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Nonavalent HPV Vaccine May Have Protected 77% of HIV+ Men With Anal HPV
  16th European AIDS Conference, October 25-27, 2017. Milan
Mark Mascolini
The nonavalent human papillomavirus (HPV) vaccine may have protected three quarters of men with HIV and anal HPV infection in a large single-clinic study [1]. The vaccine may have protected almost one third of men with oral HPV.
Researchers from the National Institute for Infectious Diseases in Rome noted that people with HIV have a 15- to 25-fold higher incidence of HPV-related anal cancer and 3-fold higher incidence of head and neck squamous cell carcinoma than people in the general population. Effective HPV vaccines are available and recommended in the United States for adolescent boys and girls and young men and women, especially men who have sex with men (MSM) and men with HIV infection [2].
The research team aimed to assess occurrence of oral and anal HPV-positivity and predictive factors for oral infection in HIV-positive men attending an outpatient sexually transmitted infection clinic in Rome from February 2015 through April 2017. Participants completed an interview and gave oral rinse and anal swab samples for HPV testing.
The analysis included 395 men with a median age of 44.4 years, 92% of them Caucasian. Most men (95.7%) were taking antiretroviral therapy, and 88.1% had a viral load below 40 copies. A large majority (86.3%) acquired HIV during sex with other men, while 8.4% picked up HIV during sex with women. Median time since HIV diagnosis stood at 6.8 years and median CD4 count at 705. About half of these men (47.3%) currently smoked, while 17.5% smoked in the past. Gay and bisexual men reported a median of 100 lifetime sex partners.
Seventy-nine of 395 men (20%) tested positive for oral HPV, 57 of whom (72%) had a single HPV type and 21 (27%) multiple HPV types. Determining how many men carried one of the nine HPV types covered by the nonavalent HPV vaccine, the researchers calculated that 23 of 78 men with oral HPV typing (29.5%) might have been protected by vaccination.
Among 395 men tested, 329 (83%) were positive for anal HPV, including 63 (19.1% of 329) carrying a single HPV type and 266 (80.9%) carrying multiple types. The investigators figured that 76.9% of men who tested positive for anal HPV may have been protected by the nonavalent HPV vaccine. Among 329 men with a positive anal or oral HPV test, only 71 (21.6%) were positive at both sites. Among these 71 dually infected men, 59 (83.1%) had completely different HPV types at each site, a result indicating separate timing or routes of infection.
Logistic regression analysis identified three variables strongly linked to oral cavity HPV infection at the following adjusted odds ratios (aOR) (and 95% confidence intervals):
-- Current smoking (versus former or never): aOR 1.63 (0.97 to 2.72), P = 0.063
-- More than 5 sex partner in past year (versus 0 or 1): aOR 2.46 (1.34 to 4.53), P = 0.004
-- CD4 count below 200 (versus higher): aOR 15.46 (2.96 to 80.81), P = 0.001
The researchers proposed that "HIV-positive MSM should be screened for both oral and anal HPV infection" and should be offered the nonavalent HPV vaccine.
1. Vergori A, Piselli P, Garbuglia A, et al. Multi-site HPV infection in HIV-positive men. 16th European AIDS Conference. October 25-27, 2017. Milan. Abstract PS7/4. 2. Centers for Disease Control and Prevention. HPV vaccines: vaccinating your preteen or teen. https://www.cdc.gov/hpv/parents/vaccine.html