HPV genotyping and risk factors for anal high-risk HPV infection in men who have sex with men from Toronto, Canada

Yoojin Choi,Roberta Halpenny,Sanja Huibner,Anuradha Rebbapragada,Mona Loutfy,Tatjana Reko,Graham Smith,Troy Grennan,Jason Brunetta,Rupert Kaul,Robert S Remis,Juan Liu

doi:10.1038/s41598-021-84079-y

Abstract

Men who have sex with men (MSM) are disproportionately affected by anal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection. Currently, the nonavalent HPV vaccine provides coverage against nine HPV genotypes, including seven HR-HPV genotypes. Here, we characterize anal HR-HPV genotype distribution and associated risk factors in MSM from Toronto, Canada recruited between September 2010 and June 2012. Wilcoxon–Mann–Whitney test was used for continuous variables, Chi-square test was performed for categorical variables, and a multivariable model using logistic regression was created to assess for correlates of anal HR-HPV infection. A total of 442 MSM were recruited, with a median age of 45 (IQR 38–50) and an overall HPV prevalence of 82%. The prevalence of any HR-HPV infection was 65.3% and 50.7% in the HIV-positive and HIV-negative MSM, respectively. No participant tested positive for all genotypes covered by the nonavalent vaccine. HIV status (aOR 1.806; 95% CI 1.159–2.816), smoking (aOR 2.176; 95% CI 1.285–3.685) and the number of lifetime sexual partners (aOR 2.466; 95% CI 1.092–5.567) were independent risk factors for anal HR-HPV infection. Our findings will be useful to inform HPV vaccine rollout and HPV prevention strategies in Canadian MSM.

Highlights

Men who have sex with men (MSM) are disproportionately affected by anal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection
Complete data including socio-demographic characteristics were available for 429 participants, of whom 267 (62.2%) tested positive for at least one high-risk (HR) HPV genotype versus 162 (37.8%) who tested negative for any HR-HPV genotype (Table 1)
The most common genotypes detected in participants with anal infection by multiple HPV genotypes were HPV16 (41.9%), HPV11 (26.7%) and HPV18 (23.6%) among HIV-infected participants, while HPV16 (40.7%), HPV6 (23.7%) and HPV70 (18.6%) predominated in HIV-uninfected participants. This cross-sectional study of MSM living in Toronto, Canada was performed to characterize the anal HPV genotype distribution and risk factors for anal HR-HPV infection and found a high prevalence of both HPV and HR-HPV infection in the anal canal

Summary

Introduction

Men who have sex with men (MSM) are disproportionately affected by anal cancer, predominantly caused by high-risk (HR) human papillomavirus (HPV) infection. Canada’s National Advisory Committee on Immunization (NACI) still recommends that HPV vaccine be strongly considered in all MSM and people living with HIV regardless of their age[17,18]. Men generally have lower acquired immunity in response to natural HPV infection as compared to women[20,21], and unlike cervical HPV infection which peaks shortly after sexual debut, anal HPV infection in men are found at relatively constant rates across the lifespan[22,23] Taken together, these findings suggest that older MSM may benefit from the HPV vaccine

Methods

Results

Conclusion