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High-Risk Anal Human Papillomavirus (HPV) Types in Australian Homosexual Men – Predictors, Prevalence and Patterns of Infection.

High-Risk Anal Human Papillomavirus (HPV) Types in Australian Homosexual Men – Predictors, Prevalence and Patterns of Infection.

HPV causes around 90% of anal cancer, and HPV16, causes 90% of HPV-positive cases. Morbidity and mortality from HPV-related diseases are markedly higher among homosexual men. We describe the prevalence of anal HPV, the potential predictors of anal high-risk (HR) HPV and HPV16, and incidence and clearance of HPV16, in a cohort of Australian homosexual men.

The Study for the Prevention of Anal Cancer is a three-year prospective study of HIV-negative and positive homosexual men aged ≥ 35 years. Participants complete behavioural questionnaires and undergo anal canal examination. An anal swab is analysed using liquid-based anal cytology (ThinPrep®). Thinprep® medium is used for HPV genotyping by Roche Linear Array.

By March 2013, 342 participants (median age 49 years; 28.7% HIV positive) had attended a baseline visit. Almost two thirds had at least one HR genotype (64.4%) and almost a third had HPV16 (30.3%) detected. HR-HPV detection was significantly associated with positive HIV status (p=0.010), younger age (p=0.007), more lifetime (p=0.013) and recent (p=0.005) male sexual partners, more receptive anal behaviours in the last 6 months, including unprotected (p=0.001) and protected (p=0.019) intercourse, rimming (p<0.001) and fingering (p=0.004). HPV16 detection was only associated with a recent history of receptive fisting (p=0.049). The incidence of anal HPV16 infection was 5.6 per 100PY (HIV negative 3.66 vs HIV positive 10.00 per 100PY, HR 2.74, 95% CI 0.73-10.27). Clearance of HPV16 (30.67 per 100 PY ) was similar among HIV positive and negative participants (27.69 vs 32.54 per 100 PY, HR 0.91, 95% CI 0.32-2.57).

HR anal HPV was extremely common in this cohort of homosexual men. Incident HPV16 infection was more frequent among HIV positive participants, however clearance was similar among all men. Receptive anal sexual practices and recent sexual activity were important predictors of HR-HPV detection.

Speakers: Dr Mary Poynten
Areas of Interest / Categories: AIDS 2014

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