Incidence, clearance, persistence and factors related with high-risk anal HPV persistence in South-East Asian MSM and transgender women

• Main Authors: Yunihastuti, Evy, Teeratakulpisarn, Nipat, Jeo, Wifanto Saditya, Nilasari, Hanny, Rachmadi, Lisnawati, Somia, I Ketut Agus, Sukmawati, Made Dewi Dian, Amijaya, Komang Agus Trisna, Yee, Ilias A., Hairunisa, Nany, Hongchookiat, Piranun, Trachunthong, Deondara, Pankam, Tippawan, Nonenoy, Siriporn, Ramautarsing, Reshmie, Azwa, Iskandar, Merati, Tuti P., Phanuphak, Praphan, Phanuphak, Nittaya, Palefsky, Joel M.
• Format: Article
• Published: Lippincott Williams & Wilkins 2020
• Subjects: R Medicine
• Online Access: http://eprints.um.edu.my/25737/; https://doi.org/10.1097/QAD.0000000000002654

OBJECTIVES: Persistent anal high-risk human papillomavirus (HR-HPV) infection is a major risk factor for anal cancer among MSM and transgender women (TGW). We aimed to estimate incidence, clearance, and persistence of anal HR-HPV in HIV-positive and HIV-negative MSM and TGW, and to assess factors for HR-HPV persistence. DESIGN: Prospective cohort study. METHODS: MSM and TGW aged at least 18 years, were enrolled from Indonesia, Malaysia, and Thailand, then followed up 6-monthly for 12 months. Anal swabs were collected at every visit for HR-HPV genotypes to define anal HR-HPV incidence, clearance, and persistence. Logistic regression was used to evaluate factors associated with HR-HPV persistence. RESULTS: Three hundred and twenty-five MSM and TGW were included in this study, of whom 72.3% were HIV-positive. The incidence of anal HR-HPV persistence was higher in HIV-positive than HIV-negative MSM participants (28.4/1000 vs. 13.9/1000 person-months). HIV-positive participants had HR-HPV lower clearance rate than HIV-negative participants (OR 0.3; 95% CI 0.1-0.7). The overall persistence of HR-HPV was 39.9% in HIV-positive and 22.8% HIV-negative participants. HPV-16 was the most persistent HR-HPV in both HIV-positive and HIV-negative participants. HIV infection (aOR 2.87; 95% CI 1.47-5.61), living in Kuala Lumpur (aOR 4.99; 95% CI 2.22-11.19) and Bali (aOR 3.39; 95% CI 1.07-10.75), being employed/freelance (aOR 3.99; 95% CI 1.48-10.77), and not being circumcised (aOR 2.29; 95% CI 1.07-4.88) were independently associated with anal HR-HPV persistence. CONCLUSION: HIV-positive MSM and TGW had higher risk of persistent anal HR-HPV infection. Prevention program should be made available and prioritized for HIV-positive MSM and TGW where resources are limited.