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Ejaz M, Ekström AM, Ahmed A, Haroon A, Ali D, Ali TS, Salazar M. Human Papillomavirus associated prevention: knowledge, attitudes, and perceived risks among men who have sex with men and transgender women in Pakistan: a qualitative study. BMC Public Health 2022; 22:378. [PMID: 35193544 PMCID: PMC8864907 DOI: 10.1186/s12889-022-12775-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan. DESIGN A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan. METHODS Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis. RESULTS Three themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant's recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one's sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients' integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding. CONCLUSIONS The findings from this study can help public health policy and researchers to understand this minority's perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden. .,Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.
| | - Anna Mia Ekström
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Alyan Ahmed
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Aymen Haroon
- Department of Biostatistics and Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, United States
| | - Dania Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.,School of Nursing, the Aga Khan University, Karachi, Pakistan
| | - Mariano Salazar
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
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Predicting human papillomavirus vaccine uptake in men who have sex with men the influence of vaccine price and receiving an HPV diagnosis. BMC Public Health 2022; 22:28. [PMID: 34991553 PMCID: PMC8740414 DOI: 10.1186/s12889-021-12396-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To understand how human papillomavirus (HPV) screening results, HPV-related knowledge and attitudes are related to vaccination intention in three cost ranges and the actual vaccination behavior in a community sample of men who have sex with men (MSM). METHODS MSM aged 20 years of age or older were recruited between October 2015 and May 2016 from community health centers that provide HIV testing and consultation services in Southern Taiwan and on social media. MSM were seen at baseline and again at 6 months after baseline in a cohort study. The baseline study included 253 individuals; 182 of them returned for the 6th-month follow-up. At each visit, MSM were asked to receive HPV screening and filled out a questionnaire. Structural equation modeling was used to test whether attitudinal factors and HPV screening results from the baseline affect their self-reported actual vaccine uptake at the in 6th-month follow-up. RESULTS Our research included 171 participants from the cohort because they had full information of the study variables (mean ± SD age = 29.21 ± 6.18). Our model showed good model fit using indices such as the comparative fit index (value = 0.998) and root mean square error of approximation (value = 0.013). HPV knowledge can predict those who have intention to take up HPV vaccine no matter what the price (p = .02), and then predict vaccine uptake at the follow-up (p < .001). A positive HPV screening result can predict vaccine uptake at the follow-up (p = .004). CONCLUSION Our findings highlight the impact of vaccine price and HPV screening results on the intention and uptake of HPV vaccine. It is important to raise awareness of HPV in male populations. Clinicians and health educators should establish a safe and private environment for male patients for inquiring about HPV vaccine and HPV-related cancers.
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Farahmand M, Monavari SH, Tavakoli A. Prevalence and genotype distribution of human papillomavirus infection in different anatomical sites among men who have sex with men: A systematic review and meta-analysis. Rev Med Virol 2021; 31:e2219. [PMID: 33527636 DOI: 10.1002/rmv.2219] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022]
Abstract
Men who have sex with men (MSM) are at increased risk of human papillomavirus (HPV) infection because of their high-risk sexual behaviours. In this study, a meta-analytic approach was used to systematically analyse the literature to elucidate the prevalence and genotype distribution of anal, penile, oral and urethral HPV infection among MSM in the world. To carry out this systematic review, five electronic databases including Web of Science, PubMed, Scopus, Embase, and Google Scholar were searched for relevant studies published from January 2012 to November 2019, and pertinent data were collected from the eligible articles. The pooled HPV prevalence was calculated for each anatomical region using a random-effect model weighted by the inverse variance method. The meta-analysis was performed using the "Metaprop" function in the R package Meta. The overall pooled prevalence of anal, penile, oral and urethral HPV infection among MSM were 78.4% (95% confidence interval [CI]: 75.6%-81.0%), 36.2% (95% CI: 29.1%-44.0%), 17.3% (95% CI: 13.6%-21.7%) and 15.4% (95% CI: 7.8%-27.9%), respectively. Stratified analyses showed that the prevalences of HPV were significantly higher in HIV-positive than HIV-negative MSM. The most frequent HPV high-risk type detected in the anus, penis and oral cavity was HPV-16 (19.9%, 4.9% and 3.1%, respectively). HPV infection is rising in MSM because of high-risk sexual behaviours, suggesting an increased future risk of developing HPV-related diseases and malignancies in this population.
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Affiliation(s)
- Mohammad Farahmand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamidreza Monavari
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Tavakoli
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
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Grubb LK, Powers M. Emerging Issues in Male Adolescent Sexual and Reproductive Health Care. Pediatrics 2020; 145:peds.2020-0627. [PMID: 32341182 DOI: 10.1542/peds.2020-0627] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.
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Affiliation(s)
- Laura K Grubb
- Departments of Adolescent Medicine, Pediatrics, and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and
| | - Makia Powers
- Departments of Pediatrics and Public Health and Community Medicine, Morehouse School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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Kesten JM, Flannagan C, Ruane-McAteer E, Merriel SWD, Nadarzynski T, Shapiro G, Rosberger Z, Prue G. Mixed-methods study in England and Northern Ireland to understand young men who have sex with men's knowledge and attitudes towards human papillomavirus vaccination. BMJ Open 2019; 9:e025070. [PMID: 31092645 PMCID: PMC6530382 DOI: 10.1136/bmjopen-2018-025070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) are at greater risk for human papillomavirus (HPV)-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when received prior to sexual debut, at genitourinary medicine clinics in the UK. In September 2019, the national HPV vaccination programme will be extended to boys. This study aimed to understand young MSM's (YMSM) knowledge and attitudes towards HPV vaccination. DESIGN Questionnaires assessed YMSM demographics, sexual behaviour, culture, knowledge and attitudes towards HPV vaccination and stage of vaccine decision-making using the precaution adoption process model. Focus groups explored sexual health information sources, attitudes, barriers and facilitators to vaccination and strategies to support vaccination uptake. Questionnaire data were analysed using descriptive statistics and focus group data were analysed thematically. SETTING Questionnaires were completed online or on paper. Focus groups were conducted within Lesbian Gay Bisexual Transgender Queer organisational settings and a university student's union in England and Northern Ireland. PARTICIPANTS Seventeen YMSM (M=20.5 years) participated in four focus groups and 51 (M=21.1 years) completed questionnaires. RESULTS Over half of YMSM were aware of HPV (54.9%), yet few (21.6%) had previously discussed vaccination with a healthcare professional (HCP). Thematic analyses found YMSM were willing to receive the HPV vaccine. Vaccination programmes requiring YMSM to request the vaccine, particularly prior to sexual orientation disclosure to family and friends, were viewed as unfeasible. Educational campaigns explaining vaccine benefits were indicated as a way to encourage uptake. CONCLUSIONS This study suggests that to effectively implement HPV vaccination for YMSM, this population requires clearer information and greater discussion with their HCP. In support of the decision made by the Joint Committee on Vaccination and Immunisation, universal vaccination is the most feasible and equitable option. However, the absence of a catch-up programme will leave a significant number of YMSM at risk of HPV infection.
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Affiliation(s)
- Joanna May Kesten
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West, University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Carrie Flannagan
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Newtownabbey, UK
| | - Eimear Ruane-McAteer
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | | | - Tom Nadarzynski
- School of Social Sciences, University of Westminster, London, UK
| | - Gilla Shapiro
- Department of Psychology, McGill University, Montreal, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, Montreal, Canada
| | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
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6
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Strong C, Yu YF, Zou H, Ku WW, Lee CW, Ko NY. Sexual network and detection of anogenital human papillomavirus in a community cohort of men who have sex with men in Taiwan. PLoS One 2019; 14:e0216784. [PMID: 31075133 PMCID: PMC6510428 DOI: 10.1371/journal.pone.0216784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 04/29/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We examined the association between anogenital human papillomavirus (HPV) infection and sexual networks in men who have sex with men (MSM). METHODS A total of 253 MSM, 20 years of age and older, were recruited from the community in Southern Taiwan in 2015-2016. At baseline and at each follow-up visit, MSM were screened for HPV to identify 37 HPV genotypes. At the six-month follow-up, MSM were asked to fill out an egocentric network assessment and to report the last five persons with whom they had sex regarding the characteristics of sexual behavior with each network member. RESULTS A total of 182 participants (71.9%) returned for the follow-up and one third had at least one HPV type detected. A higher level of bridging network position calculated by the level of constraints in the network was significantly less likely to have HPV detection at the anal site. A high level of concurrency was associated with penile HPV detection (AOR = 3.16, 95% CI = 1.01-9.86). CONCLUSIONS Identifying network-related characteristics can advance our understanding of high-risk populations and for prioritizing HPV vaccine recommendations.
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Affiliation(s)
- Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
| | - Yi-Fang Yu
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Wen-Wei Ku
- Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Wen Lee
- Fengshan Lee Chia Wen Urologic Clinic, Kaohsiung, Taiwan
| | - Nai-Ying Ko
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, National Cheng Kung University and Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Halkitis PN, Valera P, LoSchiavo CE, Goldstone SE, Kanztanou M, Maiolatesi AJ, Ompad DC, Greene RE, Kapadia F. Human Papillomavirus Vaccination and Infection in Young Sexual Minority Men: The P18 Cohort Study. AIDS Patient Care STDS 2019; 33:149-156. [PMID: 30932696 PMCID: PMC6459271 DOI: 10.1089/apc.2018.0276] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We examined the prevalence of infection with human papillomavirus (HPV) and HIV in a cohort of young gay, bisexual, and other men who have sex with men [sexual minority men (SMM)]. HPV vaccination uptake was assessed; HIV antibody testing was performed and genetic testing for oral and anal HPV infection was undertaken. We examined both HPV vaccination and infection in relation to key demographic and structural variables. Participants (n = 486) were on average 23 years old; 70% identified as a member of a racial/ethnic minority group, and 7% identified as transgender females. Only 18.1% of the participants indicated having received the full dosage of HPV vaccination and 45.1% were unvaccinated. Slightly over half the participants (58.6%) were infected with HPV, with 58.1% testing positive for anal infection and 8.8% for oral infection. HIV seropositivity was associated with infection to oral HPV [adjusted odds ratio (AOR) = 4.03] and vaccine-preventable HPV, whereas both neighborhood-level poverty (AOR = 1.68) and HIV infection (AOR = 31.13) were associated with anal infection to HPV (AOR = 1.68). Prevalence of HPV infection is high among unvaccinated young SMM, despite the availability and eligibility for vaccination. HPV infection adds further health burden to these populations and is particularly concerning for those who are HIV positive as HIV infection increases the risk of developing HPV-related cancers. These findings underscore a missed prevention opportunity for an at-risk and underserved population and suggest the need for active strategies to increase HPV vaccination uptake in young SMM before the onset of sexual behavior.
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Affiliation(s)
- Perry N. Halkitis
- Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Medicine, RWJ School of Medicine, Rutgers University, Newark, New Jersey
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey
- School of Public Affairs and Administration, Rutgers University, Newark, New Jersey
| | - Pamela Valera
- Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Caleb E. LoSchiavo
- Departments of Biostatistics and Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, Piscataway, New Jersey
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Stephen E. Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Kanztanou
- Department of Epidemiology and Preventive Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anthony J. Maiolatesi
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
| | - Danielle C. Ompad
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Epidemiology, College of Global Public Health, New York University, New York, New York
| | - Richard E. Greene
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Medicine, Langone School of Medicine, New York University, New York, New York
| | - Farzana Kapadia
- Center for Health, Identity Behavior and Prevention Studies, Rutgers University, Newark, New Jersey
- Department of Epidemiology, College of Global Public Health, New York University, New York, New York
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Diaz M, de Sanjosé S, Bosch FX, Bruni L. Present challenges in cervical cancer prevention: Answers from cost-effectiveness analyses. Rep Pract Oncol Radiother 2018; 23:484-494. [PMID: 30534011 PMCID: PMC6277268 DOI: 10.1016/j.rpor.2018.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/08/2018] [Indexed: 12/20/2022] Open
Abstract
Simulation models are commonly used to address important health policy issues that cannot be explored through experimental studies. These models are especially useful to determine a set of strategies that result in a good value for money (cost-effectiveness). Several mathematical models simulating the natural history of HPV and related diseases, especially cervical cancer, have been developed to calculate a relative effectiveness and cost-effectiveness of HPV vaccination and cervical cancer screening interventions. Virtually all cost-effectiveness analyses identify HPV vaccination programmes for preadolescent girls to be cost-effective, even for relatively low vaccination coverage rates. Routine vaccination of preadolescent girls is the primary target population for HPV vaccination as it shows to provide the greatest health impact. Cost-effectiveness analyses assessing other vaccine target groups are less conclusive. Adding additional age-cohorts would accelerate health benefits in some years, although cost-effectiveness becomes less favourable as age at vaccination increases. Including men in HPV vaccination programmes may be a less efficient strategy if done at the expense of female vaccination coverage for reducing the burden of HPV in the population. However, as the HPV vaccine price decreases, the cost-effectiveness of universal vaccination improves, becoming equally as efficient as female-only vaccination. Vaccine price is a decisive factor in the cost-effectiveness analyses. The lower the price, the greater the likelihood that vaccination groups other than the primary target would be considered cost-effective.
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Affiliation(s)
- Mireia Diaz
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBERONC, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBERESP, Barcelona, Spain
- Path, Reproductive Health Programme, Geneva, Switzerland
| | - F. Xavier Bosch
- CIBERONC, Barcelona, Spain
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Laia Bruni
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia (ICO) – IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- CIBERONC, Barcelona, Spain
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Landis K, Bednarczyk RA, Gaydos LM. Correlates of HPV vaccine initiation and provider recommendation among male adolescents, 2014 NIS-Teen. Vaccine 2018; 36:3498-3504. [PMID: 29752025 PMCID: PMC6550295 DOI: 10.1016/j.vaccine.2018.04.075] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/18/2018] [Accepted: 04/25/2018] [Indexed: 01/19/2023]
Abstract
Vaccination is a safe and effective way to prevent Human Papillomavirus (HPV) infection and related cancers; however, HPV vaccine uptake remains low in the US. After the 2011 Advisory Committee on Immunization Practices (ACIP) recommendation for routine HPV vaccination of adolescent males, several studies have examined predictors for initiating the vaccine series in this population of interest, particularly with regard to provider recommendations. This study examined racial and ethnic differences for HPV vaccine initiation and provider recommendation in male adolescents. Based on prior HPV vaccine uptake estimates and healthcare utilization data, we hypothesized that minority adolescents would be more likely to initiate HPV vaccines, but less likely to receive a provider recommendation compared to white counterparts. We analyzed the 2014 National Immunization Survey-Teen (NIS-Teen), which included 10,753 male adolescents with provider-verified vaccination data in 50 US states, using multivariate logistic regression models to evaluate racial/ethnic differences in HPV vaccine initiation and provider recommendation. The odds of HPV vaccine initiation were 76 percent higher for Hispanic adolescents and 43 percent higher for non-Hispanic Other or Multiple race adolescents compared to white adolescents. Approximately half of parents reported receiving a provider recommendation for vaccination, with no significant difference in the odds of receiving a provider recommendation across racial/ethnic groups. Despite similar frequency of recommendations across racial and ethnic groups, male adolescents who are racial/ethnic minorities are more likely to initiate vaccination. Future research should focus on developing tailored interventions to increase HPV vaccine receipt among males of all racial/ethnic groups.
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Affiliation(s)
- Kathryn Landis
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | - Robert A Bednarczyk
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory Vaccine Center, 954 Gatewood Road, Atlanta, GA 30329, USA.
| | - Laura M Gaydos
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
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Pankam T, Kerr SJ, Teeratakulpisan N, Rodbamrung P, Wongkanya R, Keelawat S, Ruangritchankul K, Hongchookiat P, Watanapokasin R, Phanuphak N. Human papillomavirus in anal biopsy tissues and liquid-based cytology samples of HIV-positive and HIV-negative Thai men who have sex with men. PAPILLOMAVIRUS RESEARCH 2017; 3:149-154. [PMID: 28720449 PMCID: PMC5883198 DOI: 10.1016/j.pvr.2017.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/24/2017] [Accepted: 04/26/2017] [Indexed: 11/25/2022]
Abstract
Background Men who have sex with men (MSM) are at high risk of developing human papillomavirus (HPV)-related anal cancer. We compared HPV genotypes in anal tissues (Bx) and anal liquid-based cytology fluid (LBC) from HIV-positive and HIV-negative MSM. Methods Bx (32 normal, 41 low-grade squamous intraepithelial lesions (LSIL) and 22 high-grade squamous intraepithelial lesions (HSIL)), along with LBC from the same visit, were selected from 61 HIV-positive and 34 HIV-negative MSM who enrolled into a prospective cohort in Bangkok, Thailand. HPV genotyping was performed on Bx and LBC. Results Any HPV and high-risk HPV (HR-HPV) prevalence were 63.2% and 60.0% in Bx and 71.6% and 62.1% in LBC, respectively. HIV-positive MSM had higher rates of HR-HPV genotypes detection (70.5% vs. 47.1%, p=0.03) in LBC than HIV-negative MSM. HPV16 (27%) was the most common HR-HPV found in HSIL tissue. In HIV-positive MSM, the frequency of HR-HPV detection increased with histopathologic grading in both Bx and LBC samples. HSIL was associated with the presence of any HR-HPV(OR 7.6 (95%CI 1.8–31.9); P=0.006) in LBC and in Bx((OR 5.6 (95%CI 1.4–22.7); P=0.02). Conclusions Our data strongly support the integration of HR-HPV screening on LBC samples, along with HPV vaccination, into an anal cancer prevention program.
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Affiliation(s)
- Tippawan Pankam
- The Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Department of Biochemistry, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand
| | - Stephen J Kerr
- HIV-NAT, Bangkok, Thailand; The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | - Somboon Keelawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Komkrit Ruangritchankul
- Department of Pathology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Ramida Watanapokasin
- Department of Biochemistry, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand.
| | - Nittaya Phanuphak
- The Thai Red Cross AIDS Research Centre, Bangkok, Thailand; SEARCH, Bangkok, Thailand
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11
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Poynten IM, Tabrizi SN, Jin F, Templeton DJ, Machalek DA, Cornall A, Phillips S, Fairley CK, Garland SM, Law C, Carr A, Hillman RJ, Grulich AE. Vaccine-preventable anal human papillomavirus in Australian gay and bisexual men. ACTA ACUST UNITED AC 2017; 3:80-84. [PMID: 28720461 PMCID: PMC5883229 DOI: 10.1016/j.pvr.2017.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/16/2017] [Accepted: 02/16/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE HPV causes ~90% of anal cancer and HPV16 is the type most commonly associated with anal cancer. Gay and bisexual men (GBM) are at greatly increased risk. We investigated patterns of vaccine-preventable anal HPV in older GBM. METHODS The Study of the Prevention of Anal Cancer (SPANC) is an ongoing, prospective cohort study of HIV-positive and HIV-negative Australian GBM. Participants completed questionnaires and underwent an anal swab for HPV genotyping using Roche Linear Array. We analysed baseline data from SPANC by HPV type, mean number of types, stratified by age and HIV status. RESULTS Anal HPV results from 606 (98.2%) of 617 participants (median age 49 years, 35.7% HIV-positive) showed 525 (86.7%) had ≥1 HPV type and 178 (29.4%) had HPV16. Over one third of participants (214, 35.3%) had no nonavalent vaccine-preventable types detected. Two (0.3%) participants had all quadrivalent types and none had all nonavalent vaccine types. HIV-positive participants (p<0.001) and younger participants (p=0.059) were more likely to have more vaccine-preventable HPV types detected. CONCLUSION Anal HPV was highly prevalent in this largely community-based GBM cohort. Vaccine-preventable HPV16 was detected in approximately one third of participants. These findings suggest that the potential efficacy of HPV vaccination of older GBM should be explored.
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Affiliation(s)
- I Mary Poynten
- The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Sepehr N Tabrizi
- Regional HPV LabNet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Fengyi Jin
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia
| | - David J Templeton
- RPA Sexual Health and Central Clinical School, University of Sydney, Sydney, Australia
| | - Dorothy A Machalek
- Regional HPV LabNet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alyssa Cornall
- Regional HPV LabNet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Samuel Phillips
- Regional HPV LabNet Reference Laboratory, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Melbourne, Victoria, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynecology, University of Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Microbiology and Infectious Diseases, Royal Women's Hospital, Parkville, Melbourne, Victoria, Australia
| | | | | | - Richard J Hillman
- St Vincent's Hospital, Sydney, Australia; Western Sydney Sexual Health Centre, University of Sydney, Sydney, Australia
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Risk of Cancer among Commercially Insured HIV-Infected Adults on Antiretroviral Therapy. J Cancer Epidemiol 2016; 2016:2138259. [PMID: 27882054 PMCID: PMC5110893 DOI: 10.1155/2016/2138259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 10/11/2016] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to explore the cancer incidence rates among HIV-infected persons with commercial insurance who were on antiretroviral therapy and compare them with those rates in the general population. Paid health insurance claims for 63,221 individuals 18 years or older, with at least one claim with a diagnostic code for HIV and at least one filled prescription for an antiretroviral medication between January 1, 2006, and September 30, 2012, were obtained from the LifeLink® Health Plan Claims Database. The expected number of cancer cases in the general population for each gender-age group (<30, 30–39, 40–49, 50–59, and >60 years) was estimated using incidence rates from the Surveillance Epidemiology and End Results (SEER) program. Standardized incidence ratios (SIRs) were estimated using their 95% confidence intervals (CIs). Compared to the general population, incidence rates for HIV-infected adults were elevated (SIR, 95% CI) for Kaposi sarcoma (46.08; 38.74–48.94), non-Hodgkin lymphoma (4.22; 3.63–4.45), Hodgkin lymphoma (9.83; 7.45–10.84), and anal cancer (30.54; 25.62–32.46) and lower for colorectal cancer (0.69; 0.52–0.76), lung cancer (0.70; 0.54, 0.77), and prostate cancer (0.54; 0.45–0.58). Commercially insured, treated HIV-infected adults had elevated rates for infection-related cancers, but not for common non-AIDS defining cancers.
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13
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Maatouk I, Abdo K. Human papillomavirus prevalence in the oral cavity of men who have sex with men: a study of its first from Beirut, Lebanon. Sex Health 2016; 13:SH16045. [PMID: 27333439 DOI: 10.1071/sh16045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/05/2016] [Indexed: 02/28/2024]
Abstract
Background: Human papillomavirus (HPV) infection is the most common sexually transmissible viral infection worldwide. HPV is highly prevalent in sexually active men who have sex with men (MSM). The main objective of this study is to assess HPV prevalence in the oral cavity of MSM from Beirut, Lebanon. Methods: From November 2015 to January 2016, 42 MSM were recruited using respondent-driven sampling and provided oral samples for HPV DNA and for linear array testing to detect HPV type. Results: In total, 28 (66.67%) HIV-negative and 14 (33.33%) HIV-positive MSM were included. Overall, HPV prevalence in the oral cavity was 10% (95% CI 0.93-19.07) among all participants, but there was no statistical difference according to HIV status. The HPV type was exclusively HPV-6. Conclusions: These findings did not find an urgent need for routine HPV prevalence and screening for cancers in the oral cavity of a MSM group in Lebanon; however, they confirm previous findings about geographic variations in HPV prevalences.
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14
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Sadlier C, Lynam A, O'Dea S, Delamere S, Quinlan M, Clarke S, Sheils O, Bergin C. HPV vaccine acceptability in HIV-infected and HIV negative men who have sex with men (MSM) in Ireland. Hum Vaccin Immunother 2016; 12:1536-41. [PMID: 27153289 DOI: 10.1080/21645515.2016.1151588] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Men who have sex with men (MSM), particularly HIV-infected MSM are disproportionately affected by HPV infection and associated disease. The HPV vaccine has potential to greatly reduce the burden of HPV-associated disease including anal cancer in MSM. The efficacy of the HPV vaccine is dependent on high levels of vaccine uptake. The aim of this study was to examine HPV vaccine acceptability and factors influencing vaccine acceptability in MSM in Ireland. Methods A self-administered survey was distributed to HIV-infected and HIV negative MSM examining HPV vaccine acceptability and factors associated with vaccine acceptability. Logistic regression was used to identify key variables and predictors of HPV vaccine acceptability. Results 302 MSM participated in the study. Acceptability of HPV vaccine was 31% (unconditional), 51% (conditional on stated efficacy and a cost of €300), 65% (conditional on stated efficacy and a cost of €100) and 78% (conditional on stated efficacy and no cost). Cost was negatively associated with HPV vaccine acceptability (p<0.01) while knowledge of HPV vaccine efficacy was significantly associated with vaccine acceptability, even in the context of associated cost (p<0.01). Conclusions Acceptability of HPV vaccine in MSM in Ireland is high based on no cost vaccine and on stated vaccine efficacy (78%). Cost is negatively associated with vaccine acceptability. Understanding levels of knowledge of HPV infection, HPV associated disease and attitudes toward HPV vaccination are important as they will contribute to HPV vaccine acceptability among MSM and will help guide effective preventive programs.
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Affiliation(s)
- C Sadlier
- a Department of Genitourinary Medicine and Infectious Diseases (GUIDE) , St James's Hospital , Dublin , Ireland.,b School of Medicine, Trinity College Dublin , Dublin , Ireland
| | - A Lynam
- a Department of Genitourinary Medicine and Infectious Diseases (GUIDE) , St James's Hospital , Dublin , Ireland
| | - S O'Dea
- b School of Medicine, Trinity College Dublin , Dublin , Ireland
| | - S Delamere
- a Department of Genitourinary Medicine and Infectious Diseases (GUIDE) , St James's Hospital , Dublin , Ireland
| | - M Quinlan
- c The Gay Men's Health Service (GMHS) , Dublin , Ireland
| | - S Clarke
- a Department of Genitourinary Medicine and Infectious Diseases (GUIDE) , St James's Hospital , Dublin , Ireland.,c The Gay Men's Health Service (GMHS) , Dublin , Ireland
| | - O Sheils
- b School of Medicine, Trinity College Dublin , Dublin , Ireland.,d Department of Histopathology , St James's Hospital , Dublin , Ireland
| | - C Bergin
- a Department of Genitourinary Medicine and Infectious Diseases (GUIDE) , St James's Hospital , Dublin , Ireland.,b School of Medicine, Trinity College Dublin , Dublin , Ireland
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15
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Sadlier C, Sheils O, Bergin C. Response to letter: limitations of human papillomavirus DNA testing in measuring previous exposure and vaccine protection. HIV Med 2016; 17:557-8. [PMID: 26857554 DOI: 10.1111/hiv.12353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/29/2022]
Affiliation(s)
- C Sadlier
- Department of GU medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College, Dublin, Ireland
| | - O Sheils
- School of Medicine, Trinity College, Dublin, Ireland.,Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - C Bergin
- Department of GU medicine and Infectious Diseases (GUIDE), St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College, Dublin, Ireland
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16
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Blas MM, Brown B, Menacho L, Alva IE, Silva-Santisteban A, Carcamo C. HPV Prevalence in Multiple Anatomical Sites among Men Who Have Sex with Men in Peru. PLoS One 2015; 10:e0139524. [PMID: 26437318 PMCID: PMC4593601 DOI: 10.1371/journal.pone.0139524] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/12/2015] [Indexed: 11/21/2022] Open
Abstract
Background Human Papilloma Virus (HPV) infection is the most common sexually transmitted viral infection worldwide. HPV is highly prevalent in sexually active men who have sex with men (MSM) and has been associated with anal cancer, penile cancer, and oropharyngeal cancer. Methods From March to September 2011, we conducted a cross-sectional study of HPV prevalence among MSM above age 18 years. Participants were recruited using respondent driven sampling at Clinica Cayetano Heredia. All participants provided anal, genital, and oral samples for HPV DNA testing, and blood for HIV and HPV antibody testing. Results A total of 200 MSM were recruited in the study. The mean age was 34 years (range 18–59 years, SD = 9.4) and101 participants were HIV negative (99 HIV positive). HPV 6/11/16/18 or quadrivalent HPV vaccine (HPV4) genotype seroprevalence among HIV negative and positive MSM was 64.3% (55%-75.9%) and 93.8% (87.6%-99.2%) respectively (p<0.001). HIV positivity was associated with a higher prevalence of HPV4 and HPV 16/18 DNA at external genital sites and the anal canal. HPV4 DNA prevalence at external genital sites among HIV negative and positive MSM was 14.9% and 28.7% (p = 0.02) respectively, at anal canal was 50.9% and 79.0% (p = 0.001), and at the oral cavity was 9.9% and 8.5% (p = 0.6). Conclusions HPV4 seroprevalence was high in our study among both HIV positives and negatives, with HPV DNA prevalence much lower, and the anal canal being the anatomical site with the highest HPV DNA prevalence. HPV prevention interventions are needed among MSM at high-risk for HIV infection.
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Affiliation(s)
- Magaly M. Blas
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Brandon Brown
- Center for Healthy Communities, UCR School of Medicine, Riverside, California, United States of America
- * E-mail:
| | - Luis Menacho
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Isaac E. Alva
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alfonso Silva-Santisteban
- Unit of Health, Sexuality and Human Development, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Carcamo
- Epidemiology, STD and HIV Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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17
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Li Z, Zhang H, Li X, Yang Y, Xin H, Li M, Feng B, Gao L. Anal Human Papillomavirus Genotyping among HIV-Positive Men Who Have Sex with Men in Xi'an, China. PLoS One 2015; 10:e0125120. [PMID: 25923768 PMCID: PMC4414525 DOI: 10.1371/journal.pone.0125120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/20/2015] [Indexed: 12/28/2022] Open
Abstract
Background Anal human papillomavirus (HPV) infection and its related diseases are relatively common in men who have sex with men (MSM), especially in those HIV positive. In China, molecular epidemiology of anal HPV infection among HIV-positive MSM has been sparsely studied. Methods A cross-sectional study was conducted among HIV-positive MSM in Xi’an, China between April and July 2014. Anal swabs were collected for HPV genotyping. Results A total of 195 HIV-positive MSM were included in this study. HPV genotyping showed that 99.0% (191/193) of participants were positive for at least one of the targeted 37 HPV genotypes. 183 (94.8%) of them were infected with multiple high-risk types and 154 (79.8%) of them with low-risk HPV types. HPV 18 was the most frequently identified high-risk type, followed by HPV 16 and HPV 51. As for low-risk types, HPV11, HPV 6 and HPV 81 were most commonly observe. High-risk HPV infection was found to be associated with the status of antiretroviral therapy (ART), the distribution of low-risk types was observed to be varied by CD4+ T cell level. Conclusion Almost all HIV-positive MSM were anal HPV infected in our study. It is highly recommended to consider regular active screening and preventive intervention of HPV infection among this high risk population.
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Affiliation(s)
- Zhen Li
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Haoran Zhang
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Xiangwei Li
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Yu Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, 100191, China
| | - Henan Xin
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Mufei Li
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Boxuan Feng
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
| | - Lei Gao
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Dong Dan San Tiao No. 9, Beijing, 100730, China
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