Background:
To estimate incidence and clearance of high-risk human papillomavirus (HR-HPV),
and their risk factors, in men who have sex with men (MSM) recently infected by
HIV in Spain; 2007–2013.
Methods:
Multicenter cohort. HR-HPV infection was determined and genotyped with linear
array. Two-state Markov models and Poisson regression were used.
Results:
We analysed 1570 HR-HPV measurements of 612 MSM over 13 608 person-months (p-m)
of follow-up. Median (mean) number of measurements was 2 (2.6), median time
interval between measurements was 1.1 years (interquartile range: 0.89–1.4).
Incidence ranged from 9.0 [95% confidence interval (CI) 6.8–11.8] per 1000 p-m
for HPV59 to 15.9 (11.7–21.8) per 1000 p-m for HPV51. HPV16 and HPV18 had
slightly above average incidence: 11.9/1000 p-m and 12.8/1000 p-m. HPV16 showed
the lowest clearance for both ‘prevalent positive’ (15.7/1000 p-m; 95% CI
12.0–20.5) and ‘incident positive’ infections (22.1/1000 p-m; 95% CI
11.8–41.1). More sexual partners increased HR-HPV incidence, although it was
not statistically significant. Age had a strong effect on clearance (P-value < 0.001)
due to the elevated rate in MSM under age 25; the effect of HIV-RNA viral load
was more gradual, with clearance rate decreasing at higher HIV-RNA viral load (P-value
0.008).
Conclusion:
No large variation in incidence by HR-HPV type was seen. The most common
incident types were HPV51, HPV52, HPV31, HPV18 and HPV16. No major variation in
clearance by type was observed, with the exception of HPV16 which had the
highest persistence and potentially, the strongest oncogenic capacity. Those
aged below 25 or with low HIV-RNA- viral load had the highest clearance.
Below: In the combined analysis, none of the variables had a statistically significant effect on HR-HPV incidence; P-values for the effect of age, CD4+ cell count and HIV-RNA viral load were 0.17, 0.49 and 0.55, respectively
By: Geskus, Ronald B.a,b,*; González, Cristinac,d,*; Torres, Montserrate; Del Romero, Jorgef; Viciana, Pompeyog; Masiá, Marh; Blanco, José R.i; Iribarren, Mauricioj; De Sanjosé, Silviad,k; Hernández-Novoa, Beatrizl; Ortiz, Martae,†; Del Amo, Juliac,d,†; CoRIS-HPV Study Group
aPublic Health Service of Amsterdam
bAcademic Medical Center, Amsterdam, The
Netherlands
cNational Center of Epidemiology,
Institute of Health Carlos III, Madrid
dCIBERESP
eNational Center of Microbiology,
Institute of Health Carlos III. Madrid
fSanitary Center Sandoval, Madrid
gVirgen del Rocío University Hospital,
Sevilla
hElche University Hospital, Alicante
iSan Pedro –CIBIR Hospital, Logroño, La
Rioja
jXeral de Vigo University Hospital, Vigo
kCatalan Institute of Oncology, Barcelona
lRamón y Cajal University
Hospital-IRYCIS, Madrid, Spain.
*Ronald B. Geskus and Cristina González
contributed equally to the writing of this manuscript.
†Marta Ortiz and Julia Del Amo are senior
authors and have equally contributed to this manuscript.
Correspondence
to Julia del Amo, National Center of Epidemiology, Institute of Health Carlos
III, Av. Monforte de Lemos no 5, CP: 28029 Madrid, Spain. Tel: +34 91 822 21
42; fax: +34 91 387 75 13; e-mail: jdamo@isciii.es
Received
14 January, 2014
Revised
27 June, 2014
Accepted
2 July, 2014
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