Abstract
(1) Background: We conducted a prospective observational cohort study to measure incidence, persistence, and clearance of anal human papillomavirus (HPV) among men who have sex with men (MSM) in China. (2) Methods: MSM were recruited in Guangzhou, Shenzhen and Wuxi, China in 2017. A tablet-based questionnaire was used to collect sociodemographic and behavioral characteristics. An anal brush sample was collected for HPV testing and genotyping. Participants were followed up 12 months after enrolment. (3) Results: A total of 196 participants completed two HPV tests with a median age of 27.3 (interquartile range (IQR) 24.0–32.8) years. Rate of incidence, persistence, and clearance for HPV among MSM were 31.3 (95% confidence interval (CI) 24.7–39.2), 47.9 (36.8–61.3), and 122.5 (104.3–143.0) per 1000 person months (pm), respectively. HPV 16 (4.1/1000 pm) had the highest incidence rate, and HPV 6 (47.4/1000 pm) had the highest persistence rate. Having lower education and engaging in receptive anal intercourse were potential risk factors of HPV incidence. A higher incidence rate was observed among younger MSM. (4) Conclusions: The high incidence and low clearance of anal HPV highlight the necessity of HPV vaccination among MSM. Further studies are needed to clarify the HPV dynamics at multiple anatomical sites and the burden of HPV-related diseases among MSM.
Highlights
Anal cancer, with increased incidence in recent decades in many countries [1–6], is mostly caused by persistent infection with high-risk genotypes of human papillomavirus (HPV), HPV 16 [7]
men who have sex with men (MSM) who completed two HPV tests were older (median age 27.3 (IQR 24.0–32.8) years vs. 25.7 (22.2–29.8) years, p < 0.001), more likely to be recruited from Shenzhen, and less likely to be recruited from Wuxi than men who were only tested at baseline
This study provides an assessment of HPV incidence, persistence, and clearance for genotypes among MSM, employing multiple methods to recruit participants in three metropolitan cities in China
Summary
With increased incidence in recent decades in many countries [1–6], is mostly caused by persistent infection with high-risk genotypes of human papillomavirus (HPV), HPV 16 [7]. While the incidence of anal cancer is relatively rare among women and heterosexual men, it is high among men who have sex with men (MSM) and bisexual men, with an incidence up to 15.5 times higher than that among heterosexual men [8]. Human immunodeficiency virus (HIV) infection is an acknowledged factor associated with higher incidence of HPV-related morbidities among MSM [9–11]. It was estimated that the incidence of anal cancer was 85 and 19 per 100,000 person years for HIV-positive and HIV-negative MSM, respectively [12]. MSM have higher rates of HPV infection than heterosexual men and women [13,14]. A global systematic review and meta-analysis found that 30% of HIV-positive MSM and 14% of HIV-negative
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