Incidence and clearance of anal human papillomavirus infection in 16 164 individuals, according to HIV status, gender, and male sexuality: an international pooled analysis of 34 longitudinal studies.
Wei F., Goodman MT., Xia N., Zhang J., Giuliano AR., D'Souza G., Hessol NA., van der Loeff MFS., Dai J., Neukam K., de Pokomandy A., Poynten IM., Geskus RB., Burgos J., Etienney I., Moscicki AB., Donà MG., Gillison ML., Nyitray AG., Nowak RG., Yunihastuti E., Zou H., Hidalgo-Tenorio C., Phanuphak N., Molina JM., Schofield AM., Kerr S., Fan S., Lu Y., Ong JJ., Chikandiwa AT., Teeraananchai S., Squillace N., Wiley DJ., Palefsky JM., Georges D., Alberts CJ., Clifford GM.
BackgroundUnderstanding the natural history of anal high-risk human papillomavirus (hrHPV) infection is key for designing anal cancer prevention programmes but has not been systematically characterised.MethodsWe reanalysed data from 34 studies with 16 164 individuals in six risk groups defined by HIV status, gender, and male sexuality: men who have sex with men (MSM) living with HIV (LWH) [MSMLWH], HIV-negative MSM, women LWH (WLWH), HIV-negative women, men who have sex with women (MSW) LWH (MSWLWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their determinants.ResultsHPV16 had the highest incidence:clearance ratio of the hrHPV types. MSMLWH had highest hrHPV incidence (e.g. 15.5% newly HPV16-infected within two years), followed by HIV-negative MSM (7.5%), WLWH (6.6%), HIV-negative women (2.9%), MSWLWH (1.7%), and HIV-negative MSW (0.7%). Determinants of HPV16 incidence included HIV status and number of sexual partners for MSM, women, and MSW, and anal sex behaviour for MSM only. HPV16 clearance was lower for people LWH (PLWH), and lower for prevalent than incident infection. Among MSM, increasing age was associated with lower clearance of prevalent, but not incident, HPV16 infection.ConclusionsThis robust and unifying analysis of anal hrHPV natural history is essential to designing and predicting the impact of HPV vaccination and HPV-based screening programmes on anal cancer prevention, particularly in MSM and PLWH. Importantly, it demonstrates the higher carcinogenic potential of longstanding anal prevalent hrHPV infection than more recent incident infection.