人乳头瘤病毒疫苗接种与男同性恋、双性恋及其他与男性发生性行为的男性中的肛门人乳头瘤病毒感染

HPV vaccination and anal HPV infection in gay, bisexual, and other men who have sex with men.

作者信息

Kassam Pareesa, El-Zein Mariam, Tota Joseph E, Tellier Pierre-Paul, Coutlée François, de Pokomandy Alexandra, Franco Eduardo L

机构信息

Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada.

Department of Oncology, McGill University, Montréal, Quebec, Canada; Epidemiology Department, Merck & Co., Inc., Rahway, NJ, USA.

出版信息

Vaccine. 2025 Jan 25;45:126644. doi: 10.1016/j.vaccine.2024.126644. Epub 2024 Dec 21.

DOI:10.1016/j.vaccine.2024.126644

PMID:39708517

Abstract

BACKGROUND

Gay, bisexual, and other men who have sex with men (gbMSM) have a higher risk of human papillomavirus (HPV) infection and related diseases and would benefit from preventive measures such as HPV vaccination. We assessed the association between HPV vaccination and anal HPV infection in HIV-negative gbMSM and gbMSM living with HIV from the Lubricant Investigation in Men to Inhibit Transmission of HPV Infection study.

METHODS

Participants attended 7 visits over 12 months where they provided a nurse-collected anal sample and self-completed a questionnaire on risk factors and HPV vaccination. Samples were tested for HPV using polymerase chain reaction assays. We assessed the association with HPV vaccination and anal HPV prevalence and incidence using logistic and Cox regression, respectively. Analyses at the individual- (unit of analysis = participant) and HPV-level (unit of analysis = HPV type) considered vaccine-targeted types (any of HPVs 6/11/16/18) as the outcome. To assess construct validity, we repeated analyses considering incidence of non-vaccine-targeted (within- and cross-species) HPV types at the HPV-level. Estimates were adjusted for a propensity score to predict cumulative HPV positivity based on selected study and participant characteristics.

RESULTS

Of 258 enrolled participants (18.2-71.7 years; 69 being HIV-positive), 23.3 % were vaccinated at baseline. At the individual-level, there was no association between vaccination and HPVs 6/11/16/18 prevalence (n = 250, aOR = 1.12, 95 % CI = 0.56-2.22) or incidence (n = 152, aHR = 0.34, 95 % CI = 2.19 × 10-1.38). At the HPV-level, while there was no association with HPVs 6/11/16/18 prevalence (n = 1000, aOR = 0.99, 95 % CI = 0.57-1.71), vaccination was associated with a reduction in HPVs 6/11/16/18 incidence (n = 754, aHR = 0.22, 95 % CI = 6.01 × 10-0.79). Vaccination was not associated with incidence of within-species (n = 2299, aHR = 0.76, CI = 0.42-1.24) or cross-species (n = 3774, aHR = 1.28, CI = 0.89-1.85) HPV types. Results were similar by HIV status.

CONCLUSION

Our findings support that HPV vaccination protects against incident anal infection of vaccine-targeted HPV types, thus, gbMSM should be encouraged to get vaccinated against HPV.

摘要

背景

男同性恋者、双性恋者以及其他与男性发生性行为的男性（gbMSM）感染人乳头瘤病毒（HPV）及相关疾病的风险更高，HPV疫苗接种等预防措施对他们有益。我们在“男性润滑剂预防HPV感染调查”研究中，评估了HIV阴性的gbMSM和感染HIV的gbMSM中HPV疫苗接种与肛门HPV感染之间的关联。

方法

参与者在12个月内参加7次访视，期间提供由护士采集的肛门样本，并自行填写关于风险因素和HPV疫苗接种情况的问卷。使用聚合酶链反应检测法对样本进行HPV检测。我们分别采用逻辑回归和Cox回归评估HPV疫苗接种与肛门HPV感染率及发病率之间的关联。个体水平（分析单位 = 参与者）和HPV水平（分析单位 = HPV类型）的分析将疫苗靶向型（HPV 6/11/16/18中的任何一种）作为研究结果。为评估结构效度，我们在HPV水平上重复分析，将非疫苗靶向型（种内和跨物种）HPV类型的发病率作为研究结果。根据选定的研究和参与者特征，对估计值进行倾向得分调整，以预测累积HPV阳性情况。

结果

在258名登记参与者中（年龄18.2 - 71.7岁；69名HIV阳性），23.3%在基线时接种了疫苗。在个体水平上，疫苗接种与HPV 6/11/16/18感染率（n = 250，校正比值比[aOR] = 1.12，95%置信区间[CI] = 0.56 - 2.22）或发病率（n = 152，校正风险比[aHR] = 0.34，95% CI = 2.19×10 - 1.38）之间无关联。在HPV水平上，虽然疫苗接种与HPV 6/11/16/18感染率（n = 1000，aOR = 0.99，95% CI = 0.57 - 1.71）无关联，但与HPV 6/11/16/18发病率降低相关（n = 754，aHR = 0.22，95% CI = 6.01×10 - 0.79）。疫苗接种与种内（n = 2299，aHR = 0.76，CI = 0.42 - 1.24）或跨物种（n = 3774，aHR = 1.28，CI = 0.89 - 1.85）HPV类型的发病率无关。按HIV感染状况分析，结果相似。