Incidence and Clearance of Anal Human Papillomavirus Infection in 16 164 Individuals, According to Human Immunodeficiency Virus Status, Sex, and Male Sexuality: An International Pooled Analysis of 34 Longitudinal Studies.
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Wei Feixue, Goodman Marc T, Xia Ningshao, Zhang Jun, Giuliano Anna R, D'Souza Gypsyamber, Hessol Nancy A, Schim van der Loeff Maarten F, Dai Jianghong, Neukam Karin, de Pokomandy Alexandra, Poynten I Mary, Geskus Ronald B, Burgos Joaquin, Etienney Isabelle, Moscicki Anna-Barbara, Donà Maria Gabriella, Gillison Maura L, Nyitray Alan G, Nowak Rebecca G, Yunihastuti Evy, Zou Huachun, Hidalgo-Tenorio Carmen, Phanuphak Nittaya, Molina Jean-Michel, Schofield Alice M, Kerr Stephen, Fan Song, Lu Yong, Ong Jason J, Chikandiwa Admire T, Teeraananchai Sirinya, Squillace Nicola, Wiley Dorothy J, Palefsky Joel M, Georges Damien, Alberts Catharina J, Clifford Gary M
Аннотация
METHODS: We reanalyzed data from 34 studies including 16 164 individuals in 6 risk groups defined by human immunodeficiency virus (HIV) status, sex, and male sexuality: men who have sex with men (MSM) and people with HIV (MSMWH), HIV-negative MSM, women with HIV (WWH), HIV-negative women, men who have sex with women (MSW) with HIV (MSWWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their determinants.
RESULTS: Human papillomavirus (HPV) 16 had the highest incidence-clearance ratio of the hrHPV types. MSMWH had the highest hrHPV incidence (eg, 15.5% newly HPV-16 infected within 2 years), followed by HIV-negative MSM (7.5%), WWH (6.6%), HIV-negative women (2.9%), MSWWH (1.7%), and HIV-negative MSW (0.7%). Determinants of HPV-16 incidence included HIV status and number of sexual partners for MSM, women, and MSW, and anal sex behavior for MSM only. HPV-16 clearance was lower for people with HIV (PWH) and lower for prevalent than incident infection. Among MSM, increasing age was associated with lower clearance of prevalent, but not incident, HPV-16 infection.
CONCLUSIONS: This robust and unifying analysis of anal hrHPV natural history is essential to designing and predicting the impact of HPV vaccination and HPV-based screening programs on anal cancer prevention, particularly in MSM and PWH. Importantly, it demonstrates the higher carcinogenic potential of longstanding anal prevalent hrHPV infection than more recent incident infection.