Prevalence of Anal HPV Infection among HIV-Positive Men Who Have Sex with Men in India

India has a large population of HIV-positive individuals, including men who have sex with men (MSM) and the incidence of human papillomavirus (HPV)-related cancers is high. In developed countries, HIV-positive MSM exhibit the highest prevalence of anal HPV infection and incidence of anal cancer. Little is known about anal HPV infection in HIV-positive Indian MSM.

We evaluated 300 HIV-positive MSM from two cities in India. Men were tested for anal HPV infection using L1-HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load were measured. Participants completed an interviewer-administered questionnaire including a sexual history.

• The prevalence of anal HPV was 95%. 
• The three most common types were HPV 35 (20%), HPV 16 (13%) and HPV 6/11 (13%). 
• History of taking antiretroviral medications decreased risk of anal HPV 16 infection (RR: 0.6 (0.4-1.0). 
• Having an increased number of vaginal sex partners lowered risk of any anal HPV infection. 
• Ever having receptive sex increased risk of any anal HPV (RR: 1.2 (1.1-1.4) and anal HPV 16 (RR: 6.5 1.8-107).

Almost all Indian HIV-positive MSM had anal HPV infection. The prevalence of HPV 16 was lower and the prevalence of other oncogenic HPV types was higher than in similar populations in North America and Europe. Vaccine based prevention strategies for HPV infection in India should consider potential differences in HPV type distribution among HIV-infected MSM when designing interventions.

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By: Hernandez AL1, Karthik R, Sivasubramanian M, Raghavendran A, Gnanamony M, Lensing S, Lee JY, Kannangai R, Abraham P, Mathai D, Palefsky JM.

• 11Department of Medicine, University of California, San Francisco, AND School of Public Health, Department of Epidemiology, University of California, Berkeley 2Department of Medicine, Christian Medical College, Vellore, India 3The Humsafar Trust, Mumbai, India 4Department of Clinical Virology, Christian Medical College, Vellore, India 5Department of Cancer Biology and Pharmacology, University of Illinois Chicago 6Department of Biostatistics, University of Arkansas for Medical Sciences 7Department of Biostatistics, University of Arkansas for Medical Sciences 8Department of Clinical Virology, Christian Medical College, Vellore India 9Department of Clinical Virology, Christian Medical College, Vellore, India 10Apollo Institute of Medical Sciences and Research, Hyderabad, India 11Department of Medicine, University of California, San Francisco.
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