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Abstract：
Men who have sex with men (MSM) are at increased risk for Human papillomavirus (HPV) infection compared to women and heterosexual men. We aimed to assess the incidence, clearance and duration of anal human papillomavirus (HPV) infection in HIV-negative MSM and the influencing factors in a 5-year prospective cohort study.
From April 2016 to April 2021, HIV-negative MSM were recruited and followed every 6 months in Urumqi, Xinjiang, China. Questionnaires and anal swabs were collected at baseline and every 6 months. We detected 37 anal HPV genotypes using the HPV Geno Array Diagnostic Kit Test. Incidence and clearance rates of anal HPV infection and the influencing factors were estimated using a two-state Markov model.
A total of 585 MSM were included with a median age of 37 years [interquartile range (IQR): 31-43 years] and were followed for a median 2.8 years (IQR: 1.8-3.6 years). Incidence rates for any HPV and high-risk HPV (Hr-HPV) were 53.4 [95% confidence interval (CI): 49.1-58.0] and 39.0 (95% CI: 35.7-42.5)/1,000 person-months. Median duration of infection was 9.67 (95% CI: 8.67-10.86) and 8.51 (95% CI: 7.57-9.50) months, respectively. Clearance rates for any HPV and Hr-HPV were 50.9 (95% CI: 46.7-55.3) and 62.1 (95% CI: 56.8-66.7)/1,000 person-months, respectively. HPV16 and HPV6 had the highest incidence, lowest clearance rate and longest duration of infection among Hr-HPV and low-risk HPV (Lr-HPV) types, respectively. Receptive anal sex is a risk factor for any HPV [hazard ratio (HR) = 1.66, 95% CI: 1.16-2.38] and Hr-HPV infection (HR = 1.99, 95% CI:1.39-2.85). Recent anal sex without condom use was significantly associated with any HPV (HR = 1.80, 95% CI: 1.10-2.94) and Hr-HPV infection (HR = 2.60, 95% CI: 1.42-4.77). Age ≥35 years was significantly associated with Lr-HPV HPV infection only (HR = 1.40, 95% CI: 1.02-1.93). Both inserted and receptive anal sex (HR = 0.60, 95% CI: 0.40-0.89) and anal sex ≥2 times per week (HR = 0.61, 95% CI: 0.43-0.87) were associated with reduced Hr-HPV clearance. Six of the nine-valent vaccine types (HPV6, 11, 16, 18, 52 and 58) occurred most frequently, which indicates the need for high vaccination coverage in MSM.
In this cohort study, high incidence and low clearance of any HPV, Hr-HPV and individual HPV infections emphasize the importance of MSM vaccination. Modifiable behavioral factors such as condoms and drug use should be incorporated into HPV prevention strategies.
From April 2016 to April 2021, HIV-negative MSM were recruited and followed every 6 months in Urumqi, Xinjiang, China. Questionnaires and anal swabs were collected at baseline and every 6 months. We detected 37 anal HPV genotypes using the HPV Geno Array Diagnostic Kit Test. Incidence and clearance rates of anal HPV infection and the influencing factors were estimated using a two-state Markov model.
A total of 585 MSM were included with a median age of 37 years [interquartile range (IQR): 31-43 years] and were followed for a median 2.8 years (IQR: 1.8-3.6 years). Incidence rates for any HPV and high-risk HPV (Hr-HPV) were 53.4 [95% confidence interval (CI): 49.1-58.0] and 39.0 (95% CI: 35.7-42.5)/1,000 person-months. Median duration of infection was 9.67 (95% CI: 8.67-10.86) and 8.51 (95% CI: 7.57-9.50) months, respectively. Clearance rates for any HPV and Hr-HPV were 50.9 (95% CI: 46.7-55.3) and 62.1 (95% CI: 56.8-66.7)/1,000 person-months, respectively. HPV16 and HPV6 had the highest incidence, lowest clearance rate and longest duration of infection among Hr-HPV and low-risk HPV (Lr-HPV) types, respectively. Receptive anal sex is a risk factor for any HPV [hazard ratio (HR) = 1.66, 95% CI: 1.16-2.38] and Hr-HPV infection (HR = 1.99, 95% CI:1.39-2.85). Recent anal sex without condom use was significantly associated with any HPV (HR = 1.80, 95% CI: 1.10-2.94) and Hr-HPV infection (HR = 2.60, 95% CI: 1.42-4.77). Age ≥35 years was significantly associated with Lr-HPV HPV infection only (HR = 1.40, 95% CI: 1.02-1.93). Both inserted and receptive anal sex (HR = 0.60, 95% CI: 0.40-0.89) and anal sex ≥2 times per week (HR = 0.61, 95% CI: 0.43-0.87) were associated with reduced Hr-HPV clearance. Six of the nine-valent vaccine types (HPV6, 11, 16, 18, 52 and 58) occurred most frequently, which indicates the need for high vaccination coverage in MSM.
In this cohort study, high incidence and low clearance of any HPV, Hr-HPV and individual HPV infections emphasize the importance of MSM vaccination. Modifiable behavioral factors such as condoms and drug use should be incorporated into HPV prevention strategies.
摘要：
与女性和异性恋男性相比，男男性行为者（MSM）感染人乳头瘤病毒（HPV）的风险增加。我们的目的是评估发病率，在5年的前瞻性队列研究中，HIV阴性MSM患者肛门人乳头瘤病毒（HPV）感染的清除率和持续时间以及影响因素。
2016年4月至2021年4月，乌鲁木齐每6个月招募一次HIV阴性MSM，新疆,中国。在基线和每6个月收集问卷和肛门拭子。我们使用HPV基因芯片诊断试剂盒检测了37种肛门HPV基因型。使用两状态马尔可夫模型估计肛门HPV感染的发生率和清除率及其影响因素。
共纳入585名MSM，年龄中位数为37岁[四分位距（IQR）：31-43岁]，随访中位数为2.8年（IQR：1.8-3.6年）。任何HPV和高危HPV（Hr-HPV）的发病率分别为53.4[95％置信区间（CI）：49.1-58.0]和39.0（95％CI：35.7-42.5）/1,000人-月。感染持续时间中位数为9.67（95％CI：8.67-10.86）和8.51（95％CI：7.57-9.50）个月，分别。任何HPV和Hr-HPV的清除率分别为50.9（95％CI：46.7-55.3）和62.1（95％CI：56.8-66.7）/1,000人-月，分别。HPV16和HPV6发病率最高，Hr-HPV和低危型HPV（Lr-HPV）之间的清除率最低，感染持续时间最长，分别。肛交是任何HPV[危险比（HR）=1.66，95％CI：1.16-2.38]和Hr-HPV感染（HR=1.99，95％CI：1.39-2.85）的危险因素。最近没有使用安全套的肛交与任何HPV（HR=1.80，95％CI：1.10-2.94）和Hr-HPV感染（HR=2.60，95％CI：1.42-4.77）显着相关。年龄≥35岁仅与Lr-HPVHPV感染显着相关（HR=1.40，95％CI：1.02-1.93）。插入性和接受性肛交（HR=0.60，95％CI：0.40-0.89）和每周肛交≥2次（HR=0.61，95％CI：0.43-0.87）均与Hr-HPV清除率降低有关。九价疫苗类型中的六种（HPV6、11、16、18、52和58）发生频率最高，这表明MSM需要高疫苗接种覆盖率。
在这项队列研究中，任何HPV的高发病率和低清除率，Hr-HPV和个体HPV感染强调了MSM疫苗接种的重要性。可改变的行为因素，如避孕套和药物使用应纳入HPV预防策略。
2016年4月至2021年4月，乌鲁木齐每6个月招募一次HIV阴性MSM，新疆,中国。在基线和每6个月收集问卷和肛门拭子。我们使用HPV基因芯片诊断试剂盒检测了37种肛门HPV基因型。使用两状态马尔可夫模型估计肛门HPV感染的发生率和清除率及其影响因素。
共纳入585名MSM，年龄中位数为37岁[四分位距（IQR）：31-43岁]，随访中位数为2.8年（IQR：1.8-3.6年）。任何HPV和高危HPV（Hr-HPV）的发病率分别为53.4[95％置信区间（CI）：49.1-58.0]和39.0（95％CI：35.7-42.5）/1,000人-月。感染持续时间中位数为9.67（95％CI：8.67-10.86）和8.51（95％CI：7.57-9.50）个月，分别。任何HPV和Hr-HPV的清除率分别为50.9（95％CI：46.7-55.3）和62.1（95％CI：56.8-66.7）/1,000人-月，分别。HPV16和HPV6发病率最高，Hr-HPV和低危型HPV（Lr-HPV）之间的清除率最低，感染持续时间最长，分别。肛交是任何HPV[危险比（HR）=1.66，95％CI：1.16-2.38]和Hr-HPV感染（HR=1.99，95％CI：1.39-2.85）的危险因素。最近没有使用安全套的肛交与任何HPV（HR=1.80，95％CI：1.10-2.94）和Hr-HPV感染（HR=2.60，95％CI：1.42-4.77）显着相关。年龄≥35岁仅与Lr-HPVHPV感染显着相关（HR=1.40，95％CI：1.02-1.93）。插入性和接受性肛交（HR=0.60，95％CI：0.40-0.89）和每周肛交≥2次（HR=0.61，95％CI：0.43-0.87）均与Hr-HPV清除率降低有关。九价疫苗类型中的六种（HPV6、11、16、18、52和58）发生频率最高，这表明MSM需要高疫苗接种覆盖率。
在这项队列研究中，任何HPV的高发病率和低清除率，Hr-HPV和个体HPV感染强调了MSM疫苗接种的重要性。可改变的行为因素，如避孕套和药物使用应纳入HPV预防策略。
