Vaccine effectiveness against anal HPV infection among men with HIV who have sex with men attending sexual health clinics in three United States cities, 2018-2023

Carla L DeSisto; Damilola Dada; Preeti Pathela; Rachel L Winer; Lenore Asbel; Troy D Querec; John Lin; Jennifer Tang; Alfred Iqbal; Elissa Meites; Elizabeth R Unger; Lauri E Markowitz

doi:10.1097/QAI.0000000000003691

Vaccine effectiveness against anal HPV infection among men with HIV who have sex with men attending sexual health clinics in three United States cities, 2018-2023

J Acquir Immune Defic Syndr. 2025 May 8. doi: 10.1097/QAI.0000000000003691. Online ahead of print.

Authors

Affiliations

¹ Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
² Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, NY, USA.
³ Department of Epidemiology, University of Washington, Seattle, WA, USA.
⁴ Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA , USA.
⁵ Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁶ Public Health Laboratory, Prevention Division, Seattle and King County Department of Public Health, Seattle, WA, USA.

PMID: 40338823
DOI: 10.1097/QAI.0000000000003691

Abstract

Background: Men who have sex with men (MSM) with HIV are disproportionately affected by human papillomavirus (HPV) and related diseases. We assessed HPV vaccine effectiveness (VE) against anal HPV among MSM with HIV.

Methods: During 2018-2023, residual anal specimens from MSM with HIV, aged 18-45 years, attending sexual health clinics in three U.S. cities were collected and tested for HPV. Demographic and vaccination information were obtained from clinic records or immunization registries. Timing of vaccination relative to HIV acquisition was unknown. Log-binomial regression was used to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between vaccination (≥1 dose) and quadrivalent vaccine (4vHPV)-type infection, adjusting for city. Models were stratified by age group (18-26, 27-45 years). VE was calculated as (1-aPR) x 100.

Results: Among 224 persons aged 18-26 years, 54% were vaccinated. Compared with unvaccinated persons, 4vHPV-type prevalence was lower in those vaccinated at age <18 (aPR=0.31, 95% CI:0.14-0.72, VE=69%) and ≥2 years before specimen collection (aPR=0.54, 95% CI:0.31-0.92, VE=46%). Among 700 persons aged 27-45 years, 17% were vaccinated. Compared with unvaccinated persons, 4vHPV-type prevalence was lower in those vaccinated at ages 18-26 (aPR=0.63, 95% CI:0.45-0.89, VE=37%) and ≥2 years before specimen collection (aPR=0.63, 95% CI:0.46-0.86, VE=37%).

Conclusions: While timing of vaccination relative to HIV acquisition was unknown, we found significant VE against prevalent HPV infection in adult MSM with HIV. Within each age group, VE was higher with younger age at vaccination.

Keywords: HIV infections; papillomavirus infections; papillomavirus vaccines; vaccination.