Objective: Human papillomavirus (HPV) vaccination is routinely recommended in HIV-positive men who have sex with men (MSM) aged ≤26 years. Levels of previous HPV exposure in older HIV-positive MSM are assumed to be too high to warrant routine HPV vaccination. However, little is known about the prevalence of and risk factors for neutralizing antibody seropositivity to HPV-16 or HPV-18, a key measure of previous exposure to these types.
Methods: Cross-sectional analysis of baseline visit for 296 HIV-positive MSM participating in a prospective cohort study of anal squamous intraepithelial lesions at a university-based research clinic. Participants completed a questionnaire detailing behaviors and medical history. Phlebotomy, anal cytology, HPV DNA testing with quantitation, and high-resolution anoscopy with biopsy were performed. A pseudovirion-based neutralizing antibody assay was used to measure HPV-16 and HPV-18 neutralizing antibodies.
Results: One hundred thirty-two of 296 (45%) men were HPV-16 seropositive and 141 of 296 (48%) were HPV-18 seropositive. One hundred seventy-five of 296 (59%) of the men were positive for HPV-16 antibodies or DNA and 167 of 296 (56%) were positive for HPV-18 antibodies or DNA. In multivariable analysis, HPV-16 seropositivity did not correlate with age, years of HIV positivity, CD4+ level, or HIV viral load. Significant risk factors included HPV-16 DNA positivity with higher DNA levels (ptrend < 0.001) and higher number of receptive sexual partners in the last year (ptrend = 0.012).
Conclusions: A high proportion of HIV-positive MSM aged >26 years are DNA negative and seronegative to HPV-16 and HPV-18 even when using a sensitive pseudovirion-based neutralizing antibody assay. Prospective studies are needed to determine the clinical- and cost-effectiveness of HPV vaccination in HIV-positive MSM aged >26 years.
*Department of Medicine, University of California, San Francisco, San Francisco, CA;
†Department of Public Health, East Carolina University Greenville, NC;
‡British Columbia Centre for Disease Control Public Health Microbiology and Reference Laboratory, BC Centre for Disease Control, Vancouver, British Columbia, Canada;
§Department of Epidemiology and biostatistics, University of California, San Francisco; and
‖Department of Pathology, University of California, San Francisco.
Correspondence to: Joel M. Palefsky, MD, CM, FRCP(C), Department of Medicine, Box 0654, 513 Parnassus Avenue, Room S420, University of California, San Francisco, San Francisco, CA 94143 (e-mail: firstname.lastname@example.org).
Supported by the National Cancer Institute at the National Institutes of Health grants R01CA 54053 and U01 CA121947.
Poster presented at the 27th International Human Papillomavirus Conference and Clinical Work Shop, September 17–22, 2011, Berlin, Germany.
The authors have no conflicts of interest to disclose.
R.S. performed the neutralization assays, compiled the data, and cowrote the article. J.T.E. performed statistical analysis of the data. A.C. assisted in performing neutralization assays. E.A.H. helped to design the study and assisted in data analysis. M.K. assisted in development of the pseudovirion-based neutralizing antibody. J.M.B., T.M.D., and N.J. assisted in the collection of anal cytology and biopsy samples. T.M.D. performed cytological and histological interpretation of the cytology and biopsy samples. J.M.P. designed the study, assisted in data analysis, and cowrote the manuscript.
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Received May 08, 2013
Accepted July 28, 2013