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Seroprevalence of antibodies to HPV-16 and HPV-18, and correlation with the presence of HPV DNA and anorectal cytologic abnormalities in a cohort of HIV-positive men involved in a study of HIV-positive males receiving the quadrivalent HPV vaccine, Gardasi
Presented by Stephen Berman (United States).
S. Berman1, A. Evens1, J. Gerken1, C. Harfouch1, J. Chapman-Bueno2, X. Dang2, L. Alvarez2, E. Horansky2, G. Kukes3, M. Dacosta-Iyer3, Y. Ouyang3
1Veterans Administration Healthcare System, Infectious Diseases, Long Beach, United States, 2Veterans Administration Healthcare System, Diagnostic Molecular Laboratory, Long Beach, United States, 3Veterans Administration Healthcare System, Pathology, Long Beach, United States
Background: Pilot study to determine the population seroprevalence of HPV-16 and 18 antibodies, the presence or absence of anal HPV DNA, and anal cytology results in a cohort of HIV+ males receiving the HPV vaccine, Gardasil®.
Methods: 62 HIV+ males (55/62 MSM, 88.5% VL < 50, mean CD4 634) in a Veterans Affairs Medical Center had baseline serologic testing for antibodies to HPV-16 and HPV-18, as well as anal PAP smears and anal testing for HPV DNA, and then received initial dose of Gardasil®.
Results: Seropositivity: 40.3% (25/62) for HPV-16 overall, 9.7% (6/62) for HPV-18 overall, 33.9% (21/62) for HPV-16 alone, 3.2% (2/62) for HPV-18 alone, and 6.5% (4/62) for both 16 and 18. 56.5% (35/62) were seronegative for both 16 and 18. 10/25 seropositive for HPV-16 had HPV-16 DNA detected; 5/37 seronegative for 16 had HPV-16 DNA detected. Of 56 seronegative for HPV-18, HPV-18 DNA was detected in 2. 12 patients (all MSM) had abnormal anal PAPs (6 ASCUS, 6 LSIL). 11.3% (7/62) had evidence of exposure and/or infection by both 16 and 18 on the basis of positive serology combined with DNA results. Seropositivity, HPV DNA results, and PAPs were all independent of CD4 count, CD4%, and HIV-1 VL.
Conclusions: HIV+ MSMs are at high risk for anal carcinoma. We demonstrated a seroprevalence considerably higher than published rates for HIV- individuals. Adding HPV DNA testing increased the proportion considered positive for exposure or infection by some 30%. The overwhelming majority still showed no evidence of exposure to, or current infection with, BOTH high-risk strains included in Gardasil®. In our cohort, 88.7% would likely benefit from vaccination, assuming that it is found that HIV infection does not impair immune response to the vaccine.
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