1. Seroprevalence, prevalence, type and factors associated with HPV infection at multiple sites in young HIV-positive MSM
On behalf of the HPV MAPS Research Group
C Sadlier1,2, S O’Dea1, S Delamere1, P Smyth3, N Myers3, G Blackshields3, F Van Der Klis, O Sheils2,3, C Bergin1,2
Department of GU Medicine and Infectious Diseases (GUIDE), St James’s Hospital, Dublin, Ireland.
Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland.
Department of Histopathology, Trinity College Dublin, Dublin, Ireland.
National Institute for Public Health and the Environment, Blithoven, Netherlands.

2. HPV infection HPV is the most common STI worldwide
Broad spectrum of clinical presentations:
Asymptomatic infection
Genital warts
Invasive malignancy
HPV infection now causes >5% of cancers worldwide
So, I think that all of us here are familiar with HPV.
It’s the most common STI worldwide with 40 of the known 200 HPV genotypes causing genital infections.
HPV infection causes a huge spectrum of clinical presentations including transient asymptomatic infections, genital warts and at the other end of the spectrum – invasive malignancies including cervical cancer, oropharyngeal cancer, anal cancers and penile cancers.
And while we have observed a dramatic decrease in the incidence of cervical cancer owing to the implementation of successful screening programmes, we have seen a significant increase in HPV related oropharyngeal cancers and anal cancers during the same period.
(1) Jemal et al., 2013
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3. HPV associated anal cancer
GUIDE cohort , 7 cases anal cancer (44/100,000) (1)
Characteristics of Anal CA cases
N= 7 (%)
Median [IQR] age
38 [35-49]
Male
6 (86)
Heterosexual
1 (14)
MSM
4 (57)
IDU
2 (29)
Median [IQR] CD4 count (cells/mm3)
239 [ ]
Median [IQR] Nadir CD 4 count (cells/mm3)
18 [6-19]
On HAART
Smoker
So, I think that all of us here are familiar with HPV.
It’s the most common STI worldwide with 40 of the known 200 HPV genotypes causing genital infections.
HPV infection causes a huge spectrum of clinical presentations including transient asymptomatic infections, genital warts and at the other end of the spectrum – invasive malignancies including cervical cancer, oropharyngeal cancer, anal cancers and penile cancers.
And while we have observed a dramatic decrease in the incidence of cervical cancer owing to the implementation of successful screening programmes, we have seen a significant increase in HPV related oropharyngeal cancers and anal cancers during the same period.
(2) Sadlier et al., Under review STD 2016.
Background l Aims l Methods l Results I Discussion l Conclusion

4. Prevention of HPV associated disease
HPV vaccine has potential to greatly impact the burden of HPV associated disease BHIVA HPV vaccine recommendations for HIV-positive adults (3) Documenting baseline epidemiology of HPV infection in young HIV+ MSM is important in guiding primary and secondary prevention strategies
(3) Geretti et al., 2016.
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5. Objectives
Investigate prevalence of hr HPV at multiple sites in young HIV+ MSM
The aims of this project were to....
Background l Aims l Methods l Results l Discussion l Conclusion

6. Objectives
Investigate prevalence of hr HPV at multiple sites in young HIV+ MSM Investigate prevalence of anti-HPV 16/18 antibodies
The aims of this project were to....
Background l Aims l Methods l Results l Discussion l Conclusion

7. Objectives
Investigate prevalence of hr HPV at multiple sites in young HIV+ MSM Investigate prevalence of anti-HPV 16/18 antibodies Investigate factors associated with hr HPV infection
The aims of this project were to....
Age , CD4, HAART, HIV VL
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8. Objectives
Investigate prevalence of hr HPV at multiple sites in young HIV+ MSM Investigate prevalence of anti-HPV 16/18 antibodies Investigate factors associated with hr HPV infection Estimate susceptibility to HPV types covered by HPV-4v and HPV-9v
The aims of this project were to....
Age , CD4, HAART, HIV VL
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9. Methods Study Design HIV+ MSM >18 and < 26 years (n=50)
Enrolment from a single site, the GUIDE clinic, St James’s Hospital, Dublin
Data Collection
Oropharyngeal, anal and penile swabs
Serum for anti-HPV 16/18 antibodies
Demographic and Sexual behaviour data collected
Ethics approval from St James’s Hospital REC
Pilot
Single site
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10. Methods Sample analysis
Swabs analysed for HPV DNA by Multiplex PCR using PGMY09/11 consensus primers
HPV DNA processed using Next Generation Sequencing(4)
Raw data mapped against all known HPV genotypes(5)
HPV Classification
hr HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59
Quadrivalent vaccine (HPV 4v) 6, 11, 16, 18
Nonavalent vaccine (HPV 9v) 6, 11, 16, 18, 31, 33, 45, 52, 58
Serum HPV 16/18 antibodies were measured against the L1 portion of the VLP using a multiplex immunoassay
PAPILLOMA VIRUS GENOME DATABASE
Raw data mapped against all known HPV genotypes
which measured HPV specific antibodies against L1 VLP of genotypes 16 and 18 and are reported in LIU/ml
((4)ion Torrent Platform®, (5)
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11. Results Selected baseline characteristics N=50 (%) Median Age [IQR]
25 [23-26]
Current smoker, N (%)
20 (40)
Duration of HIV infection (years)
2 [1-3]
CD4+ T count cells/mm3
580 [ ]
On HAART N (%)
43 (86)
Viral load not detected N (%)
36 (72)
Data reported as median [interquartile range, IQR] unless otherwise stated
Abbreviations: HAART highly active antiretroviral therapy, N number
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12. Results Selected baseline characteristics N=50 (%)
Age at sexual debut (years)
16.5 [ ]
Lifetime number sexual partners
10 [3-20]
Number of sexual partners past 3/12
1 [0-1.5]
Data reported as median [interquartile range, IQR] unless otherwise stated
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13. Detected Not-detected
HPV DNA
Detected
Not-detected
N=34 (68%)
N=16 (32%)
Of the 50 patients that were screened, 8 tested positive...
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14. Detected Not-detected
HPV DNA
Detected
Not-detected
N=34 (68%)
N=16 (32%)
Concurrent HPV infection ? %
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15. hr HPV genotypes
54% hr HPV detected on anal swabs 6% hr HPV detected on penile swabs Hr HPV not detected on oropharyngeal swabs
Number with hr HPV detected
Hr HPV type
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16. Anti-HPV 16 antibodies Detected N=22 (44%)
Of the 50 patients that were screened, 8 tested positive...
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17. HPV antibodies Anti-HPV 16 antibodies Detected N=22 (44%)
Of the 50 patients that were screened, 8 tested positive...
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18. HPV antibodies Anti-HPV 16 antibodies Detected N=22 (44%)
16% both HPV 16 and 18 antibodies detected (N=8)
Anti-HPV 18 antibodies Detected N=13 (26%)
Of the 50 patients that were screened, 8 tested positive...
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19. Concordance of HPV detection
Anti-HPV 16 antibodies Detected N=22 (44%)
9/22 with Anti-HPV 16 antibodies Detected had HPV16 on swabs
Anti-HPV 18 antibodies Detected N=13 (26%)
2/13 with Anti-HPV 18 antibodies Detected had HPV18 on swabs
Background l Aims l Methods l Results l Discussion l Conclusion

20. HPV vaccine genotypes HPV 4v vaccine types HPV 9v vaccine types
% with vaccine type HPV detected
HPV type detected HPV type not-detected
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21. HPV vaccine immunogenicity study
47 of 50 (94%) recruited to the HPV prevalence study completed the HPV vaccine course 100% seronegative for HPV 16 and 86% seronegative for HPV 18 seroconverted post completion of HPV vaccine course
Of the 50 patients that were screened, 8 tested positive...
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22. Limitations
Small sample size Study group were relatively homogenous Relatively high CD4/nadir CD4 Virally suppressed on HAART High risk sexual behaviour Point prevalence study We examined anti-HPV 16/18 antibodies only
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23. Conclusion
A significant proportion of young HIV+ MSM are infected with one or more hr HPV type The majority could derive some benefit from HPV vaccine Frequent non-vaccine hr HPV types were observed Requirement for improved primary and secondary prevention interventions in HIV+ MSM
(51, 56, 59)
The high prevalence of hr HPV infection, in combination with a rising anal cancer incidence, highlights the
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24. Acknowledgements Patients who participated in the study
HPV MAPS research group
S O’Dea
S Delamere
F Van Der Klis
P Smyth
O Sheils
C Bergin
Dr F Van Der Klis
Staff in the GUIDE clinic
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