Objective: The aim of the study is to determine the prevalence of high-risk human papillomavirus (hrHPV) genotypes in men who have sex with other men and are living with HIV and the factors associated with anal high-grade squamous intraepithelial lesions (HSIL).
Methods: Anal swabs were collected for hrHPV genotyping from a cross-sectional group ( N = 163) of eligible men who have sex with other men and are living with HIV attending a high-resolution anoscopy clinic. Persistent hrHPV infections were studied in a longitudinal subset ( n = 37). Association of anal HSIL with specific hrHPV genotype(s) and with HIV-1 suppression was assessed. Pearson's χ 2 test with continuity correction or Fisher's exact test was used to determine statistical significance (alpha = 0.05).
Results: Overall prevalence of hrHPV anal infections was 93.3% (152/163). Higher numbers of hrHPV genotypes were detected per sample in the HSIL group compared with less than or low-grade squamous intraepithelial lesion (≤LSIL) group ( p < .001). Proportion of participants infected with HPV33 was higher in the HSIL group (66.7%) than in ≤LSIL group (33.3%, p < .001), as was HPV35 (61.1% vs. 38.9%, p = .001) and HPV56 (56.7% vs. 43.3%, p = .022). HPV33 persistence was highly associated with HSIL (100%; 8/8) compared with ≤LSIL (0%; 0/8) ( p < .001). Proportion of HIV-1 suppression (<200 cp/mL) was significantly lower among the HSIL group (80%; 48/60) compared with ≤LSIL group (95.1%; 97/102) ( p = .006).
Conclusions: Statistically significant associations existed between anal HSIL and HPV33, HPV35, and HPV56 infections, with HPV33 persistence, and with the lack of HIV-1 suppression. These findings emphasize the critical need for genotyping assays that differentiate more than just HPV16, HPV18 and a pool of "other" hrHPV genotypes and that have an intended use with anal specimens. Globally, this highest-risk population would benefit from the 9-valent vaccine to prevent infections and reduce anal cancer risk.
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