title: Prevalence of Anal HPV Infection Among HIV-Positive Men Who Have Sex With Men in India.
abstract: BACKGROUND
  India has a large population of HIV-positive individuals, including men who have sex with men (MSM), and the incidence of human papillomavirus (HPV)-related cancers is high. In developed countries, HIV-positive MSM exhibit the highest prevalence of anal HPV infection and incidence of anal cancer. Little is known about anal HPV infection in HIV-positive Indian MSM.
  
  
  METHODS
  We evaluated 300 HIV-positive MSM from 2 cities in India. Men were tested for anal HPV infection using L1-HPV DNA polymerase chain reaction with probes specific for 29 types and a mixture of 10 additional types. CD4 level and plasma HIV viral load were measured. Participants completed an interviewer-administered questionnaire including a sexual history.
  
  
  RESULTS
  The prevalence of anal HPV was 95% (95% confidence interval: 91% to 97%). The 3 most common types were HPV 35 (20%), HPV 16 (13%), and HPV 6/11 (13%). History of taking antiretroviral medications decreased risk of anal HPV 16 infection [relative risk (RR): 0.6 (0.4-1.0)]. Having an increased number of vaginal sex partners lowered risk of any anal HPV infection. Ever having receptive sex increased risk of any anal HPV [RR: 1.2 (1.1-1.4)] and anal HPV 16 [RR: 6.5 (1.8-107)].
  
  
  CONCLUSIONS
  Almost all Indian HIV-positive MSM had anal HPV infection. The prevalence of HPV 16 was lower and the prevalence of other oncogenic HPV types was higher than in similar populations in North America and Europe. Vaccine-based prevention strategies for HPV infection in India should consider potential differences in HPV type distribution among HIV-infected MSM when designing interventions.
authors.affiliation: *Department of Medicine, University of California, San Francisco, CA; †School of Public Health, Department of Epidemiology, University of California, Berkeley, CA; ‡Department of Medicine, Christian Medical College, Vellore, India; §The Humsafar Trust, Mumbai, India; ‖Department of Clinical Virology, Christian Medical College, Vellore, India; ¶Department of Cancer Biology and Pharmacology, University of Illinois, Chicago, IL; #Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and **Apollo Institute of Medical Sciences and Research, Hyderabad, India.
authors.forename: Alexandra L
authors.initials: AL
authors.lastname: Hernandez
authors.forename: Rajiv
authors.initials: R
authors.lastname: Karthik
authors.forename: Murugesan
authors.initials: M
authors.lastname: Sivasubramanian
authors.forename: Anantharam
authors.initials: A
authors.lastname: Raghavendran
authors.forename: Manu
authors.initials: M
authors.lastname: Gnanamony
authors.forename: Shelly
authors.initials: S
authors.lastname: Lensing
authors.forename: Jeannette Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kannangai
authors.forename: Priya
authors.initials: P
authors.lastname: Abraham
authors.forename: Dilip
authors.initials: D
authors.lastname: Mathai
authors.forename: Joel M
authors.initials: JM
authors.lastname: Palefsky
mesh_terms: D000293:Adolescent; D000328:Adult; D001004:Anus Diseases / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D004279:DNA, Viral / Q000302:isolation & purification; D015658:HIV Infections / Q000150:complications*; D018451:Homosexuality, Male; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D027383:Papillomaviridae / Q000502:physiology*; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012725:Sexual Behavior; D055815:Young Adult
chemical_list: D004279:DNA, Viral