Incidence, Duration, Persistence, and Factors Associated With High-risk Anal Human Papillomavirus Persistence Among HIV-negative Men Who Have Sex With Men: A Multinational Study

Clin Infect Dis. 2016 Jun 1;62(11):1367-1374. doi: 10.1093/cid/ciw140. Epub 2016 Mar 8.


Background: Given high rates of anal disease, we investigated the natural history of high-risk anal human papillomavirus (HPV) among a multinational group of men who have sex with men (MSM) aged 18-64 years.

Methods: Anal specimens from human immunodeficiency virus-negative men from Brazil, Mexico, and the United States were genotyped. Over 2 years, 406 MSM provided evaluable specimens every 6 months for ≥2 visits. These men were stratified into men who have sex only with men (MSOM, n = 70) and men who have sex with women and men (MSWM, n = 336). Persistence was defined as ≥12 months' type-specific duration and could begin with either a prevalent or incident infection. Prevalence ratios and 95% confidence intervals were calculated by Poisson regression.

Results: Median follow-up time was 2.1 years. Retention was 82%. Annual cumulative incidence of 9-valent vaccine types was 19% and 8% among MSOM and MSWM, respectively (log-rank P = .02). Duration of anal HPV did not differ for MSOM and MSWM and was a median of 6.9 months for HPV-16 after combining men from the 2 groups. Among men with prevalent high-risk infection (n = 106), a total of 36.8%, retained the infection for at least 24 months. For those with prevalent HPV-16 (n = 27), 29.6% were persistent for at least 24 months. Persistence of high-risk HPV was associated with number of male anal sex partners and inversely associated with number of female sex partners.

Conclusions: MSM with prevalent high-risk HPV infection should be considered at increased risk for nontransient infection.

Keywords: HPV DNA; anal cancer; anal condyloma; natural history; prospective.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Americas / epidemiology
  • Anal Canal / virology
  • Anus Diseases / epidemiology*
  • Anus Diseases / virology*
  • Bisexuality / statistics & numerical data
  • Cohort Studies
  • DNA, Viral / analysis
  • Homosexuality, Male / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / virology*
  • Young Adult


  • DNA, Viral