Anal HPV/HIV co-infection among Men Who Have Sex with Men: a cross-sectional survey from three cities in China.
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ABSTRACT:
SUBMITTER: Li X
PROVIDER: S-EPMC4759533 | biostudies-literature | 2016 Feb
REPOSITORIES: biostudies-literature
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Anal HPV/HIV co-infection among Men Who Have Sex with Men: a cross-sectional survey from three cities in China.
Li Xiangwei X Li Mufei M Yang Yu Y Zhong Xiang X Feng Boxuan B Xin Henan H Li Zhen Z Jin Qi Q Gao Lei L
Scientific reports 20160219
Anal human papillomavirus (HPV) infection, which is linked to anal warts and anal cancer, is common among men who have sex with men (MSM), especially among those HIV positives. MSM aged 18 years or older were recruited from mainland China. Blood and anal cytologic samples were collected for HIV-1 serological test and HPV genotyping. A total of 889 eligible participations were included. The genotyping results of HPV were available for 822 participants (92.46%), 65.32% of which were positive for t ...[more]
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Project description:BackgroundAnal HPV infection, which contributes to the development of anal warts and anal cancer, is well known to be common among men who have sex with men (MSM), especially among those HIV positives. However, HIV and anal HPV co-infection among MSM has not been addressed in China.MethodsA cross-sectional study was conducted in Beijing and Tianjin, China. Study participants were recruited using multiple methods with the collaboration of local volunteer organizations. Blood and anal swabs were collected for HIV-1 serological test and HPV genotyping.ResultsA total of 602 MSM were recruited and laboratory data were available for 578 of them (96.0%). HIV and anal HPV prevalence were 8.5% and 62.1%, respectively. And 48 MSM (8.3%) were found to be co-infected. The HPV genotypes identified most frequently were HPV06 (19.6%), HPV16 (13.0%), HPV52 (8.5%) and HPV11 (7.6%). Different modes of HPV genotypes distribution were observed with respect to HIV status. A strong dose-response relationship was found between HIV seropositivity and multiplicity of HPV genotypes (p<0.001), which is consistent with the observation that anal HPV infection was an independent predictor for HIV infection.ConclusionsA high prevalence of HIV and anal HPV co-infection was observed in the MSM community in Beijing and Tianjin, China. Anal HPV infection was found to be independently associated with increased HIV seropositivity, which suggests the application of HPV vaccine might be a potential strategy to reduce the acquisition of HIV infection though controlling the prevalence of HPV.
| S-EPMC2997781 | biostudies-literature
Project description:BackgroundHuman immunodeficiency virus (HIV) has rapidly spread among men who have sex with men (MSM) in China in recent years; the magnitude of the epidemic is unclear. We sought to test 3 hypotheses: (1) The prevalence of both HIV and syphilis among MSM in China is high, (2) the 2 epidemics each have unique geographical distributions, and (3) demographic and sexual behavior characteristics are different among segments of the MSM population in China.MethodsA total of 47 231 MSM from 61 cities in China participated in a cross-sectional survey conducted from February 2008 to September 2009. Demographic and behavioral data were collected and analyzed and blood samples tested for HIV and syphilis. Three subgroups among the broader MSM sample were described. Main outcome measures were HIV and syphilis prevalence.ResultsAn overall prevalence of 4.9% (2314/47 231; 95% confidence interval [CI], 4.7%-5.1%) for HIV and 11.8% (5552/47 231; 95% CI, 11.5%-12.0%) for syphilis was found. Syphilis-positive MSM had the highest HIV prevalence, 12.5% (693/5552; 95% CI, 11.6%-13.4%). However, correlations between HIV and syphilis prevalence were found in only 3 of 6 geographical regions (Northwest: r = 0.82, P = .0253; East: r = 0.78, P = .0004; and South-central: r = 0.63, P = .0276). Three subgroups-nonlocal MSM, Internet-using MSM, and female-partnering MSM-were found to have different profiles of characteristics and behaviors.ConclusionsHIV and syphilis prevalences among MSM in China are high and the 2 epidemics are largely separate geographically. Three segments of the Chinese MSM population each have different demographic and sexual risk "profiles" that suggest high potential for bridging infection across geographies, generations, and sexes.
| S-EPMC3689345 | biostudies-literature
Project description:The HIV prevalence and incidence among men who have sex with men (MSM) in China are high. Unprotected anal intercourse (UAI) with a regular male sex partner (RP), a significant predictor of HIV sero-conversion, was high yet under-emphasized among MSM having RP (MSMRP). The present cross-sectional survey interviewed 307 HIV negative MSMRP recruited through convenient sampling from multiple sources, including venue-based outreaching, online recruitment, and referrals made by peers, in Beijing and Chengdu, China. Among MSMRP, the prevalence of UAI with RP in the last three months was 52.4%. The results of the multivariate analysis showed that trust and intimacy within the relationship with RP and presence of clinical depression symptoms were positively associated with UAI with RP in the last three months. Other associated scalar factors derived from the Theory of Planned Behavior were related to perceptions on condom use, including positive attitudes toward condom use (a negative association), subjective norm of the perception that MSM do not usually use condoms during anal intercourse with RP (a positive association), perceived behavioral control over condom use with RP (a negative association), and behavioral intention to use condoms with RP in the coming three months (a negative association). It is seen that MSMRP were at high risk of HIV/STD transmission. The associated factors hence involved those related to perceptions about condom use, mental health, and interpersonal relationship. Future interventions should take these multi-dimensional factors into account. In particular, future research to test the efficacy of couple-based interventions that include mental health elements needs to be conducted, as trust and intimacy within the relationship were associated with UAI among MSMRP, and mental health problems may exist for both the MSMRP and their RP.
| S-EPMC4376721 | biostudies-literature
Project description:BACKGROUND:Voluntary medical male circumcision reduces the risk of HIV heterosexual transmission in men, but its effect on male-to-male sexual transmission is uncertain. METHODS:Circumcision status of men who have sex with men (MSM) in China was evaluated by genital examination and self-report; anal sexual role was assessed by questionnaire interview. Serostatus for HIV and syphilis was confirmed. RESULTS:Among 1155 participants (242 were seropositive and 913 with unknown HIV status at enrollment), the circumcision rate by self-report (10.4%) was higher than confirmed by genital examination (8.2%). Male circumcision (by examination) was associated with 47% lower odds of being HIV seropositive [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.27 to 1.02] after adjusting for demographic covariates, number of lifetime male sexual partners, and anal sex role. Among MSM who predominantly practiced insertive anal sex, circumcised men had 62% lower odds of HIV infection than those who were uncircumcised (aOR: 0.38; 95% CI: 0.09 to 1.64). Among those whose anal sex position was predominantly receptive or versatile, circumcised men have 46% lower odds of HIV infection than did men who were not circumcised (aOR: 0.54; 95% CI: 0.25 to 1.14). Compared to uncircumcised men reporting versatile or predominantly receptive anal sex positioning, those who were circumcised and reported practicing insertive sex had an 85% lower risk (aOR: 0.15; 95% CI: 0.04 to 0.65). Circumcision was not associated clearly with lower syphilis risk (aOR: 0.91; 95% CI: 0.51 to 1.61). CONCLUSIONS:Circumcised MSM were less likely to have acquired HIV, most pronounced among men predominantly practicing insertive anal intercourse. A clinical trial is needed.
| S-EPMC4767598 | biostudies-literature
Project description:Men who have sex with men (MSM) in England are eligible for vaccination against human papillomavirus (HPV) via specialist sexual health services and HIV clinics. Uptake among clinic attendees is incomplete, but the reason for this is unclear. We do not know who is accessing and being offered the vaccine. This cross-sectional study conducted in England examined socio-demographic correlates of vaccine uptake for MSM and how frequently the vaccine is being offered in clinics. MSM completed an online questionnaire asking about socio-demographic characteristics, whether they had recently attended a sexual health or HIV clinic, and if so, whether they had been offered the vaccine, and vaccination status. Around 52% of MSM (N = 115; mean age = 30.2) had received at least one dose of the vaccine, and 70% of clinic attendees had been offered the vaccine. MSM were more likely to have initiated the vaccine series if they were homosexual (versus bisexual; OR: 5.22; 95% CI: 1.55-17.51) or had heard about the vaccine from one or two types of sources (versus no sources: OR: 14.70; 95% CI: 4.00-54.00 and OR: 26.00; 5.74-117.77 respectively). Initiation was not associated with age, ethnicity, education level, or number of sexual partners. Hepatitis B vaccination status was associated with vaccination initiation only in unadjusted models. The majority of eligible MSM are being offered the vaccine in clinics. Socio-demographic differences in uptake of the HPV vaccine among MSM may lead to inequalities in HPV-related disease.
| S-EPMC7672608 | biostudies-literature
Project description:IntroductionHuman papillomavirus (HPV) infection, an important pathogenic factor for cervical cancer, can be prevented by the HPV vaccine. Health care provider (HCP) recommendations contribute to improve HPV vaccination coverage. The aim of this study was to assess the frequency of HCP recommendations for HPV vaccination and associated factors.MethodsFrom Nov 8 to Dec 6 in 2018, a cross-sectional study was conducted through online questionnaires among HCPs (n = 1,371) from hospitals in three large cities in China (Shanghai, Guangzhou, and Shenzhen). Data on demographic characteristics, the frequency of HPV vaccination recommendations, HPV knowledge and related attitudes were collected through the questionnaires.ResultsAmong 1,371 participants, only 30.2% reported that they frequently recommended HPV vaccination. Multivariate analyses indicated that female sex, being employed in obstetrics or gynecology departments and community health service centers, and having higher self-reported and actual knowledge of HPV were factors associated with a higher recommendation frequency. Factors including a self-perceived non-obligation to provide recommendations and difficulties in discussing sexual topics were significantly correlated with less frequent recommendations. Employment in a community health service center (OR = 2.068, 95% CI: 1.070-3.999) was the strongest factor associated with the frequency of HCPs' recommendations for HPV vaccination.DiscussionThe frequency of HCPs' recommendations for HPV vaccination in China was much lower than that in many developed countries. To enhance the recommendation frequency, medical institutions should help HCPs gain more knowledge of HPV and master communication skills. At the same time, the government should take measures to enhance the accessibility of HPV vaccines. The media should help to alleviate people's concerns and encourage them to face up sexual health.
| S-EPMC10366465 | biostudies-literature
Project description:BackgroundThere is no consensus on screening strategy of high-grade intraepithelial neoplasia (HGAIN). Guidelines range from clinical examination with digital anorectal examination followed by standard anoscopy (SA), to anal cytology (Pap)+/- HPV genotyping. We compared screening strategy yields based on Pap, SA, and HPV-16 genotyping alone or in combination in HIV-MSM.MethodsPap, SA, and HPV-16 genotyping were performed in all HIV-MSM attending a first anal cancer screening consultation in Paris, France. High-resolution anoscopy, the gold standard to detect HGAIN, was performed in the case of HPV-16 positivity or abnormal cytology. Yield was defined as the number of patients with HGAIN relative to the total number of patients screened.ResultsOn 212 patients, the complete strategy (SA + Pap + HPV genotyping) yield (12.7%) was significantly higher than that of SA (3.3%, p < 0.001) and HPV-16 alone (6.6%, p < 0.05). Although none of the other strategies were significantly different from the complete strategy, Pap + HPV-16 and Pap + SA had closer yields (about 11%), with OR = 0.83 (95% CI [0.44;1.57]) and 0.87 (95% CI [0.46;1.64]), respectively.ConclusionsPap combined with HPV-16 genotyping or SA tended towards higher yields compared to Pap alone, and closer to that of the complete strategy.
| S-EPMC6068120 | biostudies-literature
Project description:BackgroundAnal precancers and cancers can be detected during screening with high-resolution anoscopy (HRA). The sensitivity of HRA depends on the burden and duration of human papillomavirus (HPV) among those screened as well as anoscopist proficiency, which is highly correlated with prior screening experience. Our objective was to compare the identification and type of HPV and the likelihood of HRA-detected precancer for men who have sex with men (MSM) undergoing their first HRA-screening in Nigeria.MethodsMSM were recruited from an HIV test-and-treat cohort, TRUST/RV368, into a new anal cancer screening program. Anal swabs obtained during screening underwent Ion Torrent next-generation sequencing using barcoded HPV PCR broad-spectrum primers 5+/6+ to detect up to 161 HPVs. All high-risk (HR) HPVs and the most abundant low-risk (LR)-HPVs were evaluated as type-specific infections with some categorized as belonging to a multiple infection. HRA screening results included benign, low-grade squamous intraepithelial lesions (LSIL), or HSIL as detected by cytology or histology. Multivariable logistic regression was used to assess the association of HPV and other cofactors with any SIL.ResultsAmong 342 MSM, 60% were HIV-infected, 89% were under 35 years of age, and 51% had 8 or more years since anal coital debut. Of those with SIL, 89% had LSIL and only 11% had HSIL. Prevalence of any HPV and high-risk (HR)-HPV was 92% and 74%, respectively. The most prevalent genotypes in rank order were HPV6 (31%), HPV16 (23%), HPV42 (20%), HPV11 (18%), HPV45 (18%), and HPV51 (17%). For multiple HR-HPVs, 31% had a single HR-HPV, 32% had 2-3, and 10% had 4 or more. Low-risk HPVs, type 6 and/or 11, were common (42%) and were significantly associated with SIL (adjusted odds ratio [aOR]:1.8, 95% confidence interval [CI]: 1.1-3.1) together with perianal warts (aOR:6.7, 95% CI: 3.3-13.5). In contrast, HR-HPV and multiple HR-HPVs were not significantly associated with SIL (all p > 0.05).ConclusionsDetection of HSIL was low. Although HR-HPV was abundant, HSIL development also depends on the duration of HR-HPV infections and the anoscopist's level of experience. As our cohort ages and the anoscopist becomes more skilled, detection of HSIL will likely improve.
| S-EPMC7287273 | biostudies-literature
Project description:Increasing evidence suggests an association between synthetic drug use and HIV infection among men who have sex with men (MSM). The aim of this study was to evaluate synthetic drug use prevalence, describe characteristics of synthetic drug users, and investigate whether synthetic drug use is associated with HIV infection among Chinese MSM.A cross-sectional survey was conducted in 16 Chinese cities among males >18 years old who reported having had sex with men in the prior 3 months, but did not already have a known HIV-positive serostatus. Participants were grouped according to lifetime synthetic drug use and characteristics were compared using Chi-square test. Determinants of HIV infection were assessed using univariate and multivariate regression.Among 3,135 participants, 1,249 reported lifetime synthetic drug use, for a prevalence of 39.8%. Nearly all users (96.3%) reported using inhaled alkyl nitrites ("poppers"). Synthetic drug users were more likely to be younger (<30 years, p<0.001), single (p<0.001), and more educated (p<0.001), and were more likely to engage in higher risk sexual behavior compared to non-drug users. Overall HIV prevalence was 7.8% (246/3,135). However, prevalence among synthetic drug users was 10.6% (132/246) compared to 6.0% (114/246) for non-drug users (p<0.001). Factors associated with an increased odds of HIV infection included inconsistent condom use with male partners (adjusted odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.64-2.91) and synthetic drug use (adjusted OR = 2.04, CI = 1.56-2.70).Prevalence of synthetic drug use, especially poppers use, prevalence was high in our study, and users had 2-fold greater odds of HIV acquisition. It is clear that there is an urgent need for increased prevention, testing, and treatment interventions for this key, dual-risk population in China. Moreover, we call on the Chinese Government to consider regulating poppers so that users can be properly warned about their associated risks.
| S-EPMC6067707 | biostudies-other
Project description:ImportanceOutcomes of treating high-grade squamous intraepithelial lesions (HSIL), a precursor to anal cancer, remain uncertain. Emerging evidence shows that post HSIL treatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves the effectiveness of treatment. However, no recommendations exist regarding the use of qHPV vaccine as an adjuvant form of therapy. Our objective was to determine whether post-treatment adjuvant vaccination should be adopted in HIV-infected MSM (individuals at highest risk for anal cancer) on the basis of cost-effectiveness determined using existing evidence or whether future research is needed.MethodsWe developed a Markov (state-transition) cohort model to assess the cost-effectiveness of post-treatment adjuvant HPV vaccination of 27years or older HIV-infected MSM. We first estimated cost-effectiveness and then performed value-of-information (VOI) analysis to determine whether future research is required by estimating the expected value of perfect information (EVPI). We also estimated expected value of partial perfect information (EVPPI) to determine what new evidences should have highest priority.ResultsWith the incremental cost-effectiveness ratio (ICER) of $71,937/QALY, "treatment plus vaccination" was the most cost-effective HSIL management strategy using the willingness-to-pay threshold of 100,000/QALY. We found that population-level EVPI for conducting future clinical research evaluating HSIL management approaches was US$12 million (range $6-$20 million). The EVPPI associated with adjuvant qHPV vaccination efficacy estimated in terms of hazards of decreasing HSIL recurrence was $0 implying that additional data from a future study evaluating efficacy of adjuvant qHPV vaccination will not change our policy conclusion that "treatment plus vaccination" was cost-effective. Both the ICER and EVPI were sensitive to HSIL treatment compliance.ConclusionPost-treatment adjuvant qHPV vaccination in HIV-infected MSM aged 27 or above is likely to be cost-effective. Use of adjuvant qHPV vaccination could be considered as a potential strategy to reduce rising anal cancer burden among these high-risk individuals.
| S-EPMC5581672 | biostudies-literature