High Prevalence and Genotype Diversity of Anal HPV Infection among MSM in Northern Thailand

Background: HPV infection is common and may cause cancer among men who have sex with men (MSM). Anal HPV infection (HPV+) was found in 85% of HIV-positive (HIV+) and 59% of HIV-negative (HIV-) MSM in Bangkok, central Thailand. As little is known about HPV in this group in northern Thailand, we studied MSM subgroups comprised of gay men (GM), bisexual men (BM), and transgender women (TGW). Methods: From July 2012 through January 2013, 85 (42.5% of 200) GM, 30 (15%) BM, and 85 (42.5%) TGW who practiced receptive anal intercourse were recruited after informed consent, followed by self-assisted computer interview, HIV testing, and anal swabs for HPV genotyping. Results: Of 197 adequate specimens, the overall prevalence of any HPV was 157 (80%). Prevalence was 89% (76/85) in GM, 48% (14/29) in BM, and 81% (67/83) in TGW. The most common high-risk types were HPV16 (27% of 197), HPV58 (23%), and HPV51 (18%). Prevalence of high-risk types was 74% in 85 GM, 35% in 29 BM, and 71% in 83 TGW. Prevalence of any HPV type, or high-risk type, was 100% and 94%, respectively, among 48 HIV+ MSM, 70% and 54% among 120 HIV- MSM. Of the 197 specimens, 36% (70) had HPV types 16 and/or 18 in the bivalent vaccine, compared to 48% (95) with ?1 of types 16/18/06/11 in the quadrivalent, 56% (111) for 16/18/31/33/45/52/58 in the 7-valent, and 64% (126) for 16/18/31/33/45/52/58/06/11 in the 9-valent. HIV+, GM, and TGW were independently associated with HPV infection. Conclusions: We found higher rates of both any HPV and high-risk types than previous studies. Among the heretofore unstudied TGW, their equivalent HPV rates were comparable to GM. Current and investigational HPV vaccines could substantially protect GM, BM, and TGW from the serious consequences of HPV infection especially among HIV + MSM

Treatment as Prevention: Characterization of Partner Infections in the HIV Prevention Trials Network 052 Trial

HIV Prevention Trials Network (HPTN) 052 demonstrated that antiretroviral therapy (ART) prevents HIV transmission in serodiscordant couples. HIV from index-partner pairs was analyzed to determine the genetic linkage status of partner infections. Forty-six infections were classified as linked, indicating that the index was the likely source of the partner’s infection. Lack of viral suppression and higher index viral load were associated with linked infection. Eight linked infections were diagnosed after the index started ART: four near the time of ART initiation and four after ART failure. Linked infections were not observed when the index participant was stably suppressed on ART

Prevalence of high-risk HPV types, by HIV status, ranked from left to right by decreasing percentage among total participants.

<p>Prevalence of high-risk HPV types, by HIV status, ranked from left to right by decreasing percentage among total participants.</p

Coverage by commercial^a,^b and investigational^c,^d HPV vaccines of ≥1 HPV infecting type(s), by gender identity of MSM subjects in Chiang Mai, Thailand, 2012–2013.

<p>^{<b><i>a</i></b>} 2–valent coverage: number infected with ≥1 HPV type(s) 16 and/or 18</p><p>^{<b><i>b</i></b>} 4–valent coverage: number infected with ≥1 HPV type(s) 16, 18, 6, and/or 11</p><p>^{<b><i>c</i></b>} 7–valent coverage: number infected with ≥1 HPV type(s) 16, 18, 31, 33, 45, 52, and/or 58</p><p>^{<b><i>d</i></b>} 9–valent coverage: number infected with ≥1 HPV type(s) 16, 18, 31, 33, 45, 52, 58, 6, and/or 58).</p><p>Coverage by commercial<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124499#t004fn001" target="_blank">^a</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124499#t004fn002" target="_blank">^b</a> and investigational<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124499#t004fn003" target="_blank">^c</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0124499#t004fn004" target="_blank">^d</a> HPV vaccines of ≥1 HPV infecting type(s), by gender identity of MSM subjects in Chiang Mai, Thailand, 2012–2013.</p

Treatment as Prevention: Characterization of Partner Infections in the HIV Prevention Trials Network 052 Trial

HIV Prevention Trials Network (HPTN) 052 demonstrated that antiretroviral therapy (ART) prevents HIV transmission in serodiscordant couples. HIV from index-partner pairs was analyzed to determine the genetic linkage status of partner infections. Forty-six infections were classified as linked, indicating that the index was the likely source of the partner’s infection. Lack of viral suppression and higher index viral load were associated with linked infection. Eight linked infections were diagnosed after the index started ART: four near the time of ART initiation and four after ART failure. Linked infections were not observed when the index participant was stably suppressed on ART

Virologic outcomes in early antiretroviral treatment: HPTN 052

<p><b>Introduction:</b> The HIV Prevention Trials Network (HPTN) 052 trial demonstrated that early antiretroviral therapy (ART) prevented 93% of HIV transmission events in serodiscordant couples. Some linked infections were observed shortly after ART initiation or after virologic failure.</p> <p><b>Objective:</b> To evaluate factors associated with time to viral suppression and virologic failure in participants who initiated ART in HPTN 052.</p> <p><b>Methods:</b> 1566 participants who had a viral load (VL) > 400 copies/mL at enrollment were included in the analyses. This included 832 in the early ART arm (CD4 350–550 cells/mm³ at ART initiation) and 734 in the delayed ART arm (204 with a CD4 < 250 cells/mm³ at ART initiation; 530 with any CD4 at ART initiation). Viral suppression was defined as two consecutive VLs ≤ 400 copies/mL after ART initiation; virologic failure was defined as two consecutive VLs > 1000 copies/mL > 24 weeks after ART initiation.</p> <p><b>Results:</b> Overall, 93% of participants achieved viral suppression by 12 months. The annual incidence of virologic failure was 3.6%. Virologic outcomes were similar in the two study arms. Longer time to viral suppression was associated with younger age, higher VL at ART initiation, and region (Africa vs. Asia). Virologic failure was strongly associated with younger age, lower educational level, and lack of suppression by three months; lower VL and higher CD4 at ART initiation were also associated with virologic failure.</p> <p><b>Conclusions:</b> Several clinical and demographic factors were identified that were associated with longer time to viral suppression and virologic failure. Recognition of these factors may help optimize ART for HIV treatment and prevention.</p