( p = 0.04) but suggested that incident HR‐HPV infection risk declined with decreasing CD4 count (Table ). Pooled estimates from the five studies that measured the effect of HIV on HPV clearance by CD4 count suggested that lower CD4 count reduced clearance of HPV, but non‐statistically significantly so (Figure c).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 6430 potential publications identified from the PubMed and Embase searches, 55 met our inclusion criteria. Figure summarizes publication selection, Table summarizes the characteristics of the included studies, and Tables ,,, (Appendix ) describe the extracted data and their quality.…”

Section: Resultsmentioning

confidence: 99%

Evidence of synergistic relationships between HIV and Human Papillomavirus (HPV): systematic reviews and meta‐analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status

et al. 2018

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IntroductionObservational studies suggest HIV and human papillomavirus (HPV) infections may have multiple interactions. We reviewed the strength of the evidence for the influence of HIV on HPV acquisition and clearance, and the influence of HPV on HIV acquisition.MethodsWe performed meta‐analytic systematic reviews of longitudinal studies of HPV incidence and clearance rate by HIV status (review 1) and of HIV incidence by HPV status (review 2). We pooled relative risk (RR) estimates across studies using random‐effect models. I 2 statistics and subgroup analyses were used to quantify heterogeneity across estimates and explore the influence of participant and study characteristics including study quality. Publication bias was examined quantitatively with funnel plots and subgroup analysis, as well as qualitatively.Results and DiscussionIn review 1, 37 publications (25 independent studies) were included in the meta‐analysis. HPV incidence (pooled RR = 1.55, 95% CI: 1.29 to 1.88; heterosexual males: pooled RR = 1.95, 95% CI: 1.62, 2.34; females: pooled RR = 1.63, 95% CI: 1.26 to 2.11; men who have sex with men: pooled RR = 1.36, 95% CI: 1.01 to 1.82) and high‐risk HPV incidence (pooled RR = 2.20, 95% CI: 1.90 to 2.54) was approximately doubled among people living with HIV (PLHIV) whereas HPV clearance rate (pooled RR = 0.53, 95% CI: 0.42 to 0.67) was approximately halved. In review 2, 14 publications (11 independent studies) were included in the meta‐analysis. HIV incidence was almost doubled (pooled RR = 1.91, 95% CI 1.38 to 2.65) in the presence of prevalent HPV infection. There was more evidence of publication bias in review 2, and somewhat greater risk of confounding in studies included in review 1. There was some evidence that adjustment for key confounders strengthened the associations for review 2. Misclassification bias by HIV/HPV exposure status could also have biased estimates toward the null.ConclusionsThese results provide evidence for synergistic HIV and HPV interactions of clinical and public health relevance. HPV vaccination may directly benefit PLHIV, and help control both HPV and HIV at the population level in high prevalence settings. Our estimates of association are useful for mathematical modelling. Although observational studies can never perfectly control for residual confounding, the evidence presented here lends further support for the presence of biological interactions between HIV and HPV that have a strong plausibility.

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The effect of HIV infection on anal and penile human papillomavirus incidence and clearance

Abstract: Increased anal and penile hrHPV incidence rates and decreased anal hrHPV clearance rates were found in HIV-infected compared with HIV-negative MSM, after adjusting for sexual behavior. Our findings suggest an independent effect of HIV infection on anal hrHPV infections.

Cited by 51 publications

References 26 publications

Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer

Anal cytological lesions and HPV infection in individuals at increased risk for anal cancer

What explains anorectal chlamydia infection in women? Implications of a mathematical model for test and treatment strategies

Evidence of synergistic relationships between HIV and Human Papillomavirus (HPV): systematic reviews and meta‐analyses of longitudinal studies of HPV acquisition and clearance by HIV status, and of HIV acquisition by HPV status

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