Incidence And Risk Prediction Of Anal HPV Infection In HIV-negative Men Who Have Sex With Men

Objective: To understand the incidence and influencing factors of human papilloma viruses(HPV)among HIV-negative men who have sex with men(MSM),and using the individual’s HIV risk assessment tool to predict MSM incident HPV infection risk.Methods: From March 2016 to December 2019,the snowball method was used to recruit HIV-negative MSM through non-governmental organization(NGO)in Urumqi.Follow-up was performed every 6 months based on the time that subjects were enrolled.Participants were asked to finish the questionnaire survey,HIV,HPV test at baseline,and finish the questionnaire survey and HPV test at follow-up.The questionnaire include demographic characteristics,recent sexual behavior history,general behavioral history and other relevant information.Cotton swabs were used to collect exfoliated anal canal cells for HPV typing testing,and venous blood were collected for HIV testing.Incident HPV infection was defined that HPV DNA-negative MSM at baseline and it was positive at 6,12,18,and 24 months during follow-up.Fit the poisson distribution to calculate the overall incidence rate from baseline to follow-up 24 months and the incidence rate and its confidence interval at 6,12,18,and 24 months during follow-up.COX proportional hazard regression and COX competitive risk regression were used to analyze the influencing factors of incident HPV infection among MSM;exploring the ability of HIV risk assessment tools for MSM individuals to predict the risk of incident HPV infection among MSM;and based on the influencing factors of incident HPV infection screening in COX proportional hazard regression,improving risk assessment tools to establish a new risk assessment tool for MSM incident HPV infection.Results: A total of 783 HIV~negative MSM were included.Prevelence of any HPV infection was 47.13% at baseline,a history of anal sex(aOR=1.67,95% CI: 1.11~2.53),and receptive anal sexual behavior(aOR=1.49,95% CI: 1.08~2.05),history of drug use(aOR=1.91,95% CI: 1.37~2.66),and history of sexually transmitted diseases(aOR=1.85,95% CI: 1.04~3.31)are the influencing factors of any HPV infection.Of the 414 HPV-negative MSM during the 24~month follow~up period,the incidence rate of any HPV was 61.4/1000 person-months(95% CI: 53.7~70.2).Of type-specific incident HPV infections,the incidence rate of HPV16,51,39,52,and 58 were high in high-risk types;for low-risk types,the incidence rate of HPV6,61,11 were high.The incidence rates of any HPV infection of MSM at 6,12,18,and 24 months at each follow-up time point were respectively 76.9/1000 person-months(95% CI: 63.2~93.4),67.8/1000 person-months(95% CI: 57.2~80.3),58.9/1000person-months(95% CI: 49.6~70.1),61.7/1000 person-months(95% CI: 52.0~73.2).Among type-specific incident HPV infections at each follow-up,HPV16,39,51,52,and 58 were the most common types of high-risk incident infections,and HPV6 was the most common type of low-risk infections.It is consistent with the types which were high in overall type-specific incident HPV infections.Multivariate COX proportional hazard regression analysis showed that the number of sexual partners was ≥6(aHR=2.01,95% CI: 1.03~3.93),and searching for sexual partners in the bathroom(aHR=1.54,95% CI: 1.07~2.21)were risk factors of any incident HPV infection among MSM.After improving the risk assessment tool through the number of sexual partners and searching for sexual partners in the bathroom,it predicted the risk of incident HPV infection from the baseline of MSM to 24 months of follow~up,the area under the ROC curve was 0.60.Conclusions: MSM has a high incidence of any HPV infecion,especially HPV16,51,39,52,58 and 6 types,which provides a basis for the natural history of HPV infection among MSM in the later period;the number of sexual partners and places to find sexual partners are factors of incident HPV infection among MSM;the ability of risk assessment tool predicts risk of incident HPV infection needs to be further improved in the future,and traditional sexual behavior intervention methods should be combined to reduce the incidence of HPV infection among MSM.