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

Vaccine Effectiveness Against Anal HPV Among Men Who Have Sex With Men Aged 18-45 Years Attending Sexual Health Clinics in 3 United States Cities, 2018-2023

BACKGROUND

We assessed human papillomavirus (HPV) vaccine effectiveness (VE) against anal HPV among men who have sex with men (MSM) in 2018-2023.

METHODS

Residual anal specimens from MSM without HIV aged 18-45 years were tested for HPV. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between vaccination (≥1 dose) and quadrivalent vaccine (4vHPV)-type prevalence adjusting for city, race/ethnicity, and nonvaccine-type HPV prevalence, stratified by age group (18-26, 27-45 years). VE was calculated as (1 - aPR) × 100.

RESULTS

Among 2802 persons aged 18-26, 4vHPV-type prevalence was lower in those vaccinated at age <18 (aPR = 0.13; 95% CI, .08-.22; VE = 87%) and those vaccinated ≥2 years before specimen collection (aPR = 0.52; 95% CI, .42-.64; VE = 48%) compared with unvaccinated persons. Among 3548 persons aged 27-45, 4vHPV-type prevalence was lower in those vaccinated at ages 18-26 (aPR = 0.68; 95% CI, .57-.82; VE = 32%) and those vaccinated ≥2 years before specimen collection (aPR = 0.66; 95% CI, .57-.77; VE = 33%) compared with unvaccinated persons. While we observed no VE in persons vaccinated at age >26 overall, 4vHPV-type prevalence was lower in the subgroup vaccinated ≥2 years before specimen collection (aPR = 0.71; 95% CI, .56-.89; VE = 29%).

CONCLUSIONS

We found high VE against anal 4vHPV-type prevalence among MSM aged 18-26 who were vaccinated at age <18. Lower VE was observed among MSM aged 27-45 who were vaccinated at age 18-26 or ≥2 years before specimen collection. While ideally vaccination should be given at younger ages, vaccination can prevent some future infections in this population.

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.

Detecting and genotyping high-risk human papillomavirus among male patients during 2015-2023 in Beijing, China

Few studies focused on human papillomavirus (HPV) in male patients. This study aimed to explore the detection rate and genotyping of HPV among male patients in Beijing to provide a reference for formulating prevention strategies for HPV infection. The cross-sectional study was conducted in Beijing Chaoyang Hospital from November 2015 to March 2023. It covered male patients from the urology and dermatology departments. Fifteen high-risk HPV genotypes were detected by the multiplex real-time polymerase chain reaction method. The overall detection rate of HPV was 25.19% (1288/5114, 95% confidence interval [CI] 24.00%-26.38%), of which the single infection rate was 16.99% (869/5114, 95% CI 15.97%-18.05%) and the co-infection rate was 8.19% (419/5114, 95% CI 7.46%-8.98%). The detection rate of HPV was 40.77% (521/1278), 35.58% (58/163), 32.69% (101/309), 31.91% (60/188), 12.63% (299/2367), and 32.35% (131/405) among male patients with balanitis, warts, rash, urethritis, prostatitis, and other urinary inflammation, respectively (P < 0.001). The top five HPV genotypes were HPV-52, HPV-58, HPV-16, HPV-51, and HPV-66. After the first positive HPV test, the proportion of male patients who turned negative was 22.47% within 3 months, 26.40% within 3-6 months, 24.72% within 6-12 months, 17.98% within 12-24 months, and 8.43% more than 24 months. The detection rate of HPV was high among male patients from the urology and dermatology departments in Beijing, which should be considered to develop HPV vaccines with better prevention effects.

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.

Anal HPV prevalence in individuals with and without other concomitant sexually transmitted infections

The association between human papillomavirus (HPV) and other sexually transmitted infections (STIs) in anal lesions still remains unclear. Aim of the study was to evaluate the prevalence of simultaneous infection of HPV and Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis in individuals screened for HPV anal infection. A total of 507 anal samples were tested for both anal HPV and STIs: 16% resulted positive for one or more non-HPV STIs. Specifically, C. trachomatis, M. genitalium, and N. gonorrhoeae were detected in 8%, 5%, and 4% of cases, respectively. Two groups were considered, including a positive STI group and a negative STI group. The prevalence of HPV was similar in patients in both groups: high risk (HR)-HPV and low risk (LR)-HPV were 67% and 53% versus 62% (p = 0.361) and 54% (p = 0.864) of patients, respectively. However, HPV 16, 18, 35, 51, 59, and 69 were significantly more frequent in patients tested positive for other STIs versus HPV infection alone (p < 0.05). No significant differences between the two groups were observed in vaccination coverage, 28% versus 32% (p = 0.463), and HIV status, 86% versus 84% (p = 0.658). The study shows that the overall HPV status is not directly correlated to other STIs in the investigated population, except for certain HPV types, including HR-HPV 16, reinforcing the urge for a greater vaccination coverage.