Background
Anal high-risk human papillomavirus (HRHPV) infection, especially human papillomavirus (HPV) 16, is the leading cause of anal cancer. This study explored factors associated with HRHPV incidence and clearance among individuals with acute HIV acquisition.
Methods
Participants who initiated antiretroviral therapy during acute HIV acquisition, defined as Fiebig stages 1–5, and agreed to undergo anal HPV genotyping and high-resolution anoscopy were enrolled at a sexual health clinic in Bangkok, Thailand, from May 2017 to June 2020. Demographic data, sexual history, and baseline laboratory tests were obtained at the time of acute HIV diagnosis. Anal HPV genotyping tests were performed at baseline and 6-monthly visits. Two-state continuous-time Markov models were created separately for HPV 16, HPV 18 and/or 45 (18/45), and HRHPV other than 16/18/45 (other HRHPV). Multivariate analyses were performed by adjusting for age and baseline CD4 level.
Results
A total of 87 cisgender men and 4 transgender women, median age 26 years, were included in the analyses. Over 226.6 person-years (PY), the incidence rates of anal HPV 16, 18/45, and other HRHPV were 18.6, 13.7, and 40.3 per 100 PY, respectively. The clearance rates of anal HPV 16, 18/45, and other HRHPV were 77.3, 94.0, and 90.1 per 100 PY, respectively. Factors associated with HPV-related outcomes were having six or more lifetime sex partners, compared to fewer partners, for incidence of HPV 16 (aHR 4.79, 95% CI 1.08–21.35), and being diagnosed with HIV during Fiebig stage 4, compared to stages 1–3, for clearance of HPV 18/45 (aHR 0.14, 95% CI 0.02–0.90) and incidence of other HRHPV (aHR 0.27, 95% CI 0.07–0.96), after adjusting for age and baseline CD4 level.
Conclusions
Individuals who acquired HIV and initiated antiretroviral therapy continued to engage in sexual activity, leading to the high rate of HRHPV acquisition over time. The number of lifetime sexual partners was identified as a key predictor of HRHPV acquisition. Even after early antiretroviral therapy initiation regular sexual health consultations, HPV immunization, and anal cancer screening should be strongly encouraged for people living with HIV.