Anal HPV prevalence high among young MSM regardless of HIV status
Anal HPV prevalence is high among men who have sex with men regardless of their HIV status, according to the results of a systematic review published in The Lancet HIV.
The finding, from a pooled analysis of more than 60 studies that included almost 30,000 participants, “highlights the benefits of gender-neutral HPV vaccination before sexual activity over catch-up vaccination,” Feixue Wei, PhD, a postdoctoral scientist at WHO’s International Agency for Research on Cancer, and colleagues wrote.
“Robust age-specific estimates of anal human papillomavirus and high-grade squamous intraepithelial lesions (HSIL) in men can inform anal cancer prevention efforts,” they wrote. “We aimed to evaluate the age-specific prevalence of anal HPV, HSIL, and their combination, in men, stratified by HIV status and sexuality.”
Wei and colleagues performed a systematic review for studies on anal HPV infection in men and a pooled analysis of individual-level data from eligible studies of four groups HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive men who have sex with women (MSW) and HIV-negative MSW.
Weis and colleagues said they invited authors of eligible studies with 200 participants or more to share deidentified individual-level data on “type-specific HPV infection (at least HPV16), detected by use of a PCR-based test from anal swabs, HIV status, sexuality (MSM, including those who have sex with men only or also with women, or MSW), and age.”
They also invited the authors of studies including 40 or more HIV-positive MSW or 40 or more men from Africa — regardless of their HIV status or sexuality — to share these data.
Overall, the analysis included 64 studies with data on 29,900 men.
According to the study, among HIV-negative MSW, HIV-negative MSM, HIV-positive MSW and HIV-positive MSM, the prevalence of HPV16 was 1.8%, 8.7%, 13.7% and 28.5%, respectively, and the prevalence of anal high-risk (HR)-HPV was 6.9%, 26.9%, 41.2% and 74.3%, respectively.
Broken down by age, the study showed that HPV16 prevalence among HIV-positive MSM was 5.6% among those aged 15 to 18 years of age, 28.8% among those aged 23 to 24 years (Ptrend = .0091), 31.7% among those aged 25 to 34 years and 22.8% among those aged 55 and older (Ptrend < .0001).
Among HIV-negative MSM, the prevalence of HPV16 was 6.7% among those aged 15 to 18 years of age, 13.9% among those aged 23 to 24 years (Ptrend = .0076) and then plateaued (Ptrend = .72). Wei and colleagues found no significant differences for HPV16 or HR-HPV by age for either HIV-positive or HIV-negative MSW.
Additionally, the study showed that HSIL+ detection ranged from 7.5% to 54.5% in HIV-positive MSM. After adjusting for heterogeneity, the researchers found that HIV was a significant predictor of HSIL+ (aPR = 1.54; 95% CI, 1.36-1.73), HPV16-positive HSIL+ (aPR = 1.66; 95% CI, 1.36-2.03) and HSIL+ in HPV16-positive MSM (aPR = 1.19%; 95% CI, 1.04-1.37). This HSIL+ prevalence increased with age among HPV16-positive MSM.
“These data can inform the development of various anal cancer prevention efforts, both through primary prevention (ie, vaccination against HPV or prevention and control of HIV infection) and secondary prevention (eg, the potential screening of high-risk populations, such as people living with HIV), with the aim of detecting and managing HSIL, especially HPV16-positive HSIL,” the authors wrote. “Our findings indicate that the prevalence of HPV16-positive anal HSIL in the HIV-positive MSM population is high, and that anal cancer screening research and initiatives should be prioritized in this group.”