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Most young MSM and transgender women, including those with HIV, would benefit from HPV vaccination
Michael Carter, 2016-07-13 07:20:00
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.
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
believe their results show that most sexually active younger MSM could benefit
from HPV vaccination.
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
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.
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.”