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Prevalence of anal HPV infection and anal HSIL among MSM 50 years and older living with or without HIV
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Hernandez, Alexandra L. PhD, MPH1,2; Hilton, Joan F. DSc, MPH3; Weatherly, Christopher Scott DO, MPH4; Berry-Lawhorn, J. Michael MD1; Jay, Naomi NP, PhD1; Brickman, Cristina MD1; Wang, Chia-ching J MD5; Kauffman, Jason MD6,aff6; Calderon, Joanne MD1; Farhat, Sepideh MS1; Costa, Maria DA MS1; Akha, Arezou Sadighi MD, MS1; Darragh, Teresa MD5,7; Palefsky, Joel M. MD1
JAIDS May 2, 2024
This is the first study that we are aware of that focused exclusively on evaluating anal HPV, anal HSIL, and HIV status among MSM ages 50 and over. We found the prevalence of anal HSIL, the precursor to anal cancer, to be high (37-47%) among both MSMLWH and MSM-not-LWH who are 50 years of age and older. even men in our oldest age group of 70 and older had a high prevalence of anal HSIL (MSMLWH, 55%, and MSM-not-LWH, 33%).
In summary, a large proportion of both older MSMLWH and MSM-not-LWH have the most important risk factors for anal cancer currently, anal HPV infection and anal HSIL. As the population of MSMLWH continues to age, public health professionals need to consider these older populations in their prevention strategies, as public health campaigns aimed at younger men may not reach or resonate with older MSM.20 In addition, the recent evidence that treatment of anal HSIL prevents anal cancer14, paired with the high prevalence of these risk factors in older MSM, warrant a recommendation that older MSM, regardless of HIV status, be considered for anal cancer screening.
Abstract
Background:
Anal cancer is caused by human papillomavirus (HPV), particularly HPV-16, and is preceded by anal high-grade squamous intraepithelial lesions (HSIL). The incidence of anal cancer is highest among men who have sex with men (MSM) living with HIV (MSMLWH) and increases with age. However, most previous studies of anal HPV infection and anal HSIL were performed on men under 50 years of age, and relatively little is known about HSIL among older MSMLWH or MSM not living with HIV (MSM-Not-LWH).
Setting:
We enrolled MSM who were aged 50+ during 2018-2022 in San Francisco, California.
Methods:
129 MSMLWH and 109 MSM-not-LWH participated. All participants had anal HPV DNA testing (Atila Biosystems) and high-resolution anoscopy with biopsy of visible lesions.
Results:
Among MSMLWH, 47% had anal HSIL, 19% had HPV-16, and 51% had other oncogenic anal HPV types (excluding HPV-16). Among MSM-not-LWH, 37% had anal HSIL, 22% had HPV-16, and 34% had other oncogenic anal HPV types. Increasing age was not statistically associated with prevalent HSIL, HPV-16, or other oncogenic HPV infections in MSMLWH or MSM-not-LWH. HPV-16 (OR:45.1, 95% CI:15.8-129), other oncogenic HPV types (OR:5.95, 95% CI:2.74-12.9) were associated with increased odds of anal HSIL, adjusted for age, income, education, and HIV status.
Conclusion:
The prevalence of oncogenic anal HPV, anal HPV-16, and anal HSIL remain very high in older MSMLWH and MSM-not-LWH. With recent evidence showing that treating anal HSIL prevents anal cancer, MSM aged 50+ should be considered for anal cancer screening.
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