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Anal Human Papillomavirus Infection Among Thai Men Who Have Sex With Men With and Without HIV Infection: Prevalence, Incidence, and Persistence

Phanuphak, Nittaya MD*,†; Teeratakulpisarn, Nipat MD*; Pankam, Tippawan MMA*; Kerr, Stephen J. PhD‡,§; Barisri, Jiranuwat BSc*; Deesua, Amornrat RN*; Rodbamrung, Piyanee RN*; Hongchookiat, Piranun RN*; Chomchey, Nitiya RN; Phanuphak, Praphan MD, PhD*,†,‡,||; Sohn, Annette H. MD; Ananworanich, Jintanat MD, PhD*,†,‡,||; Palefsky, Joel M. MD#

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2013 - Volume 63 - Issue 4 - p 472–479
doi: 10.1097/QAI.0b013e3182918a5a
Clinical Science

Background: HIV-positive men who have sex with men (MSM) have a higher prevalence of anal human papillomavirus (HPV) infection and anal cancer incidence than HIV-negative MSM. High-risk HPV persistence is an important risk factor for the development of anal cancer.

Methods: A total of 123 HIV-positive and 123 HIV-negative MSM were enrolled from the Thai Red Cross AIDS Research Centre in Bangkok, Thailand, and followed for 12 months. Anal sample collection for HPV genotyping was performed at every visit. HPV prevalence, incidence, clearance, and persistence were calculated. A logistic regression model was used to study factors associated with high-risk HPV persistence.

Results: The prevalence of any anal HPV infection was 85% in HIV-positive and 58.5% in HIV-negative MSM (P < 0.0001). The prevalence of high-risk HPV infection was 57.5% in HIV-positive and 36.6% in HIV-negative MSM (P = 0.001). HPV 16 was the most common high-risk HPV type. HIV-positive MSM had a higher prevalence (22.5% vs. 9.8%, P = 0.008) and persistence (16.7% vs. 1.3%, P < 0.001) of HPV 16 than HIV-negative MSM and a trend for higher incidence (16.1 vs. 6.1 episodes/1000 person-months, incidence rate ratio 2.6, P = 0.058). HIV infection (odds ratio: 4.45, 95% confidence interval: 2.11 to 9.4, P < 0.001) and smoking in HIV-positive MSM (odds ratio: 2.3, 95% confidence interval: 1.17 to 4.5, P = 0.015) were independently associated with high-risk HPV persistence in multivariate models.

Conclusions: In addition to targeting HIV-positive MSM who are at higher risk for anal, high-risk HPV persistence, anal cancer prevention programs should also integrate behavioral interventions such as smoking cessation to modify risk for high-risk HPV persistence.

*The Thai Red Cross AIDS Research Centre, Bangkok, Thailand;

SEARCH, Bangkok, Thailand;

HIV-NAT, Bangkok, Thailand;

§The Kirby Institute for Infections and Immunity in Society, The University of New South Wales, Sydney, New South Wales, Australia;

||Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;

TREAT Asia/amfAR—The Foundation for AIDS Research, Bangkok, Thailand; and

#Department of Medicine, University of California San Francisco, San Francisco, CA.

Correspondence to: Nittaya Phanuphak, MD, 104 Rajdumri Road, Pathumwan, Bangkok 10330, Thailand (e-mail:

Supported by a grant from amfAR, The Foundation for AIDS Research through the US National Institutes of Health's International Epidemiologic Databases to Evaluate AIDS (U01AI069907): National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Cancer Institute.

The authors have no conflicts of interest to disclose.

The content of this presentation is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above.

Received December 28, 2012

Accepted February 24, 2013

© 2013 by Lippincott Williams & Wilkins