Incidence, Clearance and Persistence of Anal HPV in Men who Have Sex with Men Living with HIV: Implications for HPV Vaccination.

BACKGROUND: Men who have sex with men (MSM) living with HIV have a high risk of anal cancer. We estimate the likely benefit of HPV vaccination amongst participants of the Anal Cancer Examination (ACE) study.

METHODS: Anal swabs were collected for the detection and genotyping of anal HPV DNA by Linear Array (Roche Diagnostics) in this two-year multicentre prospective cohort. We calculated the proportion of men, stratified by age, without detectable vaccine-type-specific DNA.

RESULTS: Overall, 255 men, with a median age of 50 years (IQR 44-56) contributed 488.9 person-years of follow-up. After two years of follow up, 149 (58%, 95% CI:52-65) had at least one high-risk HPV (HRHPV), and 71 (28%, 95% CI:22-34) had HPV types 16/18 detected. Assuming that DNA negative men would receive vaccine-protection, vaccination at baseline could potentially prevent HRHPV infection in 10.2% of men (95% CI:6.8-14.6, 26/255) two years later from incident HRHPV covered by the bivalent and quadrivalent vaccine, and 29.4% of men (95% CI:23.9-35.4, 75/255) from incident HRHPV covered by the nonavalent vaccine.

CONCLUSION: Though there is high prevalence of anal HPV in MSM living with HIV, there was also a high incidence of HRHPV vaccine types in the two-year follow up indicating potential for prevention if these men were not previously infected with HPV vaccine types and were vaccinated at their baseline visit.