Speaker
Description
Background Robust age-specific estimates of anal human papillomavirus (HPV) and high-grade squamous intraepithelial lesions (HSIL) in HIV-positive and HIV-negative men can inform anal cancer prevention efforts.
Methods We reanalysed individual-level data from 62 studies totalling 29,238 men across four groups: HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive men who have sex with women (MSW) and HIV-negative MSW. Pooled estimates of anal high-risk (HR) HPV, and HSIL or worse (HSIL+), were compared using adjusted prevalence ratios (aPR).
Findings Anal HPV prevalence was lowest among HIV-negative MSW (HPV16=1·8%;HR-HPV=6·9%), followed by HIV-positive MSW (8·7%;26·9%) and HIV-negative MSM (13·6%;41·0%), and highest in HIV-positive MSM (28·4%;74·5%). In HIV-positive MSM, HPV16 prevalence increased from 15–18 (5·7%) to 23–24 years (29·0%) (ptrend=0·011), then declined from 25–34 (31·6%) to ≥55 years (22·7%) (ptrend<0·001). HPV16 in HIV-negative MSM also increased from 15–18 (6·8%) to 23–24 years (13·9%) (ptrend=0·009), plateauing thereafter (ptrend=0·688). Similar age-specific patterns were observed for HR-HPV. No significant differences were found by age for either HIV-positive or HIV-negative MSW. HIV was a determinant of HSIL+ (aPR=1·54, 95%CI 1·36–1·73) and HPV16-positive HSIL+ (1·66, 1·36–2·03) among MSM, even when restricted to HPV16-positive MSM (1·19, 1·04–1·37). Among HPV16-positive MSM, HSIL+ prevalence increased with age.
Interpretation High anal HPV prevalence among young HIV-positive and HIV-negative MSM highlights benefits of gender-neutral HPV vaccination prior to sexual debut over catch-up vaccination. HIV-positive MSM are a priority for anal cancer screening programmes targeting HPV16-positive HSIL+.
