Anogenital Human Papillomavirus Infection Research Articles

Incidence, persistence, and clearance of anogenital human papillomavirus among men who have sex with men in Taiwan: a community cohort study.

Men who have sex with men (MSM) have an increased risk of human papillomavirus (HPV) infection. This study aimed to assess the incidence, persistence, and clearance of anogenital HPV infections among MSM and the correlates in a 3-year community cohort study. From 2015 to 2019, MSM were recruited and followed up at 6, 12, 24, and 36 months in Taiwan. Questionnaires and anogenital swabs were collected at baseline and each follow-up visit. Thirty-seven HPV genotypes were tested and genotyped using the linear array HPV genotyping test. The incidence, persistence, and clearance rates of anogenital HPV infection and 95% confidence intervals (CIs) were estimated through Poisson regression. Correlates of the incidence and clearance rates were examined using a generalized estimating equations (GEE) model. A total of 201 MSM were retained in the cohort study with a median age of 27 years (interquartile range [IQR]: 24-32) at baseline. The incidence, persistence, and clearance rates of any anal HPV infection among MSM were 43.6 (95% CI: 33.7-55.6), 23.4 (17.7-30.2), and 58.3 (45.1-74.1) per 1,000 person months (pms), respectively. The incidence, persistence, and clearance rates of any penile HPV infection among MSM were 26.8 (20.1-34.9), 13.4 (8.0-20.9), and 51.5 (37.8-68.5) pms, respectively. MSM who did not consistently use a condom in receptive sex (adjusted odds ratio [AOR]: 2.06, 95% CIs: 1.14-3.72) were more likely to acquire any anal HPV infection. Age at recruitment (1.05, 1.01-1.09) was positively associated with any penile HPV incidence. MSM with over one sex partner in receptive anal sex (0.53, 0.30-0.94) were less likely to clear any anal HPV infection. MSM who were unemployed/students (0.55, 0.30-0.98) were less likely to clear any penile HPV infection. High incidence and low clearance of anogenital HPV infection among MSM in the study serve as a reminder that this population needs to be targeted for HPV vaccination. It is essential for MSM to scale up HPV screening and adhere to safe sex.

Factors Associated with Morbidity and Mortality Among Sexually Active Asian Adolescents and Young Adults with Perinatally Acquired HIV.

We assessed morbidity and mortality among Thai and Vietnamese adolescents and young adults with perinatally acquired human immunodeficiency virus (PHIV) compared with matched HIV-negative peers, 12-24 years of age. Data on serious adverse events (SAEs) were prospectively collected between 2013 and 2018 according to U.S. NIH Division of AIDS criteria. Of 288 youth, 142 had PHIV and 146 were HIV negative. At enrollment, the overall median age was 19 (interquartile range [IQR] 17-20) years, 67% were female, and 95% were Thai. Almost all PHIV youth (99%) were receiving antiretroviral therapy; 50% self-reported adherence ≥95%. Median CD4 was 579 (IQR 404-800) cells/mm3, and 24% had HIV-RNA ≥1,000 copies/mL. During follow-up, 31 (22%) PHIV youth and 9 (6%) HIV-negative youth had at least one SAE. The overall crude SAE rate was 4.66 (3.42-6.35) per 100 person-years (PY); 7.22 (5.08-10.26) per 100 PY among youth with PHIV and 2.10 (1.09-4.03) per 100 PY in HIV-negative youth (p < .001). All seven deaths that occurred were among those with PHIV and primarily due to opportunistic infections (e.g., pneumocystis pneumonia, tuberculous meningitis). In multivariate analyses, having PHIV, being <20 years of age, and having anogenital high-risk human papillomavirus (HPV) infection with types 16 and/or 18 increased risk of SAEs. Among PHIV youth, CD4 count <350 cells/mm3, HIV-RNA ≥1,000 copies/mL, advanced WHO stages, and having anogenital HPV 16 and/or 18 infection predicted higher incidence of SAEs; no prior use of alcohol was protective. These data emphasize the need for tailored interventions for adolescents with PHIV to prevent long-term morbidity and mortality.

The effects of bivalent human papillomavirus (HPV) vaccination on high-risk anogenital HPV infection among sexually active female adolescents with and without perinatally acquired HIV.

Females with perinatal HIV (PHIV) infection are at elevated risk for anogenital high-risk human papillomavirus (HR-HPV) infection. Limited data are available around the effect of the HPV vaccination after initiation of sexual activity among PHIV youth. This study aims to assess the impact of a bivalent HPV vaccination on the persistence of anogenital HR-HPV among sexually active female PHIV youth and matched HIV-negative controls aged 12-24years in Thailand and Vietnam. During a 3-year study, prevalent, incident, and persistent HR-HPV infection were assessed at annual visits. A subset of participants received a bivalent HPV vaccine. Samples were taken for HPV testing from the vagina, cervix, and anus. HR-HPV persistence was defined as the detection of the same genotype(s) at any anogenital compartment over≥two consecutive visits. Of the 93 PHIV and 99 HIV-negative female youth enrolled in this study, 25 (27%) PHIV and 22 (22%) HIV-negative youth received a HPV vaccine. Persistent infection with any HR-HPV type was significantly lower among PHIV youth who received the vaccine compared to those who did not (33%vs 61%, P =0.02); a difference was not observed among HIV-negative youth (35%vs 50%, P =0.82). PHIV infection (adjusted prevalence ratio [aPR] 2.31, 95% CI 1.45-3.67) and not receiving a HPV vaccine (aPR, 1.19, 95%CI 1.06-1.33) were associated with persistent anogenital HR-HPV infection. Bivalent HPV vaccination after initiation of sexual activity was associated with reduced persistence of anogenital HR-HPV infection in Southeast Asian PHIV female youth, which may be related to vaccine cross-protection. Primary and catch-up HPV vaccinations should be prioritised for children and youth with HIV.

Does Vaccination Protect against Human Papillomavirus-Related Cancers? Preliminary Findings from the United States National Health and Nutrition Examination Survey (2011-2018).

Most oropharyngeal and anogenital cancers are caused by human papillomavirus (HPV). Although HPV vaccines showed high efficacy against oropharyngeal and anogenital HPV infections, and cancer precursors in randomized clinical trials, there are limited data on the effectiveness of HPV vaccination against HPV-related cancers. We aimed to evaluate the association of HPV vaccination with HPV-related cancers among a nationally representative sample of United States adults, aged 20-59 years. In a cross-sectional study combining four cycles from the National Health and Nutrition Examination Survey, from 2011 through 2018, we used a survey-weighted logistic regression model, propensity score matching and multiple imputations by chained equations to explore the association of HPV vaccination with HPV-related cancers. Among 9891 participants, we did not find an association of HPV vaccination with HPV-related cancers (adjusted OR = 0.58, 95% CI 0.19; 1.75). Despite no statistically significant association between HPV vaccination and HPV-related cancers, our study findings suggest that HPV-vaccinated adults might have lower odds of developing HPV-related cancers than those who were not vaccinated. Given the importance of determining the impact of vaccination on HPV-related cancers, there is a need to conduct future research by linking cancer registry data with vaccination records, to obtain more robust results.

Prevalence of anogenital infection by Human Papillomavirus (HPV) in users of immunobiological therapy

Objective: To compare the prevalence of anogenital infection by human papillomavirus (HPV) in immunobiological users being treated for immune-mediated chronic inflammatory diseases with that in non-users. Methodology: The total sample studied consisted of 228 participants divided into 2 groups: 114 users and 114 non-users of immunobiological, cytotoxic or corticosteroid therapy, with non-psoriasis dermatoses and non-HPV predisposing conditions. Both groups were evaluated clinically and by polymerase chain reaction (PCR). Results: The prevalence of low-risk HPV in the immunobiological user and non-user groups was 8/49 (16,3%) and 3/29 (10,3%), respectively (p=0.524). The low-risk types found were HPV 6, 11, 40, 42 and 44. The prevalence of high-risk HPV was 23/114 (20,2%) in the users versus 21/114 (18,4%) in the non-users (p=0.737), distributed according to the following types: HPV 16 (3/228 – 1,3%), 18 (5/228 – 2,2%), and non-16/18 (36/228 – 15,8%). After pairing by sex and age, the prevalence of high-risk HPV was 13/62 (21,0%) and 8/62 (12,9%) for immunobiological users and non-users, respectively (p=0.231). Conclusion: The prevalence of anogenital HPV infection in patients with immune-mediated chronic inflammatory diseases treated with immunobiologicals is similar to that in non-users.

Unrecognized Bowen’s disease in previously treated condylomata acuminata: indication of a common etiology?

Bowen's disease (BD) is an intraepidermal squamous cell carcinoma (SCC) with the capacity to become invasive SCC giving rise to distant metastasis. In rare cases it can be associated with human papillomavirus (HPV) infection, specifically with HPV types 16, 18, 31, 32, and 34. Here we report a case of an immunocompetent white male, age 37, with an erythematous, irregularly-shaped patch in his suprapubic region, appearing 1 year after treatment for condylomata acuminata with cryotherapy and podophyllin in the same area. At the time of clinically active disease, a urethral smear was positive for high-risk HPV types. The lesion was considered a scar by several physicians because it emerged in an area of previous postinflammatory hyperpigmentation. The aim of this report is to raise awareness of the emerging causative association between anogenital HPV infection and the development of BD, which was the possible etiological agent in the case of the patient presented here. Hereby we also advocate primary preventive measures in terms of safe sexual habits and HPV vaccination.

[Translated article] What Proportion of the Spanish Dermatology Caseload Corresponds to Primarily Sexually Transmitted Infections and Other Anogenital Dermatoses? Results From the DIADERM National Random Survey

Background and objectivePredominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methodsObservational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. ResultsOnly 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. ConclusionsSTIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

Prevalence and risk factors for anogenital HPV infection and neoplasia among women living with HIV in China

ObjectivesTo explore the prevalence and risk factors of anogenital human papillomavirus (HPV) infection and neoplasia among women living with HIV (WLHIV) in China.MethodsA cross-sectional survey was conducted from 2019 to...

¿Cuánta carga asistencial suponen las infecciones de transmisión predominantemente sexual y otras dermatosis anogenitales en las consultas de Dermatología en España? Resultados del muestreo aleatorio nacional DIADERM

Background and objectivePredominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methodsObservational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. ResultsOnly 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. ConclusionsSTIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made.

Incidence and Clearance of Penile High-Risk Human Papillomavirus Infection and Their Determinants Among HIV-Negative Men Who Have Sex With Men.

Men who have sex with men (MSM) are at increased risk of anogenital human papillomavirus (HPV) infections. We aimed to assess the incidence and clearance of penile high-risk HPV (hrHPV) infections and their determinants among HIV-negative MSM living in the Netherlands. Between 2010 and 2015, HIV-negative MSM were semiannually tested for penile HPV and completed detailed questionnaires on health and sexual behavior. Self-collected penile swabs were tested for HPV DNA using SPF10-PCR DEIA/LiPA25 system. Type-specific hrHPV incidence (IR) and clearance rates (CR) were calculated for 12 hrHPV types (HPV-16, HPV-18, HPV-31, HPV-33, HPV-35, HPV-39, HPV-45, HPV-51, HPV-52, HPV-56, HPV-58, and HPV-59). Determinants of incidence and clearance of HPV-16 and HPV-18, separately, and combined 7 hrHPV types covered by the nonavalent vaccine were assessed by Poisson regression using generalized estimating equations for combined hrHPV types. We included 638 HIV-negative MSM, with a median age of 38 (interquartile range, 33-43) years. HPV-16 had an IR of 4.9/1000 person-months of observation at risk (PMO; 95% confidence interval [95% CI], 3.8-6.3) and CR of 90.6/1000 PMO (95% CI, 60.7-135.1). The IR and CR of HPV-18 were 3.4/1000 PMO (95% CI, 2.5-4.5) and 119.2/1000 PMO (95% CI, 76.9-184.8), respectively. Age and condom use during insertive anal sex were not associated with hrHPV incidence, whereas high number of recent sex partners was. The relatively high IR and low CR of penile HPV-16 and HPV-18 among HIV-negative MSM correlates with their high prevalence and oncogenic potential. Incident HPV infections were associated with recent sexual risk behavior.

Prevalence and sociodemographic correlates of anogenital Human Papillomavirus (HPV) carriage in a cross-sectional, multi-ethnic, community-based Asian male population.

Addressing the burden of HPV-associated diseases among men is increasingly becoming a public health issue. The main objective of this study was to determine HPV prevalence among a healthy community-based Malaysian men. This was a cross-sectional study that recruited 503 healthy males from 3 community-based clinics in Selangor, Malaysia. Genital and anal samples were collected from each participant for 14 high risk and 2 low risk HPV DNA detection and genotyping. All participants responded to a set of detailed sociodemographic and sexual behaviour questionnaire. The median age at enrolment was 40 years old (IQR: 31-50). The anogenital HPV6/11 prevalence was 3.2% whereas high risk HPV prevalence was 27.1%. The genital HPV prevalence for HPV6/11 was 2.9% while high risk HPV was 18.8%. HPV6/11 prevalence in the anal canal was 1.6% and high risk HPV was 12.7%. HPV 18 was the most prevalent genotype detected in the anogenital area. There was a significant independent association between genital and anal HPV infections. Anogenital HPV infection is common among Malaysian men. These findings emphasize the ubiquity of HPV infection and thus the value of population-wide access to HPV prevention.

Increased Burden of Concordant and Sequential Anogenital Human Papillomavirus Infections Among Asian Young Adult Women With Perinatally Acquired HIV Compared With HIV-Negative Peers.

Youth with perinatally acquired HIV (YPHIV) are at higher risk for anogenital human papillomavirus (HPV) infection. We enrolled a cohort of YPHIV and HIV-negative youth in Thailand and Vietnam, matched by age and lifetime sex partners, and followed them up for 144 weeks (to 2017). Participants had annual pelvic examinations with samples taken for HPV genotyping. Concordant infection was simultaneous HPV detection in multiple anogenital compartments (cervical, vaginal, anal); sequential infection was when the same type was found in successive compartments (cervicovaginal to/from anal). Generalized estimating equations were used to assess factors associated with concordant infection, and Cox regression was used to assess factors associated with sequential infection. A total of 93 YPHIV and 99 HIV-negative women were enrolled, with a median age of 19 years (interquartile range, 18-20 years). High-risk anogenital HPV infection was ever detected in 76 (82%) YPHIV and 66 (67%) HIV-negative youth during follow-up. Concordant anogenital high-risk HPV infection was found in 62 (66%) YPHIV versus 44 (34%) HIV-negative youth. Sequential cervicovaginal to anal high-risk HPV infection occurred in 20 YPHIV versus 5 HIV-negative youth, with an incidence rate of 9.76 (6.30-15.13) versus 2.24 (0.93-5.38) per 100 person-years. Anal to cervicovaginal infection occurred in 4 YPHIV versus 0 HIV-negative women, with an incidence rate of 1.78 (0.67-4.75) per 100 person-years. Perinatally acquired HIV was the one factor independently associated with both concordant and sequential high-risk HPV infection. Children and adolescents with perinatally acquired HIV should be prioritized for HPV vaccination, and cervical cancer screening should be part of routine HIV care for sexually active YPHIV.

A Case of Condyloma Acuminatum on the Nipple Detected via Dermoscopy

Introduction Condyloma acuminatum (CA), also known as genital warts, is an anogenital warty growth caused by some types of the human papilloma virus (HPV). CA is usually found within the anal or genital area, but it occasionally presents in the oral, respiratory, conjunctival, nasal, or nipple region. We herein report a rare case of a 29-year-old Chinese woman with a tiny CA on her nipple, which was diagnosed through dermoscopy. With noninvasion and convenience, dermoscopy is valuable for the early diagnosis of tiny CA that is unable to be discerned by the naked eye. Case report A 29-year-old Chinese woman presented with a one-week history of a pink papule affecting her right nipple. The lesion was asymptomatic. Just two months ago, she had been diagnosed with CA caused by HPV-6 and HPV-18 and treated with carbon dioxide (CO2) laser in Chengdu Second People's Hospital. Physical examination revealed a pink papule with a size of millet at the center of her right nipple (Fig. 1A). Dermoscopy showed fingerlike patterns with hairpin and dotted vessels within the papillae (Fig. 1B). The acetowhitening test was positive, and real-time polymerase chain reaction (PCR) amplification positively detected HPV-18 sequences. In addition, a test for antihuman immunodeficiency virus antibody (HIV-Ab), the Treponema pallidum particle agglutination assay, and the tolulized red unheated serum test all produced negative results.Figure 1: Clinical and dermoscopic features of the lesion. (A) A pink papule with a size of millet at the center of the right nipple. (B) Dermoscopy shows fingerlike patterns with hairpin or dotted vessels within the papillae (×50).Based on these findings, we diagnosed this patient with CA on the nipple and started treatment with liquid nitrogen cryotherapy and topical 5% imiquimod cream. There has been no recurrence in the ensuing three months. Discussion CA is a sexually transmitted infection caused by certain types of HPV, most commonly HPV-6 and HPV-11. Suzanne et al.1 used PCR to assess the lesions of 472 patients with CA and detected a total of 14 HPV genotypes (6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59), of which HPV-6 and HPV-11 were the dominant types (94.7%) followed by HPV-16 and HPV-18. HPV-16 and HPV-18 accounted for 50% of the 22 CA patients, who were positive for a high-risk HPV genotype. Although CA usually occurs in the anal or genital area, it occasionally presents in the oral, respiratory, conjunctival, nasal, or nipple region. The anogenital HPV infection is almost acquired through sexual contact. The lesions are characterized by localized single or multiple papules without any symptoms in the early stage, which gradually develop into papillary, cristate, cauliflower-like, or crumby neoplasms. To date, a few cases of CA on the nipple have been reported. Wood2 reported the first case of CA on the nipple in 1978. Later, Kulke et al.3 cloned HPV-6 subtype from a CA located on the nipple, and Kowalzick et al.4 described a case of CA on the nipple associated with HPV-41. In 2014, Saeki et al.5 reported a case of CA on the nipple and areola that resembled seborrheic keratosis. This patient visited our clinic again for a new tiny papule on her nipple. If she had not been previously diagnosed with genital CA, we might have easily ignored such a tiny lesion. Then, dermoscopy showed typical wart manifestations, and HPV-18 sequences were positively detected by real-time PCR. However, there have been no reports of the correlation between HPV-18 and verruca vulgaris. In view of her history of CA caused by both HPV-6 and HPV-18, our patient was diagnosed with CA on the nipple. In most cases, clinicians familiar with the clinical manifestations of CA can easily make a diagnosis only based upon a physical examination. However, examination with a dermoscopy is helpful for diagnosing CA when the lesions are particularly small or atypical.6-7 The specific dermoscopic findings of CA include morphologic patterns (fingerlike, knoblike, mosaic-like) and multiple vascular features (glomerular/dotted, hairpin).6 As a noninvasive and convenient examination method, dermoscopy is valuable for the early diagnosis of tiny CA that is unable to be discerned by the naked eye.

Anogenital Human Papillomavirus and HIV Infection in Rwandan Men Who Have Sex With Men

Background:Men who have sex with men (MSM) have a high prevalence of anal and penile human papillomavirus (HPV) infections with MSM living with HIV (MSMLH) bearing the highest rates. Data on anogenital high-risk HPV (hrHPV) among MSM in Rwanda and the associated risk factors are scant.Methods:We recruited 350 self-identified MSM aged 18 years living in Kigali, Rwanda, with 300 recruited from the community and 50 from partner clinics. Anal and penile specimens from all participants were analyzed for hrHPV using the AmpFire platform. Logistic regression was used to calculate crude odds ratios (ORs) and adjusted ORs (aORs) with 95% confidence intervals (95% CIs) as a measure of association between various factors and anal and penile hrHPV infection prevalence.Results:Anal hrHPV prevalence was 20.1%, was positively associated with having receptive anal sex with more partners (aOR: 9.21, 95% CI: 3.66 to 23.14), and was negatively associated with having insertive anal sex with more partners (aOR: 0.28, 95% CI: 0.12 to 0.66). Penile hrHPV prevalence was 35.0%, was negatively associated with having receptive anal sex with more partners (aOR: 0.29, 95% CI: 0.13 to 0.66), and differed significantly by HIV status, with 55.2% and 29.7% for MSMLH and HIV-negative MSM, respectively (P < 0.01).Conclusion:Penile hrHPV prevalence was higher than that of anal hrHPV and it was significantly higher in Rwandan MSMLH than in HIV-negative MSM. The prevalence of anal and penile HPV infections is likely variable at different locations in Africa, according to a number of factors including HIV status and sexual practices.

Incidence and Persistence of High-risk Anogenital Human Papillomavirus Infection Among Female Youth With and Without Perinatally Acquired Human Immunodefiency Virus Infection: A 3-year Observational Cohort Study.

Female youth with perinatally acquired human immunodeficiency virus (PHIV) may be at higher risk than uninfected youth for persistent anogenital human papillomavirus (HPV) infection, due to prolonged immunodeficiency. A 3-year cohort study was conducted between 2013 and 2017 among Thai and Vietnamese PHIV and HIV-uninfected females 12-24 years, matched by age group and number of lifetime sexual partners. For HPV genotyping, cervical and anal samples were obtained at baseline and annually. Vaginal samples were collected at baseline and every 6 months. Factors associated with high-risk HPV (HR-HPV) persistence and incidence were assessed. We enrolled 93 PHIV and 99 HIV-uninfected females. Median age was 19 (interquartile range [IQR] 18-20) years. For the 7 HR-HPV types (16, 18, 31, 33, 45, 52, 58) in the nonavalent HPV vaccine, PHIV had significantly higher incidence (P = .03) and persistence (P = .01) than HIV-uninfected youth over a 3-year period. Having HIV (adjusted hazard ratio [aHR] 2.1, 95% confidence interval [CI] 1.1-3.9) and ever using illegal substances (aHR 4.8, 95% CI 1.8-13.0) were associated with incident 7 HR-HPV infections. HIV-positive status (adjusted prevalence ratio [aPR] 2.2, 95% CI 1.5-3.2), recent alcohol use (aPR 1.75, 95% CI 1.2-2.5), and higher number of lifetime partners (aPR 2.0, 95% CI 1.4-3.1, for 3-5 partners; aPR 1.93, 95% CI 1.2-3.2, for ≥6 partners) were significantly associated with persistent 7 HR-HPV infections. Female PHIV were at higher risk of having anogenital HR-HPV acquisition and persistence. Primary and secondary prevention programs for HPV infection and HPV-related diseases should be prioritized for PHIV children and youth.

Sequential Acquisition of Human Papillomavirus Infection between Genital and Anal Sites in Men and Women in Liuzhou, China: An Observational Cohort Study

Background: The aim of this study was to assess the sequential risk of acquiring a concordant human papillomavirus (HPV) infection in a genital (or anal) site following an anal (or genital) HPV infection in men and women. Method: Independent specimens from 2309 male and 2378 female genital and anal sites were collected and genotyped for HPV at months 0, 6 and 12. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by Cox regression to analyze the sequential acquisition of a genotype-concordant HPV infection in the genital (or anal) site following an incident HPV infection in the anal (or genital) site in men and women. Findings: The incidence rate of anal HPV infection was 8·8 (95% CI: 5·2- 14·8) and 3·8 (95% CI: 2·9-4·9) per 1000 person-months in men with or without a prior genital HPV infection of the same type (HR, 2·6; 95% CI: 1·4-4·6); these values were 25·9 (95% CI: 21·0-31·9) and 6·2 (95% CI: 5·3-7·3) in women (HR, 4·4; 95% CI: 3·4-5·8). Compared with men, women had a higher risk of sequentially acquiring a concordant anal HPV infection following a genital HPV infection (P = 0·0013). Women with prior anal HPV infections also had a higher risk of subsequent genital concordant HPV infections (HR, 1·9; 95% CI: 1·2-3·1), whereas for men, a significant difference was not found for any HPV type (HR, 0·7; 95% CI: 0·2-1·9). Among participants without a prior anogenital HPV infection, the incidence rate of any HPV infection was higher at the genital site than at the anal site in both sexes (both P < 0·0001); however, among subjects with prior infection of the other site, females became more likely to acquire an anal infection than a genital infection, although the difference was not statistically significant (P = 0·0758). Interpretation: Both men and women with prior HPV infection at the genital (or anal) site had a higher risk of sequentially acquiring a concordant HPV infection at the anal (or genital) site. In addition to sexual intercourse, autoinoculation might play an important role in anogenital HPV infection in both sexes, especially anal HPV infection in women. Funding Statement: This study was supported by grant 2015ZX09101034 from National Science and Technology Major Project, grants 81673240 and 81601805 from National Natural Science Foundation of China, and grant 2018ZY001 from the Scientific Research Foundation of State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Written informed consent was obtained from each participant, and the protocol was approved by the Ethics Committee of the Liuzhou Center for Disease Control and Prevention.

Abstract 4216: The microbiota associated to cervical and anal HPV infections in a Hispanic population

Abstract Anogenital human papillomavirus (HPV) are the world’s most commonly diagnosed sexually transmitted infections and high-risk types are linked to dysplasia. Susceptibility to HPV infections is related to the microbial communities of these genital surfaces, which are interfaces between the host and environment. Microbes are a predicted cause of malignancies, revealing a tremendous potential of microbiome-related processes for cancer prevention and diagnostics. The cervix and anus share a susceptible transformation zone, characterized by a metaplastic epithelial site. In fact, in women, anal and cervical squamous intraepithelial lesions tend to occur concurrently, an observation that could be explained by the fact that anal and cervical HPV infections are strongly correlated. We hypothesized that bacterial communities may differ in the anus and cervix and may reveal populations associated to HPV infections in these two body sites. To test this hypothesis we characterized the microbiota of a cross-sectional population-based sample of Puerto Rican women (self-sampled) from the San Juan metropolitan (n=300 samples) and related them to anogenital HPV infections (HPV typing performed by PCR). The microbiota of resident cervical and anal bacterial communities was performed through sequencing of the 16S ribosomal RNA V4 region with the Illumina platform. Data was analyzed at first with QIIta, using the SILVA database as taxonomic reference, and community analyses were performed in QIIME and R. Significant differences in community structure (betadiversity) were found between cervical and anal communities (p-value = 0.001), but not according to HPV (p-value = 0.212) in any of the body sites. Indeed, overall anal communities were dominated by OTUs within Prevotella, Bacteroides and Clostridiales, while cervical samples were dominated by Lactobacillus and Bifidobacteraceae (Gardnerella). Despite the common core communities at each body site, cervical samples of HPV positive patients revealed an enrichment of Ureaplasma and Prevotella while Peptinophilus was associated with anal HPV infections. Although more analyses are needed, our data suggests cervical and anal bacteria are associated to HPV infections which could pave the way to the development of early detection methods or novel probiotics for in women living in Puerto Rico. Citation Format: Frances Vázquez-Sánchez, Gilmary Ortiz, Ana P. Ortiz, Filipa Godoy-Vitorino. The microbiota associated to cervical and anal HPV infections in a Hispanic population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4216.

Sex Differences in the Incidence and Clearance of Anogenital Human Papillomavirus Infection in Liuzhou, China: An Observational Cohort Study.

Human papillomavirus (HPV) causes anogenital warts and cancers in men and women. However, little is known about sex differences regarding the natural history of anogenital HPV infection. Starting in May 2014, an observational cohort study including 2309 men and 2378 women aged 18-55 years was conducted in Liuzhou, China. Samples from anogenital sites were tested for HPV genotypes by multicolor real-time polymerase chain reaction and melting curve analysis biannually for ~1 year. The incidence of oncogenic HPV infection was similar in men and women (10.3 and 11.5/1000 person-months; P = .275), whereas the incidence of HPV-6/11 infection was higher in men than in women (2.0 vs 1.1; P = .018). The incidence of both oncogenic HPV and HPV-6/11 infections was significantly higher in women in the 18- to 25-year age group than in the older age groups (P = .006 and .011, respectively), whereas it did not vary by age among men (P = .552 and .425, respectively). Additionally, men were more likely than women to clear oncogenic infections (101.5 vs 58.6/1000 person-months; P < .001), but no significant difference was found in the clearance of HPV-6/11 by sex (111.7 vs 84.8; P = .266). The median time to clearance of oncogenic type and type 6/11 infections was not age dependent for either sex (all P > .05). The natural history of oncogenic and nononcogenic HPV infection differs by sex, which implies that sex-specific vaccination strategies should be considered for oncogenic and nononcogenic HPV. NCT02188004.

Evaluation of the efficiency and safety of combined therapy in patients with clinical manifestationsof anogenital human papillomavirus infection

Evaluation of the efficiency and safety of combined therapy in patients with clinical manifestationsof anogenital human papillomavirus infection

Seropositivity to Multiple Anogenital Human Papillomavirus (HPV) Types Is Associated With Current Anogenital HPV Infection, Abnormal Cytology, and Seropositivity for Nongenital HPVs.

Antibodies against human papillomaviruses (HPVs) are biomarkers for current or past infections. We assessed whether antibodies against multiple HPV types were determinants of current multiple anogenital HPV infections, abnormal cytology, and seropositivity for cutaneous HPVs. A total of 1848 Slovenian women attended 2 rounds of cervical cancer screening 3 years apart and provided data on HPV antibodies and HPV DNA at both visits. Antibodies against 15 anogenital HPV types and 6 cutaneous HPVs were determined using pseudovirion-Luminex serology and anogenital HPV DNA using Linear Array. Antibodies to polyomaviruses were evaluated as a control. Women were grouped as either HPV seronegative or having antibodies to 1-2 HPV types or to ≥3 HPV types. Presence of antibodies to multiple anogenital HPV types at baseline was associated strongly with (i) presence of HPV DNA at the cervix (χ2 = 68.8; P < .0001), (ii) multiple types of HPV DNA at baseline (χ2 = 58.6; P < .0001), (iii) HPV DNA at follow-up (χ2 = 22.9; P < .0001), (iv) abnormal cytology (χ2 = 9.8; P = .0017), and (v) concomitant presence of antibodies to any of 6 nongenital HPV types (χ2 = 40.1; P < .0001). Presence of antibodies to ≥3 anogenital HPV types tended to persist over time. Seropositivity against at least 3 anogenital HPV types is associated with current multiple anogenital HPV infections, abnormal cytology, and seropositivity to nongenital HPVs.