Incidence and clearance of anal high-risk human papillomavirus in HIV-positive men who have sex with men: estimates and risk factors.
BACKGROUND
To estimate incidence and clearance of high-risk human papillomavirus (HR-HPV), and their risk factors, in men who have sex with men (MSM) recently infected by HIV in Spain; 2007-2013.


METHODS
Multicenter cohort. HR-HPV infection was determined and genotyped with linear array. Two-state Markov models and Poisson regression were used.


RESULTS
We analysed 1570 HR-HPV measurements of 612 MSM over 13 608 person-months (p-m) of follow-up. Median (mean) number of measurements was 2 (2.6), median time interval between measurements was 1.1 years (interquartile range: 0.89-1.4). Incidence ranged from 9.0 [95% confidence interval (CI) 6.8-11.8] per 1000 p-m for HPV59 to 15.9 (11.7-21.8) per 1000 p-m for HPV51. HPV16 and HPV18 had slightly above average incidence: 11.9/1000 p-m and 12.8/1000 p-m. HPV16 showed the lowest clearance for both 'prevalent positive' (15.7/1000 p-m; 95% CI 12.0-20.5) and 'incident positive' infections (22.1/1000 p-m; 95% CI 11.8-41.1). More sexual partners increased HR-HPV incidence, although it was not statistically significant. Age had a strong effect on clearance (P-value < 0.001) due to the elevated rate in MSM under age 25; the effect of HIV-RNA viral load was more gradual, with clearance rate decreasing at higher HIV-RNA viral load (P-value 0.008).


CONCLUSIONS
No large variation in incidence by HR-HPV type was seen. The most common incident types were HPV51, HPV52, HPV31, HPV18 and HPV16. No major variation in clearance by type was observed, with the exception of HPV16 which had the highest persistence and potentially, the strongest oncogenic capacity. Those aged below 25 or with low HIV-RNA- viral load had the highest clearance.
aPublic Health Service of AmsterdambAcademic Medical Center, Amsterdam, The NetherlandscNational Center of Epidemiology, Institute of Health Carlos III, MadriddCIBERESPeNational Center of Microbiology, Institute of Health Carlos III. MadridfSanitary Center Sandoval, MadridgVirgen del Rocío University Hospital, SevillahElche University Hospital, AlicanteiSan Pedro -CIBIR Hospital, Logroño, La RiojajXeral de Vigo University Hospital, VigokCatalan Institute of Oncology, BarcelonalRamón y Cajal University Hospital-IRYCIS, Madrid, Spain.*Ronald B. Geskus and Cristina González contributed equally to the writing of this manuscript.†Marta Ortiz and Julia Del Amo are senior authors and have equally contributed to this manuscript.
Ronald B
RB
Geskus
Cristina
C
González
Montserrat
M
Torres
Jorge
J
Del Romero
Pompeyo
P
Viciana
Mar
M
Masiá
José R
JR
Blanco
Mauricio
M
Iribarren
Silvia
S
De Sanjosé
Beatriz
B
Hernández-Novoa
Marta
M
Ortiz
Julia
J
Del Amo
D001004:Anus Diseases / Q000453:epidemiology* / Q000821:virology; D015331:Cohort Studies; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult