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Incidence of and risk factors for type-specific anal human papillomavirus infection among HIV-positive MSM

Hernandez, Alexandra L.a,b; Efird, Jimmy T.c; Holly, Elizabeth A.d; Berry, J. Michaela; Jay, Naomia; Palefsky, Joel M.a

doi: 10.1097/QAD.0000000000000254
Epidemiology and Social

Objective: HIV-positive MSM are at increased risk of anal human papillomavirus (HPV) infection compared with men in the general population, and little is known about the natural history of anal HPV infection in this population. The objective of this study was to determine the incidence of and risk factors for anal type-specific HPV infection.

Design: Prospective cohort study.

Methods: HIV-positive MSM were evaluated for anal HPV DNA, lifestyle factors, and sexual risk behaviors every 6 months for at least 2 years.

Results: The overall incidence rate of detectable type-specific anal HPV infection was 21.3 per 100 person-years [95% confidence interval (CI) 17.7–25.4] and was 13.3/100 person-years (10.5–16.6) for oncogenic HPV types. The most common incident infections were HPV 18 (3.7/100 person-years) and HPV 16 (3.5/100 person-years). An increased number of recent partners with whom the participant was the receptive partner [odds ratio (OR) 2.9 (1.6–5.1) 8+ partners vs. 0–1], an increased number of new partners in which the participant was the receptive partner [OR 1.03 (1.01–1.1) per partner], an increased number of new oral–anal contact partners in which the participant was the receptive partner [OR 1.1 (1.03–1.1) per partner], and the frequency of receptive anal intercourse [OR 1.1 (1.03–1.1) per act] all significantly increased the odds of incident HPV infection (P ≤ 0.05).

Conclusion: HIV-positive MSM have a high incidence of oncogenic anal HPV infection. Recent receptive anal sexual behaviors, including receptive anal intercourse and receptive oral–anal contact, are the most important risk factors for incident anal HPV infection.

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aDepartment of Medicine, University of California, San Francisco, San Francisco

bSchool of Public Health, Department of Epidemiology, University of California, Berkeley, Berkeley, California

cCenter for Health Disparities Research and Department of Public Health, Brody School of Medicine, Greenville, North Carolina

dDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.

Correspondence to Alexandra L. Hernandez, PhD, MPH, Division of Infectious Diseases, University of California, San Francisco, Box 0654, 513 Parnassus Ave, Room S420, San Francisco, CA 94143, USA. Tel: +1 415 502 0515; fax: +1 415 476 9364; e-mail:

Received 3 September, 2013

Revised 29 January, 2014

Accepted 5 February, 2014

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© 2014 Lippincott Williams & Wilkins, Inc.