Ecole Doctorale Régionale d'Infectiologie Tropicale de Franceville, Franceville, Gabon.
Ecole Doctorale Bio Sorbonne Paris Cité, BioSPC, Paris Descartes, Paris, France.
PLoS One. 2018 May 24;13(5):e0197845. doi: 10.1371/journal.pone.0197845. eCollection 2018.
High-risk (HR) human papillomavirus (HPV) infection remains a great concern in relation to African men who have sex with men (MSM), especially those infected with HIV. The prevalence of HR-HPV and associated risk factors was estimated in a cross-sectional observational study covering MSM living in Bangui, Central African Republic.
MSM receiving care at the Centre National de Référence des Infections Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, were included. HIV serostatus and socio-demographic and behavioral characteristics were collected. HPV DNA was detected and genotyped on anal swabs using Anyplex™ II HPV28 test (Seegene, South Korea), and HSV DNA by in-house real-time PCR. Logistic regression analyses were used to determine risk factors associated with HPV outcomes.
42 MSM (mean age, 23.2 years; range, 14-39) including 69.1% HIV-1-positive and 30.9% HIV-negative were prospectively enrolled. The prevalence of anal HPV was 69.1%, including 82.7% of HR-HPV which were multiple in 52.0%. The most prevalent genotypes were HPV-35, HPV-58, HPV-59 and HPV-31. While, HPV-16 and HPV-18 were present in a minority of samples. Multiple HR-HPV infection was more frequent in HIV-positive MSM (41.4%) with 2.7 genotypes per anal samples than in HIV-negative (7.7%) with 1.5 genotypes per anal samples. HPV types included in the prophylactic Gardasil-9® vaccine were detected in 68.9% of specimens and HPV-58 was the most frequently detected. MSM infected by HPV-16 and HPV-18 were all infected by HIV-1. Few anal swabs (11.9%) contained HSV-2 DNA without relationship with HPV detection. Condomless receptive anal intercourse was the main risk factor to being infected with any type of HPV and condomless insertive anal intercourse was significantly less associated with HPV contamination than receptive anal intercourse (Odd ratio = 0.02).
MSM in Bangui are at-risk of HIV and HR-HPV anal infections. The unusual distribution of HPV-35 as predominant HPV suggests possible geographic specificities in the molecular epidemiology of HR-HPV in sub-Saharan Africa. Scaling up prevention strategies against HPV infection and related cancers adapted for MSM in Africa should be prioritized. Innovative interventions should be conceived for the MSM population living in Bangui.
高危型（HR）人乳头瘤病毒（HPV）感染仍然是非洲男男性行为者（MSM）的一个重大问题，尤其是那些感染 HIV 的人。本横断面观察性研究旨在评估中非共和国班吉的 MSM 中 HR-HPV 的流行情况和相关的危险因素。
纳入在班吉国家性传播感染和抗逆转录病毒治疗参考中心接受治疗的 MSM。收集 HIV 血清学状况以及社会人口学和行为特征。使用 Anyplex™ II HPV28 检测（韩国 Seegene）对肛门拭子进行 HPV DNA 检测和基因分型，使用内部实时 PCR 对 HSV DNA 进行检测。采用逻辑回归分析确定与 HPV 结果相关的危险因素。
前瞻性纳入了 42 名 MSM（平均年龄 23.2 岁；范围 14-39），包括 69.1% HIV-1 阳性和 30.9% HIV 阴性。肛门 HPV 感染率为 69.1%，包括 82.7%的 HR-HPV，其中 52.0%为多重感染。最常见的基因型为 HPV-35、HPV-58、HPV-59 和 HPV-31。而 HPV-16 和 HPV-18 则较少见。HIV 阳性 MSM 中多重 HR-HPV 感染更为常见（41.4%），每个肛门样本有 2.7 种基因型，而 HIV 阴性 MSM （7.7%）有 1.5 种基因型。预防性 Gardasil-9®疫苗包含的 HPV 类型在 68.9%的标本中被检出，其中 HPV-58 最为常见。感染 HPV-16 和 HPV-18 的 MSM 均感染了 HIV-1。少数肛门拭子（11.9%）未检出 HSV-2 DNA，但与 HPV 检测无关。无保护的肛门受方性行为是感染任何类型 HPV 的主要危险因素，而无保护的肛门插入方性行为与 HPV 污染的相关性明显低于受方性行为（比值比=0.02）。
班吉的 MSM 存在 HIV 和 HR-HPV 肛门感染的风险。HPV-35 作为主要 HPV 的异常分布表明，在撒哈拉以南非洲地区，HR-HPV 的分子流行病学可能存在地域特异性。应优先重视针对非洲 MSM 的 HPV 感染和相关癌症的预防策略。应针对居住在班吉的 MSM 人群设计创新的干预措施。
