Association between carcinogenic HPV and selected STIs and risk behaviors in HIV positive men who have sex with men in Lima, Peru

Abstract

Background: HIV infection in Peru is concentrated among MSM, and over the last 25 years, rates of anal cancer due to HPV have increased in this population. Currently, fifteen types of HPV types have been described as high-risk types for cancer. Other STIs such as HTLV-1/-2, syphilis, gonorrhea or chlamydia, may have an impact on HPV transmission in HIV positive MSM. The aim of this study was to assess for an association between the presence of carcinogenic types of HPV and infection with selected STI's in HIV positive individuals. Methods: Adult HIV-positive MSM were invited to participate. Participants were asked to complete a questionnaire (assessing demographic data and medical health history), give a 15 ml blood sample (for HTLV and syphilis testing), provide a urine sample (for detection of Chlamydia trachomaties and Neisseria gonorrhoeae) and undergo a rectal examination with swabbing (for HPV diagnosis by PCR). Results: All participants (152) considered themselves either "gay" (75.7%) or bisexual (24.3%); 50.9% reported having a versatile role in bed; another 27.8% considered their role mainly insertive or mainly receptive, meaning a degree of versatile behavior. The mean time from HIV diagnosis to enrollment was 4.4 years (SD 3.9 years); 78.3% were receiving HAART at the time of enrollment. Their mean CD4 cell count was 437.4 cells/mm3 (SD 193.5). Eighty participants (52.6%) had one or more STIs signs in the six months prior to the study. PCR assessment of HPV showed147 participants (96.7%) had at least one type of HPV; 90.5% of those had one or more carcinogenic types of HPV; most prevalent types were 6, 16, and 58. Four participants (2.6%) had chlamydia and 1 (0.7%) gonorrhea. The prevalence of confirmed syphilis was 26.3%. Factors associated with presence of carcinogenic types of HPV were ever having receptive anal intercourse (OR=10.17; 95% C.I. 2.12 - 52.61), having a versatile (OR=5.91; 95% C.I.1.36 - 25.63) or exclusively receptive role in bed (OR= 9.50; 95% C.I. 1.07 - 84.09). Conclusion: Given the high prevalence of carcinogenic types of HPV, different strategies are needed to improve compliance towards safer sex in this population, including male adolescent HPV vaccination.