Incidence and Clearance of Anal High-risk Human Papillomavirus Infections and Their Determinants Over 5 Years Among Human Immunodeficiency Virus-negative Men Who Have Sex With Men

Clin Infect Dis. 2019 Apr 24;68(9):1556-1565. doi: 10.1093/cid/ciy738.


Background: We aimed to assess the incidence and clearance of anal high-risk human papillomavirus (hrHPV) infections and determinants thereof among human immunodeficiency virus (HIV)-negative men who have sex with men (MSM) over a period of up to 5 years.

Methods: From 2010 to 2015, HIV-negative MSM were followed every 6 months. Anal self-swabs were collected at inclusion and every 6 months thereafter, and were HPV genotyped using the SPF10-PCR DEIA/LiPA25-system-v1. Incidence rates (IRs) and clearance rates (CRs) of incident anal hrHPV infections were assessed by hrHPV type (types 16, 18, 31, 33, 45, 52, and 58). Determinants of transitions between uninfected and infected states were assessed by hrHPV type using a time-homogenous multi-state Markov model.

Results: This study included 713 HIV-negative MSM, with a median age of 37 years (interquartile range [IQR] 31-43) and a median number of study visits of 6 (IQR 2-7). The IRs of anal infections had a median of 5.2 per 100 person-years (range: 2.2-7.9) across types, with HPV16 having the highest IR. The CRs of incident anal hrHPV infections had a median of 53.7 per 100 person-years (range: 33.4-65.3) across types, with HPV16 having the lowest CR. Having had over 100 lifetime sex partners was significantly associated with incident anal hrHPV infections in multivariable analyses.

Conclusions: The high incidence and low clearance rates of anal HPV16 infection, compared to other hrHPV types, is consistent with HPV16 being implicated in the large majority of anal cancer cases.

Keywords: HIV-negative; anal HPV infection; clearance; incidence; men who have sex with men.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anal Canal / virology
  • Anus Diseases / diagnosis
  • Anus Diseases / epidemiology*
  • Anus Diseases / virology
  • DNA, Viral / classification
  • DNA, Viral / genetics
  • Genotype
  • Homosexuality, Male*
  • Human papillomavirus 16 / genetics*
  • Human papillomavirus 16 / isolation & purification
  • Humans
  • Incidence
  • Male
  • Models, Genetic
  • Netherlands / epidemiology
  • Papillomaviridae / classification
  • Papillomaviridae / genetics*
  • Papillomaviridae / isolation & purification
  • Papillomavirus Infections / diagnosis
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / transmission*
  • Papillomavirus Infections / virology
  • Risk Factors
  • Sexual Partners


  • DNA, Viral