title: Anal human papillomavirus infection among HIV-infected and uninfected men who have sex with men in Beijing, China.
abstract: BACKGROUND
  In light of China's unique ethnic and sociocultural context, and a marked rise in HIV prevalence among MSM, it is important to determine prevalence, genotypes and predictors of anal human papillomavirus (HPV) among HIV-infected and uninfected men who have sex with men (MSM) in Beijing, China.
  
  
  METHODS
  In 2010-2011, we recruited MSM (age range 18-61; median 28 years) through peer volunteers, and collected demographic/behavioral information via interviewer-administrated questionnaires. Trained health workers collected anal swabs for HPV genotyping by PCR and blood samples for HIV/syphilis serologies.
  
  
  RESULTS
  We obtained anal specimens from 212 HIV-infected and 459 HIV-uninfected participants. Among HIV-infected MSM, 82.1% were HPV-infected vs. 57.5% in HIV-uninfected (p<0.01). HIV-infected men had the greatest likelihood of multiple types: 17.9% uninfected; 36.3% with one type; 36.8% with 2-3; 9.0% with ≥4. Oncogenic HPV prevalence was higher among HIV- infected (61.3%) than uninfected participants (39.7%; p<0.01). HIV-uninfected MSM reporting always using condoms during insertive anal intercourse (past 6 months) were less likely to be HPV-infected (OR=0.49, 95%CI: 0.31-0.77). Among HIV-uninfected MSM, HPV infection was associated with unprotected receptive anal intercourse (past 6 months; OR=1.92, 95%CI: 1.19-3.11) and being forced to have sex (previous year; OR=3.32, 95%CI: 1.10-10.0). Multivariable logistic analysis among HIV infected MSM suggested that unprotected oral intercourse (past 6 months) was associated with HPV (adjusted OR=2.12, 95%CI: 1.00-4.48). Syphilis occurred in 55.8% of HIV-infected/HPV-infected, 50.0% of HIV-infected/HPV-uninfected, 19.6% of HIV-uninfected/HPV-infected, and 13.0% of HIV-uninfected/HPV-uninfected MSM.
  
  
  CONCLUSIONS
  HPV anal infections were more common among HIV-infected than uninfected MSM in China, including oncogenic and multiple types. Unprotected oral and receptive anal sex were was independently associated with HPV infection. Promotion of safer sex and HPV vaccination is strongly recommended among MSM.
authors.affiliation: State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention China CDC, Beijing, China.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Hu
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
authors.forename: Jiangping
authors.initials: J
authors.lastname: Sun
authors.forename: Lei
authors.initials: L
authors.lastname: Gao
authors.forename: Lu
authors.initials: L
authors.lastname: Yin
authors.forename: Xiangwei
authors.initials: X
authors.lastname: Li
authors.forename: Dong
authors.initials: D
authors.lastname: Xiao
authors.forename: Dongliang
authors.initials: D
authors.lastname: Li
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Sun
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Milam
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Pan
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000473:pathology* / Q000821:virology; D001004:Anus Diseases / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control / Q000821:virology*; D002681:China / Q000453:epidemiology; D060085:Coinfection; D003430:Cross-Sectional Studies; D005838:Genotype; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000473:pathology; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D052163:Human papillomavirus 6 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires