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. 2013 Nov 20;8(11):e79492.
doi: 10.1371/journal.pone.0079492. eCollection 2013.

Factors affecting the prevalence of strongly and weakly carcinogenic and lower-risk human papillomaviruses in anal specimens in a cohort of men who have sex with men (MSM)

Dorothy J Wiley  1 , Xiuhong Li, Hilary Hsu, Eric C Seaberg, Ross D Cranston, Stephen Young, Gypsyamber D'Souza, Otoniel Martínez-Maza, Katherine DeAzambuja, Kristofer Chua, Shehnaz K Hussain, Roger Detels
Affiliations

Factors affecting the prevalence of strongly and weakly carcinogenic and lower-risk human papillomaviruses in anal specimens in a cohort of men who have sex with men (MSM)

Dorothy J Wiley et al. PLoS One. .

Abstract

Background: MSM are at higher risk for invasive anal cancer. Twelve human papillomaviruses (HPVs) cause cervical cancer in women (Group 1 high-risk HPVs (hrHPVs)) and 13 HPVs are probable/possible causes (Group 2 hrHPVs) of cervical malignancy. HPVs rarely associated with malignancy are classified as lower-risk HPVs (lrHPVs).

Materials and methods: Dacron-swab anal-cytology specimens were collected from and data complete for 97% (1262/1296) of Multicenter AIDS Cohort Study (MACS) men tested for HPVs using the Linear Array assay. Multivariate Poisson regression analyses estimated adjusted prevalence ratios for Group 1/2 hrHPVs and lrHPVs, controlling for the effects of age, race, ethnicity, sexual partnerships, smoking; HIV-infection characteristics, treatment, and immune status among HIV-infected men.

Results: HIV-infected men showed 35-90% higher prevalence of Group 1/2 hrHPVs and lrHPVs than HIV-uninfected men, and higher prevalence of multi-Type, and multiple risk-group infections. CD4+ T-cell count was inversely associated with HPV Group 2 prevalence (p<0.0001). The number of receptive anal intercourse (RAI) partners reported in the 24 months preceding HPV testing predicted higher prevalence of Group 1/2 hrHPVs. Men reporting ≥30 lifetime male sex partners before their first MACS visit and men reporting ≥1 RAI partners during the 24 months before HPV testing showed 17-24% and 13-17% higher prevalence of lrHPVs (p-values ≤0.05). Men reporting smoking between MACS visit 1 and 24 months before HPV testing showed 1.2-fold higher prevalence of Group 2 hrHPVs (p = 0.03). Both complete adherence to CART (p = 0.02) and HIV load <50 copies/mL (p = 0.04) were protective for Group 1 hrHPVs among HIV-infected men.

Conclusions: HIV-infected men more often show multi-type and multi-group HPV infections HIV-uninfected men. Long-term mutual monogamy and smoking cessation, generally, and CART-adherence that promotes (HIV) viremia control and prevents immunosuppression, specifically among HIV-infected MSM, are important prevention strategies for HPV infections that are relevant to anal cancer.

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Conflict of interest statement

Competing Interests: Wiley, Cranston and D’Souza receive research funding from Merck, Sharp, & Dohme (Merck & Co., Inc). Wiley has been paid for educational lectures to healthcare providers by Merck & Co., Inc. Cranston has received honoraria for published works for Wolters Kluwer, publishers of UptoDate.com. Young is a member of a scientific advisory board for Roche Diagnostic Corporation & Quidel Corporation. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials. None of these entities funded this work. Other authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A–D: Age-specific Prevalence of Group 1 and 2 High-risk HPVs and Lower-risk HPVs for 1262 Men Enrolled in the Multicenter AIDS Cohort Study Anal Health Sub-study.
(A) Virus Type Group-specific Prevalence for All Men. (B–D) Comparison of 579 HIV-infected and 683–Uninfected Men for (B) Group 1 High-risk HPVs, (C) Group 2 High-risk HPVs, and (D) Lower-risk HPVs.
Figure 2
Figure 2. Comparison of Prevalence Ratios for Group 1 and 2 High-risk and Lower-risk HPVs for 1262 Men Group 1 and 2 High-risk HPVs and Lower-risk HPVs for 1262 Men Enrolled in the Multicenter AIDS Cohort Study Anal Health Sub-study.a
Figure 3
Figure 3. Comparison of Prevalence Ratios for Group 1 and 2 High-risk and Lower-risk HPVs for 579 HIV-infected Men Enrolled in the Multicenter AIDS Cohort Study Anal Health Sub-study.a
See this image and copyright information in PMC

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