Lin Chia-Chun, Hsieh Ming-Chang, Hung Hung-Chang, Tsao Shih-Ming, Chen Shiuan-Chih, Yang Hao-Jan, Lee Yuan-Ti
Division of Infectious Diseases, Department of Internal Medicine.
Department of Public Health, College of Health Care and Management.
Medicine (Baltimore). 2018 Nov;97(45):e13201. doi: 10.1097/MD.0000000000013201.
Human papillomavirus (HPV) infection is associated with cancer and can be prevented through vaccination. Few studies from Taiwan have reported on HPV infection among human immunodeficiency virus (HIV)-infected subjects. The aim of this study was to examine the prevalence of HPV infection among men who have sex with men (MSM) with and without HIV infection in Taiwan, and explore the behavioral risk factors thereof.We conducted a cross-sectional study in Taiwan during 2013 to 2016 to collect data on MSM aged 20 years or older. We used a questionnaire in a face-to-face interview, and subsequently collected oral, anal, and genital specimens from HIV-infected and HIV-uninfected subjects. Multivariate analysis was performed to predict factors associated with high-risk HPV (HR-HPV) positivity.Overall, 279 subjects, including 166 (59.5%) HIV-uninfected and 113 (40.5%) HIV-infected men were enrolled. Compared to HPV-negative subjects, HPV-positive subjects had significantly higher rates of receptive anal sex (91.3% vs 75.6%), substance use (22.6% vs 11%), history of sexually transmitted infections (75.7% vs 38.4%), anogenital or oral warts (39.1% vs 6.72%), syphilis (32.2% vs 11.6%), and HIV infection (69.6% vs 20.1%). We detected 489 HPV deoxyribonucleic acid (DNA) types (through 379 viable specimens), of which 43.6%, 5.7%, 56.4%, and 10.4% were HR-HPV type, HPV type 16, low-risk HPV types, and HPV type 6, respectively. In multivariate analysis, HIV-infected subjects had a significantly higher prevalence of HR-HPV infection (adjusted odds ratio, 5.80; 95% confidence interval, 2.57-13.11), compared to HIV-uninfected subjects.These results suggest that the prevalence of HPV infection was high among HIV-infected MSM. Additionally, anal HPV infection was observed to be common among both HIV-infected and HIV-uninfected MSM in Taiwan. The prevalence of oral and genital HPV infection, HR-HPV DNA types, and multiple HPV types was higher in HIV-infected subjects than in HIV-uninfected subjects. As only 35% of subjects practiced safe sex, we recommend routine HPV vaccination with 4-valent HPV or 9-valent HPV vaccines for both MSM, and HIV-infected subjects.
人乳头瘤病毒（HPV）感染与癌症相关，且可通过接种疫苗预防。台湾地区鲜有研究报道人类免疫缺陷病毒（HIV）感染者中的HPV感染情况。本研究旨在调查台湾地区感染HIV和未感染HIV的男男性行为者（MSM）中HPV感染的患病率，并探究其行为危险因素。
我们于2013年至2016年在台湾地区开展了一项横断面研究，收集20岁及以上MSM的数据。我们通过面对面访谈使用问卷进行调查，随后从感染HIV和未感染HIV的受试者中采集口腔、肛门和生殖器标本。进行多变量分析以预测与高危型HPV（HR-HPV）阳性相关的因素。
总体而言，共纳入279名受试者，其中166名（59.5%）未感染HIV，113名（40.5%）感染HIV。与HPV阴性受试者相比，HPV阳性受试者接受肛交的比例显著更高（91.3%对75.6%）、使用毒品的比例更高（22.6%对11%）、有性传播感染史的比例更高（75.7%对38.4%）、有肛门生殖器或口腔疣的比例更高（39.1%对6.72%）、患梅毒的比例更高（32.2%对11.6%）以及感染HIV的比例更高（69.6%对20.1%）。我们检测到489种HPV脱氧核糖核酸（DNA）类型（通过379份有效标本），其中分别有43.6%、5.7%、56.4%和10.4%为HR-HPV型、HPV 16型、低危型HPV和HPV 6型。在多变量分析中，与未感染HIV的受试者相比，感染HIV的受试者HR-HPV感染的患病率显著更高（调整后的优势比为5.80；95%置信区间为2.57 - 13.11）。
这些结果表明，感染HIV的MSM中HPV感染的患病率较高。此外，在台湾地区，感染HIV和未感染HIV的MSM中肛门HPV感染均较为常见。感染HIV的受试者口腔和生殖器HPV感染、HR-HPV DNA类型以及多种HPV类型的患病率均高于未感染HIV的受试者。由于只有35%的受试者采取了安全性行为，我们建议对MSM以及感染HIV的受试者常规接种四价HPV疫苗或九价HPV疫苗。
