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Hernandez AL, Weatherly CS, Gonzalez R, Farhat S, Da Costa M, Calderon J, Kauffman J, Akha AS, Hilton JF, Palefsky JM. Rationale and design of the Anal HPV, HIV and Aging (AHHA) study: Protocol for a prospective study of anal HPV infection and HSIL among men who have sex (MSM) or trans women living with and without HIV, ages 50 and older. FRONTIERS IN EPIDEMIOLOGY 2022; 2:992718. [PMID: 38455337 PMCID: PMC10910993 DOI: 10.3389/fepid.2022.992718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/06/2022] [Indexed: 03/09/2024]
Abstract
Introduction More than half of people living with HIV in the US are 50+ years old. Despite the benefits of antiretroviral therapy, older individuals with HIV are at higher risk for illnesses than their HIV-negative counterparts. Anal cancer, anal high-grade squamous intraepithelial lesions (HSIL), and anal HPV-16 infection occur most frequently among men who have sex with men living with HIV (MSMLWH). Men aged 60+ are 3-fold more likely to be diagnosed with anal cancer compared with younger men. Despite the increasing risk of anal cancer with age and HIV, little is known about the relationships among aging, HPV infection, HSIL and HIV. Methods and analysis The Anal HPV, HIV, and Aging (AHHA) Study is a two-stage project to evaluate the relationships among anal HPV infection, HSIL, HIV infection, and biomarkers of biological aging in MSM or trans women over the age of 50 years. Stage 1 will estimate the cross-sectional prevalence of both anal HPV infection and HSIL, based on outcomes of anal HPV DNA testing, and high-resolution anoscopy with biopsy. We will also study associations with study outcomes and serological biomarkers of inflammation (interleukin-6, C-reactive protein, D-dimer) and with the Veterans Aging Cohort Study Index and the Fried Frailty Phenotype using multivariable models. Participants living with HIV (n = 150) and HIV-negative participants (n = 150) will be enrolled. The 3-year Stage 2 longitudinal sample restricted to HSIL-negative and anal HPV-16 DNA-negative participants will estimate the 3-year incidence of both anal HSIL and anal HPV, stratified by HIV status through Cox proportional hazards regression. The effect of biomarkers of inflammation and markers of aging on study outcomes will be evaluated through multivariable repeated measures models stratified by HIV status. Ethics and dissemination This protocol was approved by the University of California, San Francisco Institutional Review Board (IRB: 16-18966). Results will be disseminated through presentations at national/international scientific conferences and publication in peer-reviewed journals.
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Affiliation(s)
- Alexandra L. Hernandez
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Public Health Program, College of Education and Health Sciences, Touro University, Vallejo, CA, United States
| | - Christopher Scott Weatherly
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, United States
| | - Ryan Gonzalez
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Sepideh Farhat
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Maria Da Costa
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Joanne Calderon
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jason Kauffman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Arezou Sadighi Akha
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Joel M. Palefsky
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Palefsky JM, Poongulali S, Lensing S, Lee J, Da Costa M, Chein A, Beulah F, Murugavel KG, Kumarasamy N. AIDS Malignancy Consortium 054: Safety and Immunogenicity of the Quadrivalent Vaccine in Indian Women Living With HIV. J Acquir Immune Defic Syndr 2021; 87:875-881. [PMID: 33587509 PMCID: PMC9310671 DOI: 10.1097/qai.0000000000002657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human papillomavirus (HPV)-associated cervical cancer is a leading cause of death among Indian women. Indian women living with HIV (WLWH) may be at especially high risk. The quadrivalent HPV (qHPV) vaccine is effective in prevention of initial infection with HPV-6/11/16/18 in HIV-negative women. Little is known about previous exposure to HPV-6/11/16/18, safety, and immunogenicity of qHPV in Indian WLWH. METHODOLOGY One hundred fifty WLWH with different CD4 levels and HIV viral load (VL) were vaccinated at 0/2/6 months at CART-CRS-IDMC, Chennai, India. Serology was performed at weeks 0, 28, and 52 for HPV-6/11/16/18 using a competitive Luminex immunoassay and for HPV-16/18 using a pseudovirion-based neutralization assay. RESULTS Mean age was 30.8 years (range, 19-44 years). 71/87/73/81% of women were naive (sero-negative and DNA-negative) to HPV-6/11/16/18 at baseline, respectively. Among per-protocol women naive to HPV-6/11/16/18 at baseline, 100/99/99/90%, respectively, seroconverted at week 28 and 95/96/98/71% were sero-positive at week 52, respectively. Pseudovirion-based neutralization assay identified more seroconversion to HPV-18 than competitive Luminex immunoassay. There were no significant differences in the proportion seroconverting by baseline or nadir CD4 or HIV VL; however, there was a trend for increased proportion seroconverting to HPV-18 among women with higher baseline CD4 level (P = 0.052). There were no qHPV-related serious adverse events and no change in CD4 level or HIV VL among women on ART. CONCLUSIONS qHPV vaccine was safe and immunogenic in Indian WLWH. A high proportion were naive to HPV-6/11/16/18 and may benefit from vaccination although many were married and several years post-initiation of sexual activity.
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Affiliation(s)
- Joel M Palefsky
- Department of Medicine, University of California, San Francisco, CA
| | - Selvamuthu Poongulali
- Chennai Antiviral Research and Treatment Centre Clinical Research Site, CART-CRS-Infectious Diseases Medical Centre, VHS Chennai, India
| | - Shelly Lensing
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR; and YRGCARE Infectious Diseases Laboratory
| | - Jeannette Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR; and YRGCARE Infectious Diseases Laboratory
| | - Maria Da Costa
- Department of Medicine, University of California, San Francisco, CA
| | - Aung Chein
- Department of Medicine, University of California, San Francisco, CA
| | - Faith Beulah
- Chennai Antiviral Research and Treatment Centre Clinical Research Site, CART-CRS-Infectious Diseases Medical Centre, VHS Chennai, India
| | - K G Murugavel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR; and YRGCARE Infectious Diseases Laboratory
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Centre Clinical Research Site, CART-CRS-Infectious Diseases Medical Centre, VHS Chennai, India
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Halkitis PN, Valera P, LoSchiavo CE, Goldstone SE, Kanztanou M, Maiolatesi AJ, Ompad DC, Greene RE, Kapadia F. Human Papillomavirus Vaccination and Infection in Young Sexual Minority Men: The P18 Cohort Study. AIDS Patient Care STDS 2019; 33:149-156. [PMID: 30932696 DOI: 10.1089/apc.2018.0276] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We examined the prevalence of infection with human papillomavirus (HPV) and HIV in a cohort of young gay, bisexual, and other men who have sex with men [sexual minority men (SMM)]. HPV vaccination uptake was assessed; HIV antibody testing was performed and genetic testing for oral and anal HPV infection was undertaken. We examined both HPV vaccination and infection in relation to key demographic and structural variables. Participants (n = 486) were on average 23 years old; 70% identified as a member of a racial/ethnic minority group, and 7% identified as transgender females. Only 18.1% of the participants indicated having received the full dosage of HPV vaccination and 45.1% were unvaccinated. Slightly over half the participants (58.6%) were infected with HPV, with 58.1% testing positive for anal infection and 8.8% for oral infection. HIV seropositivity was associated with infection to oral HPV [adjusted odds ratio (AOR) = 4.03] and vaccine-preventable HPV, whereas both neighborhood-level poverty (AOR = 1.68) and HIV infection (AOR = 31.13) were associated with anal infection to HPV (AOR = 1.68). Prevalence of HPV infection is high among unvaccinated young SMM, despite the availability and eligibility for vaccination. HPV infection adds further health burden to these populations and is particularly concerning for those who are HIV positive as HIV infection increases the risk of developing HPV-related cancers. These findings underscore a missed prevention opportunity for an at-risk and underserved population and suggest the need for active strategies to increase HPV vaccination uptake in young SMM before the onset of sexual behavior.
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Affiliation(s)
- Perry N Halkitis
- 1 Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- 2 Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- 3 Department of Medicine, RWJ School of Medicine, Rutgers University, Newark, New Jersey
- 4 Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
- 5 School of Public Affairs and Administration, Rutgers University, Newark, New Jersey
| | - Pamela Valera
- 1 Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- 2 Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Caleb E LoSchiavo
- 1 Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- 2 Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Stephen E Goldstone
- 6 Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Kanztanou
- 7 Department of Epidemiology and Preventive Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anthony J Maiolatesi
- 2 Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Danielle C Ompad
- 2 Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- 8 Department of Epidemiology, College of Global Public Health, New York University, New York, New York
| | - Richard E Greene
- 2 Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- 9 Department of Medicine, Langone School of Medicine, New York University, New York, New York
| | - Farzana Kapadia
- 2 Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- 8 Department of Epidemiology, College of Global Public Health, New York University, New York, New York
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Abstract
The prevalence of anal human papillomavirus (HPV) infection and anal high-grade squamous intraepithelial lesion (HSIL) remain high among HIV-infected individuals on effective antiretroviral therapy (ART). The incidence of HPV-related anal cancers has continued to increase since the introduction of ART. Therefore, ART may confer only limited benefit with respect to reducing the risk of anal HSIL and cancer. Efforts are in progress to define the efficacy of secondary prevention programs for prevention of anal cancer. In the modern ART era, anal cancer recurrence and survival outcomes are similar in HIV-infected and HIV-uninfected patients, but HIV-infected patients may experience more toxicities. This article reviews the current literature on HPV-associated anal cancer in the HIV-infected population, including epidemiology, screening, clinical characteristics, and treatment outcomes.
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Affiliation(s)
- Chia-Ching J Wang
- Division of Hematology/Oncology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
- , 995 Potrero Avenue, Building 80, 4th Floor, San Francisco, CA, 94110, USA
| | - Joel M Palefsky
- Division of Infectious Diseases, Department of Medicine, University of California at San Francisco, San Francisco, CA, USA.
- , 513 Parnassus Ave, Med Sci Room 420E, Box 0654, San Francisco, CA, 94143, USA.
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Giuliani M, Latini A, Colafigli M, Benevolo M, Rollo F, Zaccarelli M, Giuliani E, Moretto D, Giglio A, Rezza G, Cristaudo A, Donà MG. Vaccine-preventable anal infections by human papillomavirus among HIV-infected men who have sex with men. Future Microbiol 2018; 13:1463-1472. [PMID: 30311788 DOI: 10.2217/fmb-2018-0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM HIV-infected men who have sex with men (MSM) show the highest prevalence of anal HPV infection. Anal prevalence of the HPVs targeted by the quadrivalent HPV vaccine (4vHPV) and nonavalent HPV vaccine (9vHPV) was estimated in this population. MATERIALS & METHODS Anal specimens were collected from HIV-infected MSM attending a sexually transmitted infection/HIV center. Specimens were analyzed using the Linear Array HPV Genotyping Test. RESULTS A total of 49.5 and 71.2% of the 313 enrolled MSM harbored at least one of the 4vHPV and 9vHPV types, respectively. A significantly decreasing trend was observed for the prevalence of both 4vHPV (p = 0.04) and 9vHPV types (p < 0.001) across age classes. CONCLUSION A substantial proportion of HIV-infected MSM do not harbor a current anal infection with vaccine-preventable HPVs. The potential benefit of the 4vHPV versus 9vHPV vaccination in these subjects, including older MSM, should be investigated.
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Affiliation(s)
- Massimo Giuliani
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Alessandra Latini
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Manuela Colafigli
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maria Benevolo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesca Rollo
- Pathology Department, Regina Elena National Cancer Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Mauro Zaccarelli
- Clinical and Research Department, Istituto Nazionale Malattie Infettive INMI Lazzaro Spallanzani IRCCS, Via Portuense, 292, 00149, Rome, Italy
| | - Eugenia Giuliani
- Department of Molecular Medicine, Sapienza University, Viale Regina Elena, 291-293 00161, Rome, Italy
| | - Domenico Moretto
- Microbiology & Clinical Pathology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Amalia Giglio
- Microbiology & Clinical Pathology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giovanni Rezza
- Department of Infectious, Parasitic & Immune-mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00141, Rome, Italy
| | - Antonio Cristaudo
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Maria G Donà
- HIV/STI Unit, Clinical and Experimental Dermatology Department, San Gallicano Dermatological Institute IRCCS, Via Elio Chianesi 53, 00144, Rome, Italy
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Poynten IM, Waterboer T, Jin F, Templeton DJ, Hillman RJ, Law C, Cornall A, Tabrizi S, Roberts JM, Garland SM, Fairley CK, Grulich AE. Human Papillomavirus Seroprevalence and Association with Anal HPV Infection and Squamous Intraepithelial Lesions in Australian Gay and Bisexual Men. Cancer Epidemiol Biomarkers Prev 2018; 27:768-775. [PMID: 29700009 DOI: 10.1158/1055-9965.epi-17-0694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/26/2017] [Accepted: 04/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Gay and bisexual men (GBM) are at disproportionately high risk of anal cancer. The precursor lesions, high-grade squamous intraepithelial lesions (HSIL), are very common and it is evident that not all HSIL progresses to cancer. The serologic response to anal human papillomavirus (HPV) in GBM has not been well characterized.Methods: The Study of the Prevention of Anal Cancer is an ongoing cohort study of GBM ages 35 years and older. At six visits over three years, anal samples are collected for cytology, HPV DNA testing, and histology. Baseline serum was tested for HPV L1, E6, and E7 antibodies for 10 HPV types. Seroprevalence and associated predictors were analyzed.Results: A total of 588 of 617 participants were included in this analysis. A total of 436 (74.2%) were seropositive for at least one of the 10 HPV types. Almost half had L1 antibodies to HPV6 (48.5%), over a third to HPV11 (36.4%) and HPV16 (34.5%). HIV-positive men were more likely to be HPV L1 seropositive. HSIL detection was highest among participants who were HPV serology and DNA positive. There was a borderline significant association between presence of HPV16 E6 antibodies and prevalent HSIL (OR = 2.97; 95% confidence interval, 0.92-9.60; P = 0.068).Conclusions: HPV L1 seropositivity was common in this cohort of older GBM. These results suggest that HPV L1 seropositivity, in conjunction with anal HPV DNA detection, predicts concurrent HSIL. The apparent association between HPV16 E6 antibodies and prevalent HSIL is a finding with potential clinical significance that needs further exploration.Impact: HPV seropositivity with concurrent DNA detection predicted anal HSIL detection. Cancer Epidemiol Biomarkers Prev; 27(7); 768-75. ©2018 AACR.
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Affiliation(s)
- Isobel M Poynten
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DFKZ), Germany
| | - Fengyi Jin
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - David J Templeton
- RPA Sexual Health, Sydney Local Health District, Australia and Central Clinical School, The University of Sydney, Sydney, Australia
| | | | - Carmella Law
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Alyssa Cornall
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sepehr Tabrizi
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | | | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
| | | | - Andrew E Grulich
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of New South Wales, Sydney, Australia
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Abstract
OBJECTIVE To describe effects of HAART on high-risk human papillomavirus (HPV) antibody response in HIV-positive MSM and the meaning of this response for subsequent HPV-related cancer risk. DESIGN Prospective seroepidemiological study of 281 HIV-positive MSM initiating HAART between 1995 and 2004 in the Swiss HIV Cohort Study. METHODS For each individual, two serum samples, one at HAART initiation (pre-HAART) and another 24 months later (post-HAART), were tested for L1 antibodies to HPV6, 11, 16, 18, 31, 33, 35, 45, 52 and 58, as well as HPV16-E6 antibodies, using a multiplex serology assay. Identification of HPV-related cancer included data linkage with Swiss cancer registries. RESULTS Pre-HAART, 45.2% were seropositive for any high-risk HPV-L1 and 32.4% for HPV16-L1. Sexual intercourse during the last 6 months was the only evaluated factor associated with L1 seropositivity pre-HAART. Seropositivity increased post-HAART to 60.5% for any high-risk HPV-L1 [prevalence ratio versus pre-HAART = 1.34, 95% confidence interval (CI) 1.14-1.57] and 48.0% for HPV16-L1 (prevalence ratio versus pre-HAART = 1.48, 95% CI 1.20-1.83), and seroconversion was significantly associated with both lower CD4 cell count and CD4/CD8 ratio (P < 0.01). Only one individual was HPV16-E6-seropositive pre-HAART, but two more seroconverted post-HAART. Anal cancer incidence among the three HPV16-E6-positives post-HAART was significantly increased compared with HPV16-E6-negatives (incidence rate ratio = 63.1, 95% CI 1.1-1211). CONCLUSION HAART-related immune reconstitution increases HPV-specific antibody responses, which may discriminate future anal cancer risk in this high-risk population.
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