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J Infect Dis. 2018 Apr 23;217(10):1535-1543. doi: 10.1093/infdis/jiy059.

Prevalence and Risk Factors for Anal Human Papillomavirus Infection in Human Immunodeficiency Virus-Positive Men Who Have Sex with Men.

Author information

1
International Agency for Research on Cancer, Lyon.
2
Centre National de Référence des HPV, Institut Pasteur, Paris.
3
Hôpital Tenon, AP-HP, Paris.
4
Service d'Immuno-Hématologie Clinique, Université Aix Marseille, APHM Sainte-Marguerite, Marseille.
5
Inserm U912 (SESSTIM), Marseille.
6
Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, AP-HP, Paris.
7
Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Rennes.
8
Département d'Infectiologie, CHU de Dijon.
9
INSERM CIC 1432, Université de Bourgogne, Dijon.
10
Département d'Hépato-Gastroentérologie, CHU Saint Eloi et Université de Montpellier, Montpellier.
11
Département d'Infectiologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon.
12
Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges.
13
ANRS (France Recherche Nord et Sud Sida-HIV et Hépatites), Paris.
14
Service d'Anatomie et Cytologie Pathologiques, Hôpital Saint-Antoine, GH HUEP, AP-HP, Paris.
15
Faculté de Médecine Sorbonne Université, Paris.
16
Service de Proctologie Médico-Interventionnelle, Groupe Hospitalier Diaconesses Croix-Saint-Simon, Paris, France.

Abstract

Background:

We assessed prevalence and risk factors for anal human papillomavirus (HPV) in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM), who are at high-risk of HPV-related anal cancer.

Methods:

APACHES is a multicentric, prospective study of anal HPV infection and lesions in HIV-positive MSM aged ≥35 years. At baseline, participants underwent anal swabs for HPV and cytology, plus high-resolution anoscopy. High-risk HPV (HR-HPV) was tested by Cobas4800, with genotyping of HR-HPV positives by PapilloCheck.

Results:

Among 490 participants, prevalence of HPV16 and HR-HPV was 29% and 70%, respectively, and did not differ significantly by age, sexual behavior, or markers of HIV or immune deficiency. Smoking was the only, albeit weak (odds ratio, 1.8; 95% confidence interval, 1.2-2.7), predictor of HR-HPV. High-risk HPV and HPV16 prevalence increased strongly with anal diagnosis severity, both by worse cytological/histological (composite) diagnosis at APACHES baseline and worse historical diagnosis. HPV16 rose from 19% among participants who were negative for lesions to 63% among participants with high-grade lesions. In contrast, non-HPV16 HR-HPVs were less prevalent in high-grade (37%) than negative (64%) composite diagnosis, and their causal attribution was further challenged by multiple HPV infections.

Conclusions:

Human papillomavirus 16 is ubiquitously frequent among human immunodeficiency virus -positive men having sex with men, and more strongly associated with high-grade anal lesions than other high-risk types, confirming it as a target for anal cancer prevention.

PMID:
29394362
DOI:
10.1093/infdis/jiy059

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