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Back to Infectious Disease Articles
Thursday, 18 November 2004
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Previous assumptions about extrapolating data from cervical disease in women
to anal HPV infection in men who have sex with men must be questioned.
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The age-specific prevalence of sexually transmitted human
papillomavirus infection in women differs substantially from that in men
who have sex with men, according to a new study published in the
December 15 issue of The Journal of Infectious Diseases, now available
online.
The study, led by Peter V. Chin-Hong of the University of California,
San Francisco, indicates a high prevalence of anal human papillomavirus
(HPV) infection in all age groups of men who have sex with men. This
finding contrasts with the age-related prevalence of cervical HPV
infection.
Numerous studies have previously documented a causal link between HPV
infection and anal and cervical cancers. Many studies have also shown
that cervical HPV infection is strongly related to age, peaking early
and falling after age 30. Little, however, is known about the
age-specific prevalence of anal HPV infection in men who have sex with
men. Most research on the subject has involved men in a narrow age range
who were HIV-infected. The investigators described their study as the
first to document anal HPV infection in a HIV-seronegative population of
men who have sex with men who were diverse in terms of age and
geography.
The EXPLORE Study
The study was conducted between January 2001 and October 2002 and
involved 1,218 men who have sex with men living in Boston, Denver, New
York, and San Francisco. The men were aged 18 to 89 years and 78% were
white, 14% were Latino, 6% were African American, and 3% were Asian. The
researchers found the prevalence rate of anal HPV infection to be 57%,
and this rate did not change with age or from city to city. Factors
associated with infection were receptive anal sex and having more than
five sex partners in the previous six months.
Study results also described the nature of anal HPV infection in this
group. Forty-five percent of those infected had more than one type of
HPV. The prevalence of infection with “high-risk” HPV types associated
with invasive anal cancer was 26%, suggesting that a high proportion of
men who have sex with men may be at risk for anal cancer.
Chin-Hong and colleagues hypothesized that the sex-based difference
in HPV epidemiology may reflect a difference between these populations
in the number of new sex partners after age 30. They also suggest that
there may be organ-specific and hormonal differences that contribute to
the epidemiological differences. The investigators noted that one of the
strengths of their study was its size and that it is the first
multi-city study of anal HPV infection. A potential limitation, they
explained, is that they do not know if their results can be generalized
to certain subgroups of men who have sex with men, such as those living
in rural areas.
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Future implications
“Based on the results of this study, previous assumptions about
extrapolating data from cervical disease in women to anal HPV infection
in men who have sex with men must be questioned,” Dr. Chin-Hong said.
“The unique epidemiology of anal HPV infection should be further
explored for its implications for HPV vaccine development and for
understanding the risk factors of anal cancer.”
"This study is most likely the largest study to be done on Human
Immunodeficiency virus
(HIV) negative patients", says Mohamed Yassin, MD of The Doctors Lounge.
"It adds to the understanding of the incidence of this type of cancer in
men who have sex with men (MSM) whether they have HIV or not." I believe
this may have an impact on implementing a health policy of screening for
anorectal carcinoma for MSM regardless of HIV history. The exact age of
starting screening and frequency of screening in this population is yet
to be determined."
References
Peter V. Chin-Hong, Eric Vittinghoff, Ross D. Cranston, Susan
Buchbinder, Daniel Cohen, Grant Colfax, Maria Da Costa, Teresa Darragh,
Eileen Hess, Franklyn Judson, Beryl Koblin, Maria Madison, and Joel M.
Palefsky. Age-Specific Prevalence of Anal Human Papillomavirus Infection
in HIV-Negative Sexually Active Men Who Have Sex with Men: The EXPLORE
Study. The Journal of Infectious Diseases 2004;190:000.
| Author: |
Dr. Tamer Fouad, M.D.
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