iconstar paper   HIV Articles  
Back grey arrow rt.gif
Risks of HPV Infection in Men, Heterosexual Men, Screening
  Download the PDF here
Download the PDF here
Download the PDF here
Anal squamous intraepithelial lesions and condyloma in HIV-infected heterosexual men, homosexual men and women: prevalence and associated factors [2008]
A pragmatic approach could be proposed: in homosexual men, the presence of HPV related lesion with histological sign of dysplasia in more than one fifth of patients suggests that this detection should include all homosexual HIV-infected men regardless of CD4 cell count or use of antiretrovirals, and especially in the case of frequent sexual activity and of history (even long past) of anal HPV lesions.. In heterosexual men and in women, detection should probably focus on patients with a history of HPV-related diseases and previous mentioned at-risk behaviors. This screening should also be accompanied by prevention information to help reduce the rate of the at-risk behaviors for HPV exposure.
Pdf attached


Anal Intraepithelial Neoplasia in Heterosexual and Homosexual HIV-Positive Men with Access to Antiretroviral Therapy [2004] pdf attached
------Sixty percent of participants reported a history of RAI, including all 46 homosexual men, 8 of 10 bisexual men, and 1 of 35 heterosexual men.
The rate of anal cancer is twice as high in HIV-positive than in HIV-negative MSM [7]. Investigators have used anal cytological testing and colposcopy to test for anal intraepithelial neoplasia (AIN), which are precancerous lesions that can progress to invasive cancer. A high incidence and prevalence of AIN have been reported in HIV-positive and -negative MSM [8-12].
High-risk HPV DNA was identified in 61%, and this was associated with a history of RAI (78% vs. 33%; P < .001); 47% had abnormal cytological results, and 40% had AIN on biopsy. In multivariate analysis, both were associated with a history of RAI (odds ratio [OR], 10 [P < .001] and OR, 3.6 [P=.02], respectively) and lower nadir CD4+ cell counts (P=.06 and P=.01). Current ART use was protective (OR, 0.09; P < .01 and OR, 0.18; P=.02).
Conclusions. Although anal infections with high-risk HPV and AIN in HIV-positive men are associated with a history of RAI, both conditions are commonly identified in HIV-positive men without this history. Both lower nadir CD4+ cell counts and lack of current ART were associated with AIN but not with the detection of anal HPV.
-----Participants were enrolled from June 2001 through March 2002. Clinicians referred men from the Columbia-Presbyterian Medical Center Infectious Diseases Clinic, an urban clinic that serves ∼1000 HIV-positive patients. The racial/ ethnic breakdown of the referring clinic is 60% Hispanic or Latino, 35% African American, and 5% white.
--- Our study also found that the nadir CD4+ cell count was significantly associated with AIN on histology in the multivariate analysis.
----Current use of ART was significantly associated with a lower prevalence of abnormal cytological results and AIN in the multivariate model. Substituting current plasma HIV RNA load for ART use yielded similar results (data not shown).
-----Our study does not provide direct evidence as to whether screening for AIN is clinically beneficial. An anal cancer screening program should identify patients with high-grade AIN for which there is a surgical intervention, which will reduce the risk of invasive carcinoma. Studies by Goldie et al. [32, 33] have suggested that cytological screening for anal cancer is cost-effective for HIV-positive and -negative men. However, those studies assumed reasonable levels of effectiveness for the treatment of high-grade AIN. There are few data on the efficacy of various treatment modalities for high-grade AIN
------We have demonstrated a high prevalence of AIN and anal HPV in a predominantly Latino and African American group of HIV-positive men. Although a history of RAI was strongly related to AIN, there was a significant prevalence (23%) in men without this history, 94% of whom self-identified as heterosexual. This suggests that RAI is not a necessary factor for anal HPV infection and AIN and is supported by the results of a recent study that found a high prevalence of high-grade AIN (18%) in heterosexual HIV-positive men with a history of intravenous drug use [20] and a study that found that husbands of women with cervical cancer are at an increased risk for anal cancer
[21]. In a study of HIV-positive women, 23% of participants without a history of RAI were found to have abnormal anal cytological results [22]. The questionnaire used in the present study, which provides a much more detailed sexual history than would be obtained in clinical practice, did not identify factors that reliably discriminated those at low risk for AIN. These data strongly suggest that, if instituting an anal cancer screening program, all HIV-positive men, regardless of sexual orientation, should be offered participation. Other researchers have made a similar claim to include all HIV-positive women in anal cancer screening programs, regardless of history of RAI [23].
Some of the types of HPV associated with genital cancers can lead to cancer of the anus or penis in men. Both of these cancer types are rare, especially in men with a healthy immune system. The American Cancer Society (ACS) estimates about 2,120 men in the U.S. will be diagnosed with cancer of the penis in 2017, and about 2,950 men will be diagnosed with anal cancer.
The risk of anal cancer is about 17 times higher in sexually active gay and bisexual men than in men who have sex only with women. Men who have HIV (human immunodeficiency virus) are also at higher risk of getting this cancer.
Most cancers that are found in the back of the throat, including at the base of the tongue and in the tonsils, are HPV related. In fact, these are the most common HPV-related cancers found in men. More than 13,000 new cases are diagnosed in men each year. Other types of HPV virus rarely cause cancer in men, but they do cause genital warts. At any given point in time, about 1% of sexually active men in the U.S. will have genital warts.
There is no routine test for men to check for high-risk HPV strains that can cause cancer. However, some doctors are urging anal Pap tests for gay and bisexual men, who are at higher risk of anal cancer caused by HPV. In an anal Pap test, the doctor collects cells from the anus, and then has them checked for abnormalities in a lab.
Treatments for HPV Infection in Men
There is no treatment for HPV infection in men when no symptoms are present. Instead, doctors treat the health problems that are caused by the HPV virus.
When genital warts appear, a variety of treatments can be used. The patient can apply prescription creams at home. Or a doctor can surgically remove or freeze off the warts. Early treatment of warts is discouraged by some doctors because genital warts can go away on their own. It can also take time for all warts to appear. So a person who treats warts as soon as they appear may need another treatment later on.
Anal cancer can be treated with radiation, chemotherapy, and surgery. The specific treatments depend on the stage of cancer -- how big the tumor is and how far the cancer has spread.
How to Prevent Spreading HPV
Abstinence is the only sure way to prevent HPV transmission. Risk of transmission can be lowered if a person has sex only with one person who is not infected and who is also monogamous.
To lower the risk of HPV transmission, men can also limit the number of sex partners and pick partners who have had few or no partners in the past.
Condoms can provide some protection against HPV transmission. Unfortunately, they aren't 100% effective, since HPV is transmitted primarily by skin-to-skin contact. The virus can still infect the skin uncovered by the condom
In a recent study of young women who had just become sexually active, those whose partners used a condom each time they had sex were 70% less likely to get an HPV infection than were women whose partners used a condom less than 5% of the time.
WebMD Medical Reference Reviewed by Nayana Ambardekar, MD on October 29, 2017

  iconpaperstack View Older Articles   Back to Top   www.natap.org