Men who have sex with men (MSM) living with HIV, especially those who are young or who have had gonorrhea, should get the HPV 9-valent vaccine (Gardasil 9), the findings of a new study suggest.

According to the World Health Organization, only 30% of the target population worldwide has received the HPV vaccine. Despite an 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 determined the prevalence of anal HPV genotypes in MSM who had 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 1 person (6) was detected in 0.4% (n=6) people The prevalence of high-risk (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," researchers said.

To determine the prevalence of HPV genotypes at anal sites and the risk factors, the authors conducted a time-trend, monocentric study on participants who self-identified as MSM who had engaged in anal intercourse. The participants underwent 1 or more anoscopies for HPV genotyping between 2015 and 2019.

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

To detect HPV phenotypes, the specimens were processed by multiplex real-time PCR.

Key results

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 HR HPV genotype, and 67.4% were exposed to at least 1 low-risk HPV genotype.
HPV-53, prevalent in 27%, was the most prevalent genotype. The prevalence of HPV-6, HPV-11, HPV-16, and HPV-18 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 HR HPV genotype was linked with younger age (the adjusted OR [aOR] for 30 years or younger compared with those aged older than 45 years was 2.714; 95% 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 1 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

"We are underutilizing the HPV vaccine — 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 Mehri S. McKellar, MD, Duke Health in Durham, North Carolina, who was not involved in the study.

"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," said Robert Salata, MD, Case Western Reserve University School of Medicine in Cleveland, Ohio, who was also not involved in the study.

"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.

A version of this article first appeared on Medscape.com, part of the Medscape Professional Network.

HPV vaccine advised for men who have sex with men living with HIV

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