Prevalence and risk factors for neutralizing antibodies to human papillomavirus types 16 and 18 in HIV-positive men who have sex with men.
OBJECTIVE
Human papillomavirus (HPV) vaccination is routinely recommended in HIV-positive men who have sex with men (MSM) aged ≤ 26 years. Levels of previous HPV exposure in older HIV-positive MSM are assumed to be too high to warrant routine HPV vaccination. However, little is known about the prevalence of and risk factors for neutralizing antibody seropositivity to HPV-16 or HPV-18, a key measure of previous exposure to these types.


METHODS
Cross-sectional analysis of baseline visit for 296 HIV-positive MSM participating in a prospective cohort study of anal squamous intraepithelial lesions at a university-based research clinic. Participants completed a questionnaire detailing behaviors and medical history. Phlebotomy, anal cytology, HPV DNA testing with quantitation, and high-resolution anoscopy with biopsy were performed. A pseudovirion-based neutralizing antibody assay was used to measure HPV-16 and HPV-18 neutralizing antibodies.


RESULTS
One hundred thirty-two of 296 (45%) men were HPV-16 seropositive and 141 of 296 (48%) were HPV-18 seropositive. One hundred seventy-five of 296 (59%) of the men were positive for HPV-16 antibodies or DNA and 167 of 296 (56%) were positive for HPV-18 antibodies or DNA. In multivariable analysis, HPV-16 seropositivity did not correlate with age, years of HIV positivity, CD4 level, or HIV viral load. Significant risk factors included HPV-16 DNA positivity with higher DNA levels (ptrend < 0.001) and higher number of receptive sexual partners in the last year (ptrend = 0.012).


CONCLUSIONS
A high proportion of HIV-positive MSM aged >26 years are DNA negative and seronegative to HPV-16 and HPV-18 even when using a sensitive pseudovirion-based neutralizing antibody assay. Prospective studies are needed to determine the clinical- and cost-effectiveness of HPV vaccination in HIV-positive MSM aged >26 years.
*Department of Medicine, University of California, San Francisco, San Francisco, CA; †Department of Public Health, East Carolina University Greenville, NC; ‡British Columbia Centre for Disease Control Public Health Microbiology and Reference Laboratory, BC Centre for Disease Control, Vancouver, British Columbia, Canada; §Department of Epidemiology and biostatistics, University of California, San Francisco; and ‖Department of Pathology, University of California, San Francisco.
Rachna
R
Sharma
Jimmy T
JT
Efird
Aung
A
Chein
Elizabeth A
EA
Holly
Mel
M
Krajden
J Michael
JM
Berry
Teresa M
TM
Darragh
Naomi
N
Jay
Joel M
JM
Palefsky
D000328:Adult; D000368:Aged; D057134:Antibodies, Neutralizing / Q000097:blood*; D000914:Antibodies, Viral / Q000097:blood*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006785:Hospitals, University; D052162:Human papillomavirus 16 / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000276:immunology; D011446:Prospective Studies; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral