Increases in human papillomavirus vaccine coverage over 12 months among a community-recruited cohort of gay, bisexual, and other men who have sex with men in Canada

Human papillomavirus vaccination uptake among men who have sex with men living with HIV

BACKGROUND

Human papillomavirus (HPV) is a very common sexually transmitted infection. Persistent infection with high-risk subtypes can lead to a variety of cancers. Men who have sex with men (MSM), particularly those who are living with HIV (MSMLWH), have a high prevalence of HPV infection and are at greatest risk of HPV-related diseases such as anal cancer. HPV vaccines are effective in preventing new infections, and many countries have implemented HPV vaccination for MSM.

METHODS

This systematic review aimed to examine HPV vaccine uptake among MSM and MSMLWH. Quantitative studies published between 2010 and 2022 were screened and included if they detailed HPV vaccination uptake data for MSM and MSMLWH. Identified studies were screened using Covidence, data were extracted from the final included studies and narratively synthesised, and risk of bias of studies was assessed using the Joanna Briggs Institute Checklist tool for prevalence studies.

RESULTS

There were 19 studies all from high-income countries, included in the final review. This review showed a wide variety of HPV vaccine uptake, ranging from 2.7% to 91.5% for HIV-negative MSM and among MSMLWH ranging from 5.6% to 90%. Although limited by the heterogeneity of studies and settings, there was evidence of a consistent, steady increase in HPV vaccination particularly among younger men. MSMLWH generally had higher rates of HPV vaccination, but overall HPV vaccine uptake remained suboptimal.

CONCLUSION

MSMLWH are at high risk of HPV-related disease. Despite an available and efficacious vaccine in many countries, this review showed overall rates of HPV vaccination uptake remain inadequate. Further research and policy should aim to address and overcome barriers to HPV vaccination.PROSPERO registration numberCRD42023382251.

HPV vaccination and anal HPV infection in gay, bisexual, and other men who have sex with men

BACKGROUND

Gay, bisexual, and other men who have sex with men (gbMSM) have a higher risk of human papillomavirus (HPV) infection and related diseases and would benefit from preventive measures such as HPV vaccination. We assessed the association between HPV vaccination and anal HPV infection in HIV-negative gbMSM and gbMSM living with HIV from the Lubricant Investigation in Men to Inhibit Transmission of HPV Infection study.

METHODS

Participants attended 7 visits over 12 months where they provided a nurse-collected anal sample and self-completed a questionnaire on risk factors and HPV vaccination. Samples were tested for HPV using polymerase chain reaction assays. We assessed the association with HPV vaccination and anal HPV prevalence and incidence using logistic and Cox regression, respectively. Analyses at the individual- (unit of analysis = participant) and HPV-level (unit of analysis = HPV type) considered vaccine-targeted types (any of HPVs 6/11/16/18) as the outcome. To assess construct validity, we repeated analyses considering incidence of non-vaccine-targeted (within- and cross-species) HPV types at the HPV-level. Estimates were adjusted for a propensity score to predict cumulative HPV positivity based on selected study and participant characteristics.

RESULTS

Of 258 enrolled participants (18.2-71.7 years; 69 being HIV-positive), 23.3 % were vaccinated at baseline. At the individual-level, there was no association between vaccination and HPVs 6/11/16/18 prevalence (n = 250, aOR = 1.12, 95 % CI = 0.56-2.22) or incidence (n = 152, aHR = 0.34, 95 % CI = 2.19 × 10-18-1.38). At the HPV-level, while there was no association with HPVs 6/11/16/18 prevalence (n = 1000, aOR = 0.99, 95 % CI = 0.57-1.71), vaccination was associated with a reduction in HPVs 6/11/16/18 incidence (n = 754, aHR = 0.22, 95 % CI = 6.01 × 10-18-0.79). Vaccination was not associated with incidence of within-species (n = 2299, aHR = 0.76, CI = 0.42-1.24) or cross-species (n = 3774, aHR = 1.28, CI = 0.89-1.85) HPV types. Results were similar by HIV status.

CONCLUSION

Our findings support that HPV vaccination protects against incident anal infection of vaccine-targeted HPV types, thus, gbMSM should be encouraged to get vaccinated against HPV.

Prevalence, Determinants, and Trends in the Experience and Perpetration of Intimate Partner Violence Among a Cohort of Gay, Bisexual, and Other Men Who Have Sex with Men in Montréal, Toronto, and Vancouver, Canada (2017-2022)

Purpose: Longitudinal data on the experience and perpetration of intimate partner violence (IPV) among gay, bisexual, and other men who have sex with men (GBM) are limited. We estimated the prevalence of past 6-month (P6M) physical and/or sexual IPV (hereafter IPV) experience and perpetration, identified their determinants, and assessed temporal trends, including the impact of the coronavirus disease (COVID)-19 pandemic. Methods: We used data from the Engage Cohort Study (2017-2022) of GBM recruited using respondent-driven sampling in Montréal, Toronto, and Vancouver. Adjusted prevalence ratios (aPRs) for determinants and self-reported P6M IPV were estimated using generalized estimating equations, accounting for attrition (inverse probability of censoring weights) and relevant covariates. Longitudinal trends of IPV were also assessed. Results: Between 2017 and 2022, 1455 partnered GBM (median age 32 years, 82% gay, and 71% White) had at least one follow-up visit. At baseline, 31% of participants experienced IPV in their lifetime and 17% reported ever perpetrating IPV. During follow-up, IPV experience was more common (6%, 95% confidence interval [CI]: 5%-7%) than perpetration (4%, 95% CI: 3%-5%). Factors associated with P6M IPV experience included prior IPV experience (aPR: 2.68, 95% CI: 1.76-4.08), lower education (aPR: 2.31, 95% CI: 1.32-4.04), and substance use (injection aPR: 5.05, 95% CI: 2.54-10.05, non-injection aPR: 1.68, 95% CI: 1.00-2.82). Similar factors were associated with IPV perpetration. IPV was stable over time; periods of COVID-19 restrictions were not associated with IPV changes in this cohort. Conclusion: Prevalence of IPV was high among GBM. Determinants related to marginalization were associated with an increased risk of IPV. Interventions should address these determinants to reduce IPV and improve health.

Prevalence of Oral Human Papillomavirus Infection Among Urban Gay, Bisexual, and Other Men Who Have Sex With Men in Canada, 2017-2019

BACKGROUND

Oral human papillomavirus (HPV) infections are a leading cause of oropharyngeal cancers. In 2015 and 2016, HPV vaccines became publicly funded for gay, bisexual, and other men who have sex with men (GBM) under 27 years of age in most Canadian provinces.

METHODS

Between 2017 and 2019, sexually active GBM in Montreal, Toronto, and Vancouver were recruited through respondent-driven sampling. Participants aged 16-30 years were invited to self-collect oral rinse specimens for HPV testing. We estimated HPV prevalence in the oral tract overall and compared these by vaccination status.

RESULTS

Among the 838 GBM with a valid oral specimen, 36.9% reported receiving ≥1 dose of HPV vaccine. Overall, oral HPV prevalence was 2.6% (95% confidence interval [CI], 1.5%-3.7%) for at least 1 HPV type and 1.2% (95% CI, .5%-1.9%) for any high-risk type. We detected quadrivalent (HPV 6/11/16/18) vaccine-preventable types in 0.3% (95% CI, .0%-1.0%) of vaccinated individuals and 1.1% (95% CI, .1%-2.0%) of unvaccinated individuals.

CONCLUSIONS

Oral HPV prevalence was low in a population of young urban GBM in Canada, of whom 37% were vaccinated. Findings serve as a benchmark for monitoring of vaccination impacts on oral HPV infection within this priority population.

Unveiling the Therapeutic Horizon: HPV Vaccines and Their Impact on Cutaneous Diseases-A Comprehensive Review

Human papillomavirus (HPV) encompasses a diverse array of viruses, comprising approximately 200 serotypes that affect humans. While the majority of HPV strains are associated with benign skin or mucous membrane growths, a subset is implicated in severe health conditions, such as cervical, anal, vulvar, and vaginal cancers. Despite the established effectiveness of HPV vaccines in preventing cervical and anal carcinomas in particular, their therapeutic potential in addressing cutaneous diseases linked to diverse HPV strains remains an intriguing area of investigation. This narrative review critically examines the existing literature to assess the viability of HPV immunization as a therapeutic intervention for prevalent cutaneous conditions. These include genital and extragenital cutaneous warts, epidermodysplasia verruciformis, and keratinocyte carcinomas. The findings suggest a promising dual role for HPV vaccines in preventing and treating dermatologic conditions while emphasizing future research directions, including the immunization perspective against β-HPVs. Moreover, the presence of conflicting study outcomes underscores the imperative for larger-scale, randomized trials with well-matched control groups to validate the efficacy of HPV immunization in the dermatologic context. This review contributes valuable insights into the evolving landscape of HPV-vaccine applications in the field of dermatology.

Vaccine Effectiveness Against 12-Month Incident and Persistent Anal Human Papillomavirus Infection Among Gay, Bisexual, and Other Men Who Have Sex With Men

BACKGROUND

Real-world evidence of human papillomavirus (HPV) vaccine effectiveness (VE) against longitudinal outcomes is lacking among gay, bisexual, and other men who have sex with men (GBM). We compared 12-month incidence and persistence of anal HPV infection between vaccinated and unvaccinated GBM.

METHODS

We recruited GBM aged 16-30 years in Montreal, Toronto, and Vancouver, Canada, from 2017 to 2019. Participants were followed over a median of 12 months (interquartile range, 12-13 months). Participants self-reported HPV vaccination and self-collected anal specimens for HPV DNA testing. We calculated prevalence ratios (PR) for 12-month cumulative incidence and persistence with ≥1 quadrivalent vaccine type (HPV 6/11/16/18) between vaccinated (≥1 dose at baseline) and unvaccinated participants using a propensity score-weighted, modified Poisson regression.

RESULTS

Among 248 participants, 109 (44.0%) were vaccinated at baseline, of whom 62.6% received 3 doses. PRs for HPV 6/11/16/18 were 0.56 (95% confidence interval [CI], .24-1.31) for cumulative incidence and 0.53 (95% CI, .25-1.14) for persistence. PRs were 0.23 (95% CI, .05-1.03) and 0.08 (95% CI, .01-.59) for incidence and persistence, respectively, among participants who received their first dose at age ≤23 years and 0.15 (95% CI, .03-.68) and 0.12 (95% CI, .03-.54) among participants who were sexually active for ≤5 years before vaccination.

CONCLUSIONS

Findings support national recommendations for HPV vaccination at younger ages or soon after sexual debut.

Self-reported Human Papillomavirus Vaccination and Vaccine Effectiveness Among Men Who Have Sex with Men: A Quantitative Bias Analysis

BACKGROUND

Self-report of human papillomavirus (HPV) vaccination has ~80-90% sensitivity and ~75-85% specificity. We measured the effect of nondifferential exposure misclassification associated with self-reported vaccination on vaccine effectiveness (VE) estimates.

METHODS

Between 2017-2019, we recruited sexually active gay, bisexual, and other men who have sex with men aged 16-30 years in Canada. VE was derived as 1-prevalence ratio × 100% for prevalent anal HPV infection comparing vaccinated (≥1 dose) to unvaccinated men using a multivariable modified Poisson regression. We conducted a multidimensional and probabilistic quantitative bias analysis to correct VE estimates.

RESULTS

Bias-corrected VE estimates were relatively stable across sensitivity values but differed from the uncorrected estimate at lower values of specificity. The median adjusted VE was 27% (2.5-97.5th simulation interval = -5-49%) in the uncorrected analysis, increasing to 39% (2.5-97.5th simulation interval = 2-65%) in the bias-corrected analysis.

CONCLUSION

A large proportion of participants erroneously reporting HPV vaccination would be required to meaningfully change VE estimates.