HIV, immune dysfunction and the natural history of anal high-risk human papillomavirus infection in gay and bisexual men

2020 ◽  
Author(s):  
I Mary Poynten ◽  
Fengyi Jin ◽  
Suzanne M Garland ◽  
Richard J Hillman ◽  
Monica Molano ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
High Risk ◽  
Natural History ◽  
Anal Cancer ◽  
Gay And Bisexual Men ◽  
Hiv Positive ◽  
Bisexual Men ◽  
Clearance Rates ◽  
History Of ◽  
And Bisexual

Abstract Objectives Incidence of anal cancer is highest in gay and bisexual men (GBM). A better understanding of the natural history of anal high-risk human papillomavirus (HRHPV) infection is needed for anal cancer prevention. Methods The Study of the Prevention of Anal Cancer was a 3-year study of Australian GBM, aged 35 years or older. We examined incidence, clearance and risk factors for 13 HRHPV types tested for at baseline and 3 annual visits. Results In 525 men with ≥ 2 visits, 348 (66.3%) acquired ≥ 1 incident HRHPV infection. HPV16 incidence rates were similar, but non-16 HRHPV incidence was higher in HIV-positive (51.8/100 person years, PY) than HIV-negative men (36.5/100 PY, p < 0.001). Annual clearance rates of HPV16 (13.21/100 PY, 95% CI 10.53-16.56) were lower than for other HRHPV types. HRHPV clearance rates were not associated with HIV overall but were significantly lower in those with a lower nadir CD4 (<200 cells/µl) for HPV16 (p=0.015) and other HRHPV types (p=0.007). Conclusion The higher incidence of non-16 HRHPV types, coupled with the lower clearance of non-16 HRHPV types in those with past impaired immune function, is consistent with the greater role of non-16 HRHPV in anal cancer in HIV-positive people.

The Natural History of Anal High-grade Squamous Intraepithelial Lesions in Gay and Bisexual Men

2020 ◽  
Author(s):  
I Mary Poynten ◽  
Fengyi Jin ◽  
Jennifer M Roberts ◽  
David J Templeton ◽  
Carmella Law ◽  
...  
Keyword(s):  
Natural History ◽  
Gay And Bisexual Men ◽  
Hiv Positive ◽  
High Grade ◽  
Bisexual Men ◽  
Squamous Intraepithelial Lesions ◽  
History Of ◽  
And Bisexual ◽  
Intraepithelial Lesions

Abstract Background Gay and bisexual men (GBM) are disproportionately affected by anal cancer. Prevention is hindered by incomplete understanding of the natural history of its precursor, anal high-grade squamous intraepithelial lesions (HSIL). Methods The Study of the Prevention of Anal Cancer, conducted between 2010 and 2018, enrolled human immunodeficiency virus (HIV)-positive and HIV-negative GBM aged ≥35 years. Anal cytology and high-resolution anoscopy (HRA) were performed at baseline and 3 annual visits. A composite HSIL diagnosis (cytology ± histology) was used. Cytological high-grade squamous intraepithelial lesions (cHSIL) incidence and clearance rates were calculated with 95% confidence intervals (CIs). Predictors were calculated using Cox regression with hazard ratios (HRs) and 95% CIs. Results Among 617 men, 220 (35.7%) were HIV-positive, median age 49 years. And 124 incident cHSIL cases occurred over 1097.3 person-years (PY) follow-up (11.3, 95% CI 9.5–13.5 per 100 PY). Significant bivariate predictors of higher incidence included age <45 years (HR 1.64, 95% CI 1.11–2.41), HIV positivity (HR 1.43, 95% CI .99–2.06), prior SIL diagnosis (P-trend < .001) and human papillomavirus (HPV)16 (HR 3.39, 2.38–4.84). Over 695.3 PY follow-up, 153 HSIL cleared (clearance 22.0, 95% CI 18.8–25.8 per 100 PY). Predictors were age < 45 years (HR 1.52, 1.08–2.16), anal intraepithelial neoplasia (AIN)2 rather than AIN3 (HR 1.79, 1.29–2.49), smaller lesions (HR 1.62, 1.11–2.36) and no persistent HPV16 (HR 1.72, 1.23–2.41). There was 1 progression to cancer (incidence 0.224, 95% CI .006–1.25 per 100 PY). Conclusion These data strongly suggest that not all anal HSIL detected in screening requires treatment. Men with persistent HPV16 were less likely to clear HSIL and are more likely to benefit from effective HSIL treatments.

scholarly journals Sexual behaviours associated with incident high-risk anal human papillomavirus among gay and bisexual men

2021 ◽  
pp. sextrans-2020-054851
Author(s):  
Ian K J Wong ◽  
Isobel Mary Poynten ◽  
Alyssa Cornall ◽  
David J Templeton ◽  
Monica Molano ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Anal Cancer ◽  
Gay And Bisexual Men ◽  
Anal Intercourse ◽  
Sexual Practices ◽  
Hiv Positive ◽  
Bisexual Men ◽  
Sexual Behaviours ◽  
And Bisexual

ObjectiveHigh-risk human papillomavirus (HRHPV) causes anal cancer, which disproportionately affects gay and bisexual men (GBM). We examined sexual behaviours associated with incident anal HRHPV in an observational cohort study of GBM in Sydney, Australia.MethodsGBM aged 35 years and above were enrolled in the Study of the Prevention of Anal Cancer. Detailed information on sexual practices in the last 6 months, including receptive anal intercourse (RAI) and non-intercourse receptive anal practices, was collected. Anal human papillomavirus (HPV) testing was performed at the baseline and three annual follow-up visits. Risk factors for incident HRHPV were determined by Cox regression using the Wei-Lin-Weissfeld method.ResultsBetween 2010 and 2015, 617 men were recruited and 525 who had valid HPV results at baseline and at least one follow-up visit were included in the analysis. The median age was 49 years (IQR 43–56) and 188 (35.8%) were HIV-positive. On univariable analysis, incident anal HRHPV was associated with being HIV-positive (p<0.001), having a higher number of recent RAI partners regardless of condom use (p<0.001 for both), preference for the receptive position during anal intercourse (p=0.014) and other non-intercourse receptive anal sexual practices, including rimming, fingering and receptive use of sex toys (p<0.05 for all). In multivariable analyses, being HIV-positive (HR 1.46, 95% CI 1.09 to 1.85, p=0.009) and reporting condom-protected RAI with a higher number of sexual partners (p<0.001) remained significantly associated with incident HRHPV. When stratified by recent RAI, non-intercourse receptive anal practices were not associated with incident HRHPV in men who reported no recent RAI.ConclusionGBM living with HIV and those who reported RAI were at increased of incident anal HRHPV. Given the substantial risk of anal cancer and the difficulty in mitigating the risk of acquiring anal HRHPV, HPV vaccination should be considered among sexually active older GBM.Trial registration numberANZCTR365383.

Awareness and knowledge of anal cancer in a community-recruited sample of HIV-negative and HIV-positive gay and bisexual men

Sexual Health ◽  
2019 ◽  
Author(s):  
Lance Feeney ◽  
Mary Poynten ◽  
Fengyi (Jeff) Jin ◽  
Craig Cooper ◽  
David J. Templeton ◽  
...  
Keyword(s):  
Anal Cancer ◽  
Gay And Bisexual Men ◽  
Hiv Positive ◽  
Bisexual Men ◽  
And Bisexual ◽  
Hiv Negative

Australian gay and bisexual men’s online preferences about sex with HIV-positive partners

Sexual Health ◽  
2017 ◽  
Vol 14 (3) ◽  
pp. 221 ◽  
Author(s):  
Garrett Prestage ◽  
Benjamin Bavinton ◽  
Denton Callander ◽  
Steven P. Philpot ◽  
Iryna Zablotska ◽  
...  
Keyword(s):  
Safer Sex ◽  
Gay And Bisexual Men ◽  
Hiv Positive ◽  
Bisexual Men ◽  
Sex Partners ◽  
Hiv Status ◽  
Capital Cities ◽  
Gay Community ◽  
And Bisexual ◽  
Hiv Positive Men

Background Among gay and bisexual men (GBM), ‘serosorting’ is common and involves restricting sex, or at least condomless sex, to partners of the same HIV status. The prevalence of men conveying their serosorting preferences regarding partners they meet online remains unclear. Methods: This study reviewed 57 178 Australian online profiles obtained directly from a popular gay website. Logistic regression was used to identify factors associated with preferences for meeting HIV-positive partners. Results: Men could indicate their preferences from a list of 22 types of partners; 4358 profiles (7.6%) indicated an interest in meeting HIV-positive men. There were 1959 profiles (3.4%) listing a preference for 21 of the 22 types of men, including 1498 men (2.6%) that specifically excluded HIV-positive men. Men who specifically excluded HIV-positive men on their profiles were younger (mean age 34.7 years), less likely to identify as gay (25.6%) and more likely to always prefer ‘safer sex’ (55.3%) than those who specifically included them (mean age 39.6 years; 62.8% gay-identified; 30.9% preferred safer sex; P < 0.001). Men who specifically excluded HIV-positive partners on their profiles were also more likely to live outside major capital cities (P < 0.001). Conclusions: Being younger, living outside major cities, not identifying as gay, always preferring safer sex and either Caucasian or Asian background were associated with excluding HIV-positive men as potential sex partners. These factors may reflect lower social and community engagement with the gay community. The disinclination to include HIV-positive men as potential sex partners may be due to fear of infection, stigma or poor information about HIV.

scholarly journals Pilot Trial of a Sexual Health Counseling Intervention for HIV-Positive Gay and Bisexual Men Who Report Anal Sex without Condoms

2021 ◽  
Author(s):  
Trevor A. Hart ◽  
Natalie Stratton ◽  
Todd A. Coleman ◽  
Holly A. Wilson ◽  
Scott H. Simpson ◽  
...  
Keyword(s):  
Sexual Transmission ◽  
Psychosocial Outcomes ◽  
Gay And Bisexual Men ◽  
Sexual Compulsivity ◽  
Hiv Positive ◽  
Bisexual Men ◽  
Anal Sex ◽  
Counseling Intervention ◽  
And Bisexual ◽  
Sex With Men

Background Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior. Method HIV-positive (HIV+) peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors. Results There was a significant reduction in condomless anal sex (CAS) with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity. Conclusions The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men. Trial Registration ClinicalTrials.gov NCT02546271

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