The Kirby Insitute, UNSW Sydney, Sydney, New South Wales, Australia
The Kirby Insitute, UNSW Sydney, Sydney, New South Wales, Australia.
Sex Transm Infect. 2022 Mar;98(2):101-107. doi: 10.1136/sextrans-2020-054851. Epub 2021 Mar 16.
High-risk human papillomavirus (HRHPV) causes anal cancer, which disproportionately affects gay and bisexual men (GBM). We examined sexual behaviours associated with incident anal HRHPV in an observational cohort study of GBM in Sydney, Australia.
GBM aged 35 years and above were enrolled in the Study of the Prevention of Anal Cancer. Detailed information on sexual practices in the last 6 months, including receptive anal intercourse (RAI) and non-intercourse receptive anal practices, was collected. Anal human papillomavirus (HPV) testing was performed at the baseline and three annual follow-up visits. Risk factors for incident HRHPV were determined by Cox regression using the Wei-Lin-Weissfeld method.
Between 2010 and 2015, 617 men were recruited and 525 who had valid HPV results at baseline and at least one follow-up visit were included in the analysis. The median age was 49 years (IQR 43-56) and 188 (35.8%) were HIV-positive. On univariable analysis, incident anal HRHPV was associated with being HIV-positive (p<0.001), having a higher number of recent RAI partners regardless of condom use (p<0.001 for both), preference for the receptive position during anal intercourse (p=0.014) and other non-intercourse receptive anal sexual practices, including rimming, fingering and receptive use of sex toys (p<0.05 for all). In multivariable analyses, being HIV-positive (HR 1.46, 95% CI 1.09 to 1.85, p=0.009) and reporting condom-protected RAI with a higher number of sexual partners (p<0.001) remained significantly associated with incident HRHPV. When stratified by recent RAI, non-intercourse receptive anal practices were not associated with incident HRHPV in men who reported no recent RAI.
GBM living with HIV and those who reported RAI were at increased of incident anal HRHPV. Given the substantial risk of anal cancer and the difficulty in mitigating the risk of acquiring anal HRHPV, HPV vaccination should be considered among sexually active older GBM.
ANZCTR365383.
高危型人乳头瘤病毒（HRHPV）可引发肛门癌，而同性恋和双性恋男性（GBM）受其影响尤为严重。我们在澳大利亚悉尼的一项针对 GBM 的观察性队列研究中，对与肛门 HRHPV 感染相关的性行为进行了研究。
年龄在 35 岁及以上的 GBM 参加了预防肛门癌研究。收集了过去 6 个月内性行为的详细信息，包括接受肛交（RAI）和非性交性接受肛交行为。在基线和三次年度随访时进行肛门 HPV 检测。使用 Wei-Lin-Weissfeld 方法的 Cox 回归确定了 HRHPV 感染的危险因素。
2010 年至 2015 年期间，共招募了 617 名男性，其中 525 名在基线和至少一次随访时具有有效 HPV 结果的男性被纳入分析。中位年龄为 49 岁（IQR 43-56），188 名（35.8%）HIV 阳性。单变量分析显示，HRHPV 感染与 HIV 阳性（p<0.001）、无论是否使用避孕套，最近 RAI 伴侣的数量较多（两者均为 p<0.001）、偏好肛交中的接受体位（p=0.014）以及其他非性交性接受肛交性行为，包括舔肛、手指插入和使用性玩具（p<0.05）有关。多变量分析显示，HIV 阳性（HR 1.46，95%CI 1.09-1.85，p=0.009）和报告避孕套保护的 RAI 与更多性伴侣有关（p<0.001），与 HRHPV 感染仍显著相关。当按最近的 RAI 分层时，在报告没有最近 RAI 的男性中，非性交性接受肛交行为与 HRHPV 感染无关。
HIV 阳性的 GBM 和报告有 RAI 的男性发生肛门 HRHPV 感染的风险增加。鉴于肛门癌的风险较大，以及难以降低感染肛门 HRHPV 的风险，应考虑在活跃的老年 GBM 中接种 HPV 疫苗。
ANZCTR365383。
