Gardasil 9 HPV Vaccine Advised for MSM Living With HIV

Lorraine L. Janeczko, MPH

October 03, 2022

Men who have sex with men (MSM) living with HIV, especially those who are young or who've had gonorrhea should get the human papillomavirus (HPV) 9-valent vaccine (Gardasil 9), findings of a newly published study in JAIDS suggests.

According to the World Health Organization, only 30% of the target population worldwide has received the HPV vaccine. Despite increased risk for HPV anal infection (an estimated 3 out of 4 MSM develop an anal infection from any HPV genotype in their lifetime, epidemiological studies in MSM have been lacking, leaving gaps in data in terms of prevalence rates and prevention.

To help characterize which MSM subgroups benefit the most from early 9-valent HPV vaccination, researchers from Vita-Salute San Raffaele University in Milan determined the prevalence of anal HPV genotypes in MSM who'd been living with HIV for 5 years, and they analyzed the risk factors for HPV anal infection.

Of the 1352 study participants, 12% were not infected by any HPV genotypes, and the maximum number of genotypes infecting one person — 6 — was detected in 0.4%(6) people The prevalence of HR-HPV genotypes or those present in the vaccine remained stable over time.

"Our findings suggest…that all MSM with HIV would benefit from Gardasil 9 immunization, particularly the youngest and those with a prior gonococcal infection," lead study author Elena Bruzzesi, MD, of Vita-Salute San Raffaele University in Milan, and her co-authors wrote.

To determine prevalence of HPV genotypes at anal sites and risk factors, the authors conducted a time-trend, monocentric study on participants who self-identified as MSM who engaged in anal intercourse. The participants underwent one or more anoscopies for HPV genotyping at one academic hospital in Milan between 2015 and 2019.

Swab specimens were collected from the anal canal mucosa, then soaked in thin-layer liquid medium, and sent for molecular analysis.

To detect HPV phenotypes, the specimens were processed by multiplex real-time polymerase chain reaction.

Findings showed that:

  • The overall prevalence of MSM with at least 1 anal HPV genotype was 88%, with prevalence ranging from 77% to 84%, and no trend difference over the 5-year period.

  • 79% of participants were exposed to at least 1 high-risk (HR)-HPV genotype, and 67.4% by at least 1 low-risk (LR)-HPV genotype.

  • HPV-53, in 27%, was the most prevalent genotype. HPV-6, 11, 16, and 18 prevalence was 22%, 13%, 23%, and 11%, respectively. Of the HR genotypes, HPV-16 and HPV-18 are most often linked with squamous cell cancers and adenocarcinomas, and in the study, prevalence did not change over time.

  • 71% of participants carried at least 1 genotype covered by the vaccine, with no change over time.

  • On multivariable analysis, the risk of carrying at least 1 high-risk HPV genotype was linked with younger age (adjusted odds ratio [aOR] for 30 years or younger compared with older than 45 years 2.714; 95% confidence interval [CI], 1.484  ̶  4.961), and with having had gonorrhea (aOR, 2.118; 95% CI, 1.100  ̶  4.078).

  • Also on multivariable analysis, the risk of having one or more genotypes targeted by the 9-valent vaccine was linked with younger age (aOR, 1.868; 95% CI, 1.141  ̶  3.060) and with having had gonorrhea (aOR, 1.785; 95% CI, 1.056  ̶  3.018).

The HPV Vaccine Is Effective, Safe, and Underutilized

Dr Mehri McKellar

"We are underutilizing the HPV vaccine in our clinical settings in the United States and globally," Mehri S. McKellar, MD, an infectious disease specialist at Duke Health in Durham, North Carolina, told Medscape Medical News by email.

"This powerful study provides important data on HPV genotype prevalence in the MSM HIV+ population, validating that Gardasil 9 will greatly help these individuals," said McKellar, who was not involved in the study.

Robert Salata, MD, infectious disease specialist and professor at Case Western Reserve University School of Medicine in Cleveland, Ohio, also encourages MSM to get the vaccine.

Dr Robert Salata

"It is important to understand that the prevalence of anal HPV in men who have sex with men is very high, that the prevalence, including high-risk genotypes, has remained stable, and that the 9-valent vaccine is clearly indicated, especially in younger men and those with known gonorrhea and other STDs," Salata (who was also not involved in the study) said by email.

"This is an important reminder for us to continue promoting and providing the vaccine to our patients, especially to HIV+ men who have sex with men, who have the highest rates of anal infection with HPV," McKellar advised.  

The authors, McKellar, and Salata report no relevant financial relationships. Funding information was not provided.

J Acquir Immune Defic Syndr. Published online October 1, 2022. Abstract


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