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Incidence, Clearance, and Persistence of Anal Human Papillomavirus in Men Who Have Sex With Men Living With Human Immunodeficiency Virus

Implications for Human Papillomavirus Vaccination

Ong, Jason J., PhD*†‡; Walker, Sandra, DPsych; Grulich, Andrew, PhD§; Hoy, Jennifer, MBBS; Read, Tim R.H., PhD*‡; Bradshaw, Catriona, PhD*‡; Chen, Marcus, PhD*‡; Garland, Suzanne M., MD**††; Cornall, Alyssa, PhD**††; Hillman, Richard, MD‡‡; Templeton, David J., PhD§§§¶¶; Hocking, Jane, PhD***; Eu, Beng, MBBS†††; Tee, BK, MBBS‡‡‡; Chow, Eric P.F., PhD*‡; Fairley, Christopher K., PhD*‡

Sexually Transmitted Diseases: April 2019 - Volume 46 - Issue 4 - p 229–233
doi: 10.1097/OLQ.0000000000000958
Original Studies

Background Men who have sex with men living with human immunodeficiency virus have a high risk of anal cancer. We estimate the likely benefit of human papillomavirus (HPV) vaccination among participants of the Anal Cancer Examination study.

Methods Anal swabs were collected for the detection and genotyping of anal HPV DNA by linear array (Roche Diagnostics) in this 2-year multicenter prospective cohort. We calculated the proportion of men, stratified by age, without detectable vaccine type-specific DNA.

Results Overall, 255 men, with a median age of 50 years (interquartile range, 44–56 years) contributed 488.9 person-years of follow-up. After 2 years of follow-up, 149 (58%; 95% confidence interval [CI], 52–65) had at least 1 high-risk HPV (HRHPV), and 71 (28%, 95% CI, 22–34) had HPV types 16/18 detected. Assuming that DNA-negative men would receive vaccine protection, vaccination at baseline could potentially prevent HRHPV infection in 10.2% of men (95% CI, 6.8–14.6, 26 of 255) 2 years later from incident HRHPV covered by the bivalent and quadrivalent vaccine, and 29.4% of men (95% CI, 23.9–35.4, 75/255) from incident HRHPV covered by the nonavalent vaccine.

Conclusion Though there is high prevalence of anal HPV in men who have sex with men living with human immunodeficiency virus, there was also a high incidence of HRHPV vaccine types in the 2-year follow-up, indicating potential for prevention if these men were not previously infected with HPV vaccine types and were vaccinated at their baseline visit.

In a 2-year prospective study, high incidence of high-risk human papillomavirus vaccine types in men who have sex with men living with human immunodeficiency virus indicate potential for prevention if these men were vaccinated.

From the *Central Clinical School, Monash University, Victoria, Australia,

London School of Hygiene and Tropical Medicine, London, United Kingdom,

Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria;

§Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia,

Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne;

**Department of Obstetrics and Gynaecology, University of Melbourne;

††Department of Microbiology in Infectious Diseases, Royal Women's Hospital, Murdoch Children's Research Institute, Parkville, Victoria;

‡‡HIV, Immunology and Infectious Disease, St Vincent's Hospital, Darlinghurst, NSW, Australia,

§§RPA Sexual Health, Sydney Local Health District;

¶¶Sydney Medical Medical School, The University of Sydney, Sydney, NSW;

***Melbourne School of Population and Global Health, University of Melbourne, Parkville;

†††Prahran Market Clinic, Prahran; and

‡‡‡The Centre Clinic, Victorian AIDS Council, St Kilda, Victoria, Australia

Acknowledgments: The authors would like to thank Sandra Walker for her assistance in coordinating the trial. The authors also thank all participants of the study and the research coordinators from the various clinical sites—Stuart Cook, Sally Price and Danielle Collins.

Sources of Funding: This work was supported by the Australian National Health and Medical Research Council (NHMRC) Program grant (568971). J.J.O., E.P.F.C., and T.R.H.R. are supported by the Australian NHMRC Early Career Fellowships [grant numbers J.J.O., 1104781; E.P.F.C., 1091226; T.R.H.R., 1091536].

All authors declare that they have no conflicts of interests. The study was funded by the Australian National Health and Medical Research Council.

Correspondence: Jason Ong, 580 Swanston Street, Carlton Victoria 3053 Australia. E-mail:

Received for publication July 19, 2018, and accepted November 20, 2018.

© Copyright 2019 American Sexually Transmitted Diseases Association