School of Public Health, Xinjiang Medical University, Urumqi, China.
Front Public Health. 2022 May 11;10:891991. doi: 10.3389/fpubh.2022.891991. eCollection 2022.
Men who have sex with men (MSM) are at increased risk for Human papillomavirus (HPV) infection compared to women and heterosexual men. We aimed to assess the incidence, clearance and duration of anal human papillomavirus (HPV) infection in HIV-negative MSM and the influencing factors in a 5-year prospective cohort study.
From April 2016 to April 2021, HIV-negative MSM were recruited and followed every 6 months in Urumqi, Xinjiang, China. Questionnaires and anal swabs were collected at baseline and every 6 months. We detected 37 anal HPV genotypes using the HPV Geno Array Diagnostic Kit Test. Incidence and clearance rates of anal HPV infection and the influencing factors were estimated using a two-state Markov model.
A total of 585 MSM were included with a median age of 37 years [interquartile range (IQR): 31-43 years] and were followed for a median 2.8 years (IQR: 1.8-3.6 years). Incidence rates for any HPV and high-risk HPV (Hr-HPV) were 53.4 [95% confidence interval (CI): 49.1-58.0] and 39.0 (95% CI: 35.7-42.5)/1,000 person-months. Median duration of infection was 9.67 (95% CI: 8.67-10.86) and 8.51 (95% CI: 7.57-9.50) months, respectively. Clearance rates for any HPV and Hr-HPV were 50.9 (95% CI: 46.7-55.3) and 62.1 (95% CI: 56.8-66.7)/1,000 person-months, respectively. HPV16 and HPV6 had the highest incidence, lowest clearance rate and longest duration of infection among Hr-HPV and low-risk HPV (Lr-HPV) types, respectively. Receptive anal sex is a risk factor for any HPV [hazard ratio (HR) = 1.66, 95% CI: 1.16-2.38] and Hr-HPV infection (HR = 1.99, 95% CI:1.39-2.85). Recent anal sex without condom use was significantly associated with any HPV (HR = 1.80, 95% CI: 1.10-2.94) and Hr-HPV infection (HR = 2.60, 95% CI: 1.42-4.77). Age ≥35 years was significantly associated with Lr-HPV HPV infection only (HR = 1.40, 95% CI: 1.02-1.93). Both inserted and receptive anal sex (HR = 0.60, 95% CI: 0.40-0.89) and anal sex ≥2 times per week (HR = 0.61, 95% CI: 0.43-0.87) were associated with reduced Hr-HPV clearance. Six of the nine-valent vaccine types (HPV6, 11, 16, 18, 52 and 58) occurred most frequently, which indicates the need for high vaccination coverage in MSM.
In this cohort study, high incidence and low clearance of any HPV, Hr-HPV and individual HPV infections emphasize the importance of MSM vaccination. Modifiable behavioral factors such as condoms and drug use should be incorporated into HPV prevention strategies.
与女性和异性恋男性相比，男男性行为者（MSM）感染人乳头瘤病毒（HPV）的风险更高。我们旨在评估在一项为期 5 年的前瞻性队列研究中，HIV 阴性 MSM 人群肛门 HPV （HPV）感染的发生率、清除率和持续时间及其影响因素。
从 2016 年 4 月至 2021 年 4 月，在中国新疆乌鲁木齐招募 HIV 阴性 MSM，并每 6 个月随访一次。在基线和每 6 个月时收集问卷和肛门拭子。我们使用 HPV GenoArray 诊断试剂盒检测 37 种肛门 HPV 基因型。使用两状态马尔可夫模型估计肛门 HPV 感染的发生率、清除率和影响因素。
共纳入 585 名 MSM，中位年龄 37 岁[四分位间距（IQR）：31-43 岁]，中位随访时间 2.8 年（IQR：1.8-3.6 年）。任何 HPV 和高危型 HPV（Hr-HPV）的感染发生率分别为 53.4 [95%置信区间（CI）：49.1-58.0]和 39.0（95% CI：35.7-42.5）/1000 人月。感染中位持续时间分别为 9.67（95% CI：8.67-10.86）和 8.51（95% CI：7.57-9.50）个月。任何 HPV 和 Hr-HPV 的清除率分别为 50.9（95% CI：46.7-55.3）和 62.1（95% CI：56.8-66.7）/1000 人月。在高危型和低危型 HPV（Lr-HPV）中，HPV16 和 HPV6 的发病率最高，清除率最低，感染持续时间最长。接受肛门性行为是任何 HPV（HR=1.66，95%CI：1.16-2.38）和 Hr-HPV 感染（HR=1.99，95%CI：1.39-2.85）的危险因素。最近无保护措施的肛交与任何 HPV（HR=1.80，95%CI：1.10-2.94）和 Hr-HPV 感染（HR=2.60，95%CI：1.42-4.77）显著相关。年龄≥35 岁与仅 Lr-HPV HPV 感染显著相关（HR=1.40，95%CI：1.02-1.93）。插入式和接受式肛交（HR=0.60，95%CI：0.40-0.89）和每周肛交≥2 次（HR=0.61，95%CI：0.43-0.87）与 Hr-HPV 清除率降低相关。九价疫苗类型中的六种（HPV6、11、16、18、52 和 58）最常发生，这表明 MSM 需要高疫苗接种覆盖率。
在这项队列研究中，任何 HPV、Hr-HPV 和个体 HPV 感染的高发生率和低清除率强调了 MSM 接种疫苗的重要性。可以将可改变的行为因素（如避孕套和药物使用）纳入 HPV 预防策略中。
