Open forum infectious diseases · 2026
A Dynamic Prediction Study of Persistent Nine-valent Human Papillomavirus Infection Among HIV-negative Men Who Have Sex With Men in Urumqi, China: a Longitudinal and Time-to-event-based Joint Model.
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Zhang Guozhen, Bian Juyuan, Yang Heng, Zhang Wenjie, Yu Wenhui, Lynn Henry S, Dai Jianghong
Аннотация
BACKGROUND: Persistent infection with 9-valent human papillomavirus (9v-HPV) is a major risk factor for HPV-related cancers among men who have sex with men (MSM). This study aimed to develop a dynamic prediction model to assess whether longitudinal sexual-behavior-related and exposure-related indicators could predict persistent 9vHPV infection among human immunodeficiency virus type 1 (HIV-1)-negative MSM.
METHOD: Between 2016 and 2023, HIV-negative MSM in Urumqi, China, were followed every 6 months. Baseline questionnaires and anal swabs were collected, and HPV genotyping was performed using an assay detecting 37 HPV genotypes. The primary outcome was persistent infection with 1 or more of the 9 genotypes covered by the 9-valent HPV vaccine. Persistent 9vHPV infection was defined as detection of at least one of these 9 genotypes on 2 or more consecutive visits after a negative baseline. Key indicators included same-sex partner number, anal intercourse frequency, condom use, commercial sex, club drug use, partner-seeking venues, and sexual role. A Bayesian joint model integrating longitudinal sexual-behavior-related indicators and time-to-event outcomes was developed. Predictive accuracy was assessed using the time-dependent area under the curve (AUC) with internal validation.
RESULTS: Among 704 MSM, factors including employment, commercial sex, receptive anal intercourse, and versatile roles were associated with increased persistence risk. Higher number of sexual partners (HR = 1.95) and more frequent anal intercourse (HR = 2.04) were strong predictors. The partner-based model demonstrated superior predictive accuracy (AUC = 0.727).
CONCLUSIONS: The Bayesian joint model provides accurate dynamic predictions of persistent 9v-HPV infection in MSM, supporting personalized prevention strategies.
METHOD: Between 2016 and 2023, HIV-negative MSM in Urumqi, China, were followed every 6 months. Baseline questionnaires and anal swabs were collected, and HPV genotyping was performed using an assay detecting 37 HPV genotypes. The primary outcome was persistent infection with 1 or more of the 9 genotypes covered by the 9-valent HPV vaccine. Persistent 9vHPV infection was defined as detection of at least one of these 9 genotypes on 2 or more consecutive visits after a negative baseline. Key indicators included same-sex partner number, anal intercourse frequency, condom use, commercial sex, club drug use, partner-seeking venues, and sexual role. A Bayesian joint model integrating longitudinal sexual-behavior-related indicators and time-to-event outcomes was developed. Predictive accuracy was assessed using the time-dependent area under the curve (AUC) with internal validation.
RESULTS: Among 704 MSM, factors including employment, commercial sex, receptive anal intercourse, and versatile roles were associated with increased persistence risk. Higher number of sexual partners (HR = 1.95) and more frequent anal intercourse (HR = 2.04) were strong predictors. The partner-based model demonstrated superior predictive accuracy (AUC = 0.727).
CONCLUSIONS: The Bayesian joint model provides accurate dynamic predictions of persistent 9v-HPV infection in MSM, supporting personalized prevention strategies.