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Prevalence, Clearance, and Incidence of Human Papillomavirus Type–Specific Infection at the Anal and Penile Site of HIV-Infected Men

Darwich, Laila DVM, PhD*†; Cañadas, Mari-Paz PhD*‡; Videla, Sebastian MD, PhD*; Coll, Josep MD; Molina-López, Rafael A. MSc, DVM, PhD*†; Sirera, Guillem MD, PhD; Clotet, Bonaventura MD, PhD*§¶on behalf of the Can Ruti HIV-HPV Team

doi: 10.1097/01.OLQ.0000430798.61475.08
Original Study

Background We studied the type-specific infection of human papillomavirus (HPV) at the anal canal and penile site in a cohort of HIV-infected men.

Methods Prevalence, clearance, and incidence of specific HPV types in the anal canal and penis were determined in 733 HIV-infected men from the Spanish CAn Ruti HIV+ Men ([CARH•MEN]) cohort (538 men who have sex with men [MSM] and 195 heterosexual men).

Results In both groups, the most prevalent high-risk type was HPV-16 (anal canal [31.6% MSM; 6.8% heterosexual] and penis [4.8% MSM; 6.8% heterosexual]). The most prevalent low-risk type was HPV-6 (anal canal [23.2% MSM; 12.8% heterosexual], penis [8.1% MSM; 8.9% heterosexual]). Anal prevalence was significantly higher in MSM, as was incidence, except for HPV-16, which was similar between male groups (5.9 new cases per 1000 person-months [95% confidence interval, 4.3–7.9] in MSM; 4.4 [95% confidence interval, 2.5–7.2] in heterosexual men; P > 0.05). The anal clearance rate of the different HPV types and retention time of infection were similar in both groups, as well as the HPV infection of the penis.

Conclusions HIV-infected MSM had a high prevalence of HPV infection at the anal canal; however, heterosexual HIV-infected men were also at risk for acquiring and sustaining persistent high-risk HPV types at the anal and penile site and are at risk for developing dysplasia in the future. All HIV-infected men should be recommended for routinely anal HPV screening.

Type-specific human papillomavirus infection was studied in 733 HIV-infected men. HIV-infected men who have sex with men and heterosexual men were at risk for acquiring and sustaining persistent high-risk human papillomavirus types at the anal canal and penile site.

From the *Lluita Contra La SIDA Foundation, Badalona, Spain; †Department of Sanitat i Anatomia Animal, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; ‡Labco.GeneralLab, Barcelona, Spain; §Irsicaixa Foundation, Badalona, Spain; and ¶HIV Clinical Unit, Department of Medicine, University Hospital Germans Trias i Pujol, UAB, Badalona, Catalonia, Spain

The authors are particularly grateful to the male patients of their HIV Unit. They also thank Mr Thomas O’Boyle for the English correction of this manuscript.

Supported by grants from Red de Investigación en SIDA, ART AIDS Foundation, Gilead Sciences, Obra Social Caixa Sabadell, and Gala contra la SIDA-Barcelona 2011.

S.V. has received honoraria for collaborating with Laboratorios Dr Esteve for work unrelated to HPV/HIV. B.C. has received honoraria for speaking and participating in advisory boards from Abbott, Bristol-Myers Squibb, Boehringer-Ingelheim, Gilead Sciences, GlaxoSmithKline, Pfizer, Merck, Janssen-Tibotec, and Siemens. The remaining authors have no conflict of interest.

Correspondence: Laila Darwich, DVM, PhD, Veterinary Faculty, Department of Sanitat i Anatomia Animal, Universitat Autònoma de Barcelona, Barcelona 08193, Spain. E-mail:

HIV-HPV Study Group:

University Hospital Germans Trias i Pujol, Badalona (Barcelona), Autonomous University of Barcelona:

• Department of Proctology: Ms P. Cobarsi

• Department of Surgery: Dr Francesc Garcia-Cuyas, Dr Marta Piñol

• Department of Pathology: Dr E. Castella, Dr M. Llatjos

• HIV Clinical Unit and Internal Medicine Department: Dr A. Bonjoch, Dr P. Echevarría, Dr M. Jabaloyas, Dr A. Jou, Dr JM. Llibre, Dr J. Moltó, Dr E. Negredo, Dr C. Rey-Joly, Dr J. Romeu, Dr JR. Santos, Dr C. Tural

• HIV Clinical Unit nurses: Ms.C. Alcalde, Ms R. Guerola, Ms A. Salas

• Lluita contra la SIDA Foundation: Ms.S. Gel Labco. GeneralLab, Department of Molecular Biology: Ms I. Castilla, Dr V. Cirigliano, Dr M. Ejarque, Ms E. López, Ms E. Ordóñez, Ms L. Rueda

Authors’ contributions: S. Videla, G. Sirera, and B. Clotet designed and wrote the study protocol; G. Sirera and J. Coll visited and interviewed the patients; L. Darwich and M.P. Cañadas performed human papillomavirus detection and genotyping with multiplex polymerase chain reaction; L. Darwich, MP. Cañadas, S. Videla, J. Coll, and B. Clotet wrote the manuscript; data management was performed by R. Molina-Lopez, L. Darwich, and S. Videla; and statistical analysis was performed by R. Molina-Lopez. All authors read and approved the final manuscript.

Received for publication October 23, 2012, and accepted April 30, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association