1. High prevalence of anal high-grade squamous intraepithelial lesions, and prevention through human papillomavirus vaccination, in young men who have sex with men living with HIV
- Author
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Palefsky, Joel M, Lensing, Shelly Y, Belzer, Marvin, Lee, Jeannette, Gaur, Aditya H, Mayer, Kenneth, Futterman, Donna, Stier, Elizabeth A, Paul, Mary E, Chiao, Elizabeth Y, Reirden, Daniel, Goldstone, Stephen E, Tirado, Maribel, Cachay, Edward R, Barroso, Luis F, Da Costa, Maria, Darragh, Teresa M, Rudy, Bret J, Wilson, Craig M, Kahn, Jessica A, and Interventions, for the AIDS Malignancy Consortium and Adolescent Medicine Trials Network for HIV AIDS
- Subjects
Pediatric Research Initiative ,Infectious Diseases ,HIV/AIDS ,Clinical Research ,Cervical Cancer ,Sexually Transmitted Infections ,HPV and/or Cervical Cancer Vaccines ,Immunization ,Vaccine Related ,Cancer ,Prevention ,Prevention of disease and conditions ,and promotion of well-being ,3.4 Vaccines ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Alphapapillomavirus ,Anal Canal ,Anus Neoplasms ,HIV ,HIV Infections ,Homosexuality ,Male ,Humans ,Male ,Papillomaviridae ,Papillomavirus Infections ,Papillomavirus Vaccines ,Prevalence ,Sexual Behavior ,Sexual and Gender Minorities ,Squamous Intraepithelial Lesions ,Vaccination ,Young Adult ,anal human papillomavirus infection ,quadrivalent HPV vaccine ,anal squamous intraepithelial lesions ,men who have sex with men ,human immunodeficiency virus ,Biological Sciences ,Medical and Health Sciences ,Microbiology - Abstract
BackgroundMen who have sex with men (MSM) are at high risk for human papillomavirus (HPV)-related anal cancer. Little is known about the prevalence of low-grade squamous intraepithelial lesions (LSILs) and the anal cancer precursor, high-grade squamous intraepithelial lesions (HSILs), among young MSM with HIV (MSMLWH). HPV vaccination is recommended in this group, but its safety, immunogenicity, and protection against vaccine-type HPV infection and associated LSILs/HSILs have not been studied.MethodsTwo hundred and sixty MSMLWH aged 18-26 years were screened at 17 US sites for a clinical trial of the quadrivalent (HPV6,11,16,18) HPV (qHPV) vaccine. Those without HSILs were vaccinated at 0, 2, and 6 months. Cytology, high-resolution anoscopy with biopsies of lesions, serology, and HPV testing of the mouth/penis/scrotum/anus/perianus were performed at screening/month 0 and months 7, 12, and 24.ResultsAmong 260 MSMLWH screened, the most common reason for exclusion was detection of HSILs in 88/260 (34%). 144 MSMLWH were enrolled. 47% of enrollees were previously exposed to HPV16. No incident qHPV type-associated anal LSILs/HSILs were detected among men naive to that type, compared with 11.1, 2.2, 4.5, and 2.8 cases/100 person-years for HPV6,11,16,18-associated LSILs/HSILs, respectively, among those previously exposed to that type. qHPV was immunogenic and safe with no vaccine-associated serious adverse events.Conclusions18-26-year-old MSMLWH naive to qHPV vaccine types were protected against incident qHPV type-associated LSILs/HSILs. Given their high prevalence of HSILs, there is an urgent need to vaccinate young MSMLWH before exposure to vaccine HPV types, before initiating sexual activity, and to perform catch-up vaccination.
- Published
- 2021