HPV infection screening is important for HIV MSM
HPV infection screening is important for HIV MSM
HIV & HPV connection studied
Infectious diseases researchers have observed some interesting trends involving patients with human papillomavirus (HPV) infection and cancer, as well as HIV seroconversion.
Ear, nose, and throat physicians recently have been seeing increasing numbers of patients with pharyngeal and throat cancer, and their cases are outside the standard presentation of older patients who have long drinking and smoking histories, an investigator says.
These younger patients often were infected with anal human papillomavirus and had acquired HPV infection in the mouth, says Peter Chin-Hong, MD, MAS, an associate professor of clinical medicine in the department of medicine — infectious diseases at the University of California - San Francisco.
"So far we've focused a little on cervical cancer and a little on anal cancer, but very little attention on extra-genital areas of cancer," Chin-Hong says.
At the same time, investigators wanted to compare HIV seroconversion among at-risk participants who had HPV infection versus those who didn't.
"We wanted to look at HPV infection and see how it changes over time," Chin-Hong says.
"Once you get HPV infection you could have a lesion and a break in the barrier with possibly more bleeding, so it makes sense that if somebody has a sexually-transmitted disease (STD) compared with someone who doesn't, then the person with the STD could acquire HIV more readily if all other things are equal," Chin-Hong says.
Studies have shown this to be true of infections with herpes and syphilis, he adds.
"Immunologically, when you have these lesions it activates the immune system locally, and you have cells coming to these areas," Chin-Hong says. "You can have CD4 cells, macrophages, and studies showing that in areas of STDs, these cells are more represented than in individuals who have no STDs."
So for barrier and anatomical and immunological reasons it makes sense that STDs can increase the risk of HIV infection, he says.
Researchers studied anal HPV infection and its association with HIV acquisition in a group of men who have sex with men (MSM), who also were part of a EXPLORE trial, which was a randomized clinical trial of the efficacy of a behavioral intervention.1
"There was a high prevalence of HPV infection in this population," Chin-Hong says. "Sixty percent of individuals had any type of HPV in their anal canal at baseline, and of these, 25% had high risk anal HPV types, which are the types of HPV most implicated with cancer."
The study found that of the 1,409 initially HIV-negative participants, 51 became infected with HIV during the study. The unadjusted analyses showed that infection with one HPV type and two or more HPV types was associated with HIV seroconversion.1
The multivariable analyses showed that infection with two or more HPV types was associated with HIV seroconversion when compared with those who were not infected with HPV.1
These findings could be another reason for HIV clinicians to think about HPV vaccination, Chin-Hong says.
What's needed are randomized studies of at-risk MSM who are given the HPV vaccine to see if this helps to prevent HIV infection, he says.
"Some people think there is enough evidence that the vaccine prevents cancer so maybe one does not need to show it also prevents HIV infection," Chin-Hong notes.
The HPV vaccine likely will be rolled out internationally in regions where there are high levels of both HIV and HPV, he adds.
'These kinds of studies are making people look at not only cancer outcomes, but also community-level HIV," Chin-Hong says.
However, it remains controversial to recommend that high-risk patients be vaccinated for HPV, he adds.
"The vaccine is very expensive — $360 for a series," he says. "So whether or not society is willing to pay for people who are going to benefit partially is the question."
Since it's already a public health recommendation that all girls receive the HPV vaccine at age 12, the unresolved question is whether society would be willing to pay for boys the same age to receive the vaccine, Chin-Hong says.
HIV-infected MSM already are at an increased risk of anal cancer, he notes.
"We could vaccinate boys to protect girls and to prevent the disease they might develop when they become men," Chin-Hong says. "You don't know who will become a man who has sex with men or not."
Infectious diseases researchers have observed some interesting trends involving patients with human papillomavirus (HPV) infection and cancer, as well as HIV seroconversion.Subscribe Now for Access
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