High Prevalence of Anal High-Grade Squamous Intraepithelial Lesions, and Prevention Through Human Papillomavirus Vaccination, in Young Men Who Have Sex With Men Living With Human Immunodeficiency Virus

Joel M. Palefsky, Shelly Y. Lensing, Marvin Belzer, Jeannette Lee, Aditya H. Gaur, Kenneth Mayer, Donna Futterman, Elizabeth A. Stier, Mary E. Paul, Elizabeth Y. Chiao, Daniel Reirden, Stephen E. Goldstone, Maribel Tirado, Edward R. Cachay, Luis F. Barroso, Maria Da Costa, Teresa M. Darragh, Bret J. Rudy, Craig M. Wilson, Jessic A. Kahn

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND: Men who have sex with men (MSM) are at high risk for human papillomavirus (HPV)-related anal cancer. Little is known about the prevalence of low-grade squamous intraepithelial lesions (LSILs) and the anal cancer precursor, high-grade squamous intraepithelial lesions (HSILs), among young MSM with HIV (MSMLWH). HPV vaccination is recommended in this group, but its safety, immunogenicity, and protection against vaccine-type HPV infection and associated LSILs/HSILs have not been studied. METHODS: Two hundred and sixty MSMLWH aged 18-26 years were screened at 17 US sites for a clinical trial of the quadrivalent (HPV6,11,16,18) HPV (qHPV) vaccine. Those without HSILs were vaccinated at 0, 2, and 6 months. Cytology, high-resolution anoscopy with biopsies of lesions, serology, and HPV testing of the mouth/penis/scrotum/anus/perianus were performed at screening/month 0 and months 7, 12, and 24. RESULTS: Among 260 MSMLWH screened, the most common reason for exclusion was detection of HSILs in 88/260 (34%). 144 MSMLWH were enrolled. 47% of enrollees were previously exposed to HPV16. No incident qHPV type-associated anal LSILs/HSILs were detected among men naive to that type, compared with 11.1, 2.2, 4.5, and 2.8 cases/100 person-years for HPV6,11,16,18-associated LSILs/HSILs, respectively, among those previously exposed to that type. qHPV was immunogenic and safe with no vaccine-associated serious adverse events. CONCLUSIONS: 18-26-year-old MSMLWH naive to qHPV vaccine types were protected against incident qHPV type-associated LSILs/HSILs. Given their high prevalence of HSILs, there is an urgent need to vaccinate young MSMLWH before exposure to vaccine HPV types, before initiating sexual activity, and to perform catch-up vaccination.

Original languageEnglish (US)
Pages (from-to)1388-1396
Number of pages9
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume73
Issue number8
DOIs
StatePublished - Oct 20 2021

Keywords

  • anal human papillomavirus infection
  • anal squamous intraepithelial lesions
  • human immunodeficiency virus
  • men who have sex with men
  • quadrivalent HPV vaccine

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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