Most young MSM and transgender women, including those with HIV, would benefit from HPV vaccination

Most young gay, bisexual and other men who have sex with men (MSM) would benefit from human papillomavirus (HPV) vaccination, according to US research published in the online edition of the Journal of Infectious Diseases. Although the majority had anal and/or oral infection with one or more HPV type, only 9% of HIV-negative individuals and 30% of people with HIV had evidence of infection with all four high-risk HPV types covered by the most commonly used vaccine.

“HPV prevalence was high in this population of young MSM and transgender women,” comment the researchers. “Most participants in this large study, even those with HIV, lacked evidence of current infections to all 4vHPV types” [HPV types covered by Gardasil].

The authors believe their results show that most sexually active younger MSM could benefit from HPV vaccination.

Glossary

human papilloma virus (HPV)

A group of wart-causing viruses which are also responsible for cervical cancer, anal cancer and some cancers of the penis, vagina, vulva, urethra, tongue and tonsils.

oral

Refers to the mouth, for example a medicine taken by mouth.

transgender

An umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth.

sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

strain

A variant characterised by a specific genotype.

 

HPV is the most common sexually transmitted infection in the world. Gay and other MSM have especially high incidence and prevalence of HPV-related disease, including genital, anal and oral warts and cancerous cell changes in these sites.

Health authorities in the US now recommend that gay and other MSM up to the age of 26 years and all HIV-positive men should be vaccinated against HPV.

To inform vaccination strategies, investigators designed a large study to determine prevalence of oral and anal HPV infection among gay, bisexual and other MSM and transgender women aged 18 to 26 years. Recruitment took place between 2012 and 2014 at three clinics specialising in the sexual health of gay and other MSM. Participants provided oral rinses, anal swabs and blood samples which were tested for any HPV infection and also the presence of the four high-risk types covered by the vaccine in current use. Participants were asked about their sexual history and HIV infection status.

A total of 922 individuals were recruited. Mean and median age was 23 years. Most (93%) identified as male and 70% described their sexual orientation as gay. Participants were sexually experienced, reporting a mean of 37 lifetime sexual partners and a median of 15. Approximately 10% reported they were HIV-positive.

Any HPV type was detected in the oral and/or anal site in 74% of participants; 72% had any anal HPV, 9% had any oral HPV and 8% had infection at both sites.

The majority of participants (58%) had a high-risk HPV type detected in an anal or oral sample.

Prevalence of HPV infection was higher among HIV-positive individuals (p = 0.001), those reporting higher numbers of lifetime sexual partners (p < 0.01) and men identifying as gay (p = 0.006).

Among the 834 participants who were HIV-negative or of unknown infection status, any HPV was detected in 69% of anal specimens, including 51% with multiple types. Any HPV was also present in 8% of oral specimens. High-risk HPV types were presented in 53% of anal samples and 5% of oral specimens. Overall, 40% of people who were HIV-negative or of unknown status were positive for one of the four HPV types covered by Gardasil, however only 9% had evidence of infection with all four types.

Analysis of the HIV-positive participants showed that 93% had any HPV in anal specimens, with 91% having infection with multiple types. Any HPV was detected in a fifth of oral samples. High-risk types were detected in 89% of anal and 11% of oral samples. Approximately two-thirds of people with HIV had evidence of infection with at least one of the four main high-risk strains and 29% had evidence of infection with all four types.

“The United States was one of the first countries to recommend routine HPV vaccination for males,” conclude the researchers. “Baseline data on HPV prevalence and seroprevalence among young, vaccine-eligible MSM and transgender women should be useful for planning policy and prevention programs, as well as monitoring HPV vaccine impact in these at-risk populations.”

References

Meites E et al. Monitoring for HPV vaccine impact among gay, bisexual and other men who have sex with men – United States, 2012-2014. J Infect Dis, online edition, 2016.