Abstract
BackgroundHigh-risk human papillomavirus (HR-HPV) anal infection is a major problem among men who have sex with men (MSM) living in sub-Saharan Africa. The prevalence of anal HR-HPV infection and associated risk factors were estimated in a cross-sectional study in MSM living in Bamako, Mali.MethodsMSM consulting at sexual health center of the National NGO Soutoura, Bamako, were prospectively included. Sociodemographic and clinical-biological data were collected. HPV detection and genotyping were performed from anal swabs using multiplex real-time PCR. Risk factors associated with anal HPV infection were assessed by logistic regression analysis.ResultsFifty MSM (mean age, 24.2 years; range, 18–35) of which 32.0% were infected with HIV-1, were prospectively included. The overall prevalence of anal HPV infection of any genotypes was 70.0% (35/50) with 80.0% (28/35) of swabs positive for HR-HPV. HR-HPV-58 was the most detected genotype [13/35 (37.1%)], followed by HR-HPV-16 and low-risk (LR)-HPV-6 [12/35 (34.2%)], LR-HPV-40 [10/35 (28.6%)], LR-HPV-11 [9/35 (25.7%)], HR-HPV-51 [8/35 (22.8%)], HR-HPV types 18 and 39 [7/35 (20.0%)] and LR-HPV-43 [6/35 (17.1%)]. HR-HPV-52 and LR-HPV-44 were detected in lower proportions [5/35 (14.3%) and 4/35 (11.4%), respectively]. LR-HPV-42, LR-HPV-54, HR-HPV-31 and HR-HPV-35 were detected in very low proportions [3/35 (8.5%)]. Multiple HR-HPV infections were diagnosed in one-third of anal samples [16/50 (32.0%)], including around half of HR-HPV-positive anal swabs [16/35 (45.7%)]. More than half [27/50 (54.0%)] swabs were infected by at least one of HPV genotypes targeted by Gardasil-9® vaccine, including a majority of vaccine HR-HPV [22/50 (44.0%)]. In multivariate analysis, participation to sex in group was associated with anal infection by multiple HPV (aOR: 4.5, 95% CI: 1.1–18.1%; P = 0.032), and HIV-1 infection was associated with anal shedding of multiple HR-HPV (aOR: 5.5, 95% CI: 1.3–24.5%; P = 0.024).ConclusionsThese observations indicate that the MSM community living in Bamako is at high-risk for HR-HPV anal infections, with a unique epidemiological HPV genotypes profile and high prevalence of anal HPV covered by the Gardasil-9® vaccine. Scaling up prevention strategies against HPV infection and related cancers adapted to this highly vulnerable MSM community should be urgently prioritized with innovative interventions.
Highlights
The human papillomavirus (HPV) is responsible for a significant disease burden in men who have sex with men (MSM), including benign and malignant lesions [1]
The reported prevalences of anal High-risk human papillomavirus (HR-HPV) infection among MSM living in sub-Saharan Africa appear to be higher than those usually recorded in studies conducted in developed countries, which range from 20.9% to 65% [8, 9]
Recent reports from South Africa [10] and Nigeria [11] highlight very high prevalence of anal HR-HPV infection, ranging from 57.6% to 70.1%, among MSM living in sub-Saharan Africa, among those co-infected with human immunodeficiency virus (HIV) [10, 11]
Summary
The human papillomavirus (HPV) is responsible for a significant disease burden in men who have sex with men (MSM), including benign and malignant lesions [1]. Nowak and colleagues depicted an atypical distribution profile in Nigeria with non-vaccine HR-HPV-35 as the predominant genotype circulating in MSM [11]. Limited, these observations highlight that MSM in sub-Saharan Africa constitute a central group at high-risk for HPV infections and that the distribution of the main HPV genotypes involved in anal cancers in African MSM may be quite different from that generally observed. High-risk human papillomavirus (HR-HPV) anal infection is a major problem among men who have sex with men (MSM) living in sub-Saharan Africa. The prevalence of anal HR-HPV infection and associated risk factors were estimated in a cross-sectional study in MSM living in Bamako, Mali
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