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High Rates of Anal HPV Infection in Gay Men Using PrEP in IPERGAY: The Role of Vaccination

August 27, 2018

A substudy of the high-profile French PrEP study IPERGAY has reported alarmingly high rates of HPV infection in HIV-negative gay men.

Preliminary results were presented in a poster at AIDS 2018, by David Veyer and colleagues, categorised by HPV genotype and body site. Longitudinal follow-up is planned, but still ongoing.

This substudy was open to all participants and enrolled 162/414 (37%). Anal, oral and genital swabs were taken at baseline and every six months during two years of follow-up for HPV genotyping (19 high-risk and 9 low-risk). Anal cytology samples were obtained at baseline and at 18/24 months, with results classified as normal or abnormal (ASCUS, LSIL, HSIL, and ASC-H).

Baseline demographics for the substudy included median age 34 years (IQR: 27 to 41), with median of 34 partners in previous two months (IQR: 27 to 41), and median of having sex 10 times in the previous month (IQR: 6 to 20).

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More than 90% of the baseline anal samples showed any HPV genotype, with 76% of samples having >1 HPV infection. Presence of any high-risk genotype was 84% in anal tissue, 25% in genital tissue and 10% in oral tissue. Median (IQR) number of high-risk infections was 3 (1 to 4), 2 (1 to 3) and 1 (1 to 2) in each of the three sites respectively, see Table 1.

Although abnormal cytology results were reported for two-thirds of participants, and were associated with higher numbers of HPV infections per individual, this association was not considered significant due number of analyses performed. Overall, 4.5% of cytology results (n=7) were high-grade squamous intraepithelial lesions (HSIL).

Longitudinal data will be presented in the full analysis. No information was included in the poster about clinical treatment.


Table 1: Distribution of HPV Genotypes by Body Site (n=162)
Anal Genital Oral
Analysed samples/total samples (%) 146/157 (93%) 115/161 (71.4%) 156/159 (98.1%)
Any HPV genotype -- % (95% CI) 92% (87-96) 32% (23-41) 12% (7-17)
>1 HPV genotype -- % (95% CI) 76% (69-83) 17% (10-25) 3% (0.4-6)
Median no. of HPV genotypes (IQR) 4 (2-6) 2 (1-3) 1 (1-2)
Any HR HPV genotype -- % (95% CI) 84% (78-90) 25% (17-33) 10% (6-15)
>1 HR HPV genotype -- % (95% CI) 62% (54-70) 13% (7-20) 3% (0.1-5)
Median no. of HR HPV genotypes (IQR) 3 (1-4) 2 (1-3) 1 (1-2)
Any LR HPV genotype -- % (95% CI) 68% (60-75) 11% (6-17) 3% (0.4-6)
More than 1 LR HPV genotype -- % (95% CI) 34% (27-42) 4% (1-8) 1% (0-3)
Median no. of LR HPV genotypes (IQR) 2 (1-2) 1 (1-2) 1 (1-2)
HR HPV genotypes included in vaccine* -- % (95% CI) 38% (33-42) 36% (25-48) 41% (20-61)
LR HPV genotypes included in vaccine* -- % (95% CI) 26% (20-32) 21% (3-39) 33% (3-64)

* Gardasil 9 (MSD) -- HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58)


Comment

These data show the importance for gay men, especially young gay men, to be broadly informed and aware of the option in the UK to free HPV vaccination on the NHS. This programme extends to men up to 45 years old.

Several recent open access papers present similar incidence data for gay men in the UK, highlighting that oral HPV should be considered as a distinct infection and that sensitivity to high-risk genotypes shows the important likely efficacy of widespread vaccination for gay men.2,3


References

  1. Veyer D et al. Anal, oral and genital distribution of HPV in PrEP-users MSM: Results at baseline of the ANRS IPERGAY HPV sub-study.AIDS 2018, 23-27 July 2018, Amsterdam. Poster TUPEB056.
    http://programme.aids2018.org/Abstract/Abstract/2682
  2. King EM et al. Oral human papillomavirus (HPV) infection in men who have sex with men: prevalence and lack of anogenital concordance. Sex Transm Infect 2015;91:284-286.
    http://dx.doi.org/10.1136/sextrans-2014-051955
  3. King EM et al. Human papillomavirus DNA in men who have sex with men: type-specific prevalence, risk factors and implications for vaccination strategies. British Jof Cancer (112):1585-1593 (28 April 2015). DOI:10.1038/bjc.2015.90.
    www.nature.com/articles/bjc201590

[Note from TheBodyPRO: This article was originally published by HIV i-Base on Aug. 24, 2018. We have cross-posted it with their permission.]


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This article was provided by HIV i-Base. It is a part of the publication The 22nd International AIDS Conference. Visit HIV i-Base's website to find out more about their activities, publications and services.

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