Müller Etienne E, Rebe Kevin, Chirwa Tobias F, Struthers Helen, McIntyre James, Lewis David A
Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
Anova Health Institute, Johannesburg, South Africa.
BMC Infect Dis. 2016 Aug 22;16(1):440. doi: 10.1186/s12879-016-1706-9.
We investigated the prevalence of human papillomavirus (HPV) infection and associated behavioural risk factors in men-who-have-sex-with-men (MSM) attending a clinical service in Cape Town, South Africa.
MSM were enrolled at the Ivan Toms Centre for Men's Health in Cape Town. A psychosocial and sexual behavioral risk questionnaire was completed for each participant and urine, oro-pharyngeal and anal swabs were collected for HPV testing using the Linear Array HPV Genotyping Test. Logistic regression analyses were performed to determine sexual risk factors associated with HPV infection at the three anatomical sites.
The median age of all 200 participants was 32 years (IQR 26-39.5), of which 31.0 % were black, 31.5 % mixed race/coloured and 35.5 % white. The majority of the participants (73.0 %) had completed high school, 42.0 % had a tertiary level qualification and 69.0 % were employed. HPV genotypes were detected in 72.8 % [95 % CI: 65.9-79.0 %], 11.5 % [95 % CI: 7.4-16.8 %] and 15.3 % [95 % CI: 10.5-21.2 %] of anal, oro-pharyngeal and urine specimens, respectively. Prevalence of high-risk (HR)-HPV types was 57.6 % [95 % CI: 50.3-64.7 %] in anal samples, 7.5 % [95 % CI: 4.3-12.1 %] in oro-pharyngeal samples and 7.9 % [95 % CI: 4.5-12.7 %] in urine, with HPV-16 being the most common HR-HPV type detected at all sites. HPV-6/11/16/18 was detected in 40.3 % [95 % CI: 33.3-47.6 %], 4.5 % [95 % CI: 2.1-8.4 %] and 3.2 % [95 % CI: 1.2-6.8 %] of anal, oro-pharyngeal and urine samples, respectively. Multiple HPV types were more common in the anal canal of MSM while single HPV types constituted the majority of HPV infections in the oropharynx and urine. Among the 88 MSM (44.0 %) that were HIV positive, 91.8 % [95 % CI: 83.8-96.6 %] had an anal HPV infection, 81.2 % [95 % CI: 71.2-88.8 %] had anal HR-HPV and 85.9 % [95 % CI: 76.6-92.5 %] had multiple anal HPV types. Having sex with men only, engaging in group sex in lifetime, living with HIV and practising receptive anal intercourse were the only factors independently associated with having any anal HPV infection.
Anal HPV infections were common among MSM in Cape Town with the highest HPV burden among HIV co-infected MSM, men who have sex with men only and those that practiced receptive anal intercourse. Behavioural intervention strategies and the possible roll-out of HPV vaccines among all boys are urgently needed to address the high prevalence of HPV and HIV co-infections among MSM in South Africa.
我们调查了在南非开普敦一家临床机构就诊的男男性行为者（MSM）中人类乳头瘤病毒（HPV）感染率及相关行为危险因素。
MSM在开普敦的伊万·汤姆斯男性健康中心登记入组。为每位参与者完成一份社会心理和性行为风险调查问卷，并采集尿液、口咽拭子和肛门拭子，使用线性阵列HPV基因分型检测进行HPV检测。进行逻辑回归分析以确定与三个解剖部位HPV感染相关的性风险因素。
所有200名参与者的中位年龄为32岁（四分位间距26 - 39.5岁），其中31.0%为黑人，31.5%为混血/有色人种，35.5%为白人。大多数参与者（73.0%）完成了高中学业，42.0%拥有大专学历，69.0%就业。在肛门、口咽和尿液标本中分别检测到HPV基因型的比例为72.8% [95%置信区间：65.9 - 79.0%]、11.5% [95%置信区间：7.4 - 16.8%]和15.3% [95%置信区间：10.5 - 21.2%]。高危（HR）-HPV类型在肛门样本中的感染率为57.6% [95%置信区间：50.3 - 64.7%]，在口咽样本中为7.5% [95%置信区间：4.3 - 12.1%]，在尿液中为7.9% [95%置信区间：4.5 - 12.7%]，HPV-16是在所有部位检测到的最常见的HR-HPV类型。HPV-6/11/16/18在肛门、口咽和尿液样本中的检测率分别为40.3% [95%置信区间：33.3 - 47.6%]、4.5% [95%置信区间：2.1 - 8.4%]和3.2% [95%置信区间：1.2 - 6.8%]。多种HPV类型在MSM的肛管中更常见，而单一HPV类型构成口咽和尿液中HPV感染的大多数。在88名HIV阳性的MSM（44.0%）中，91.8% [95%置信区间：83.8 - 96.6%]有肛门HPV感染，81.2% [95%置信区间：71.2 - 88.8%]有肛门HR-HPV，85.9% [95%置信区间：76.6 - 92.5%]有多种肛门HPV类型。仅与男性发生性行为、一生中参与过群交、感染HIV以及进行接受性肛交是与任何肛门HPV感染独立相关的唯一因素。
肛门HPV感染在开普敦的MSM中很常见，在合并感染HIV的MSM中HPV负担最高，包括仅与男性发生性行为的男性以及进行接受性肛交的男性。迫切需要采取行为干预策略，并可能在所有男孩中推广HPV疫苗，以解决南非MSM中HPV和HIV合并感染的高流行率问题。
