HPV and Adolescent Males with HIV 2007-2009

Abstract

Objective: Human Papillomavirus (HPV) infection is found to be more prevalent in HIV-infected than uninfected men (73% vs. 43%). Young men who have sex with men (YMSM) with HIV with HPV anal lesions often deny or are unaware of these lesions. Unless screened, these lesions will remain undiagnosed with a potential for transmission to sexual partners and disease progression. We explored screening practices for HPV and therapeutic/diagnostic outcome of HPV screening among YMSM with HIV, including co-infection with other STIs. Methods: Chart review of all HIV+ adolescent males, age 13-24 years, reporting MSM, engaged in care, 2007-2009, at an inner city HIV clinic for adolescents and young adults. Results: The average number of males enrolled in care was 143 per year (range 127-166) and none received HPV vaccination. By visual inspection 50 YMSM were identified with anal HPV lesions: 46% received anal cytology, 30% were identified as abnormal (ASCUS, LGSIL, or HGSIL); 90% received medical treatment (Imiquimod or Podophylline); 72.3% with no evidence that lesions cleared; 68.6% were referred to Colorectal surgical clinic. In addition, 62% had STIs diagnosed: syphilis (42%); gonorrhea (39%); chlamydia (26%), and HSV (19%), Hepatitis B (6%); Hepatitis C (3%). Clearance of HPV was associated with having more than one STI (p=0.03). Conclusions: Detecting genital warts by visual inspection without acetic acid is an insensitive screening, thus the number of males suspected to have HPV would be higher than the 50 identified by visual inspection. In this cohort of HIV+ YMSM with HPV, a third were identified as having abnormal cytology, which is worrisome for infection with oncogenic HPV subtypes. Not all received HPV medical and or referred for surgical treatment. The majority of the cohort was co-infected with STIs, and having more than one STI was associated with clinical clearance of HPV lesions