Anal Human Papillomavirus Genotyping among HIV-Positive Men Who Have Sex with Men in Xi’an, China

April Anal Human Papillomavirus Genotyping among HIV-Positive Men Who Have Sex with Men in Xi'an, China Zhen Li 0 1 Haoran Zhang 0 1 Xiangwei Li 0 1 Yu Yang 0 1 Henan Xin 0 1 Mufei Li 0 1 Boxuan Feng 0 1 Lei Gao 0 1 0 Academic Editor: Ruan Yuhua, National Center for AIDS/STD Control and Prevention , CHINA 1 1 Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Dong Dan San Tiao No. 9, Beijing, 100730, China , 2 Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre , Beijing, 100191 , China These authors contributed equally to this work. * Anal human papillomavirus (HPV) infection and its related diseases are relatively common in men who have sex with men (MSM), especially in those HIV positive. In China, molecular epidemiology of anal HPV infection among HIV-positive MSM has been sparsely studied. A cross-sectional study was conducted among HIV-positive MSM in Xi'an, China between April and July 2014. Anal swabs were collected for HPV genotyping. - A total of 195 HIV-positive MSM were included in this study. HPV genotyping showed that 99.0% (191/193) of participants were positive for at least one of the targeted 37 HPV genotypes. 183 (94.8%) of them were infected with multiple high-risk types and 154 (79.8%) of them with low-risk HPV types. HPV 18 was the most frequently identified high-risk type, followed by HPV 16 and HPV 51. As for low-risk types, HPV11, HPV 6 and HPV 81 were most commonly observe. High-risk HPV infection was found to be associated with the status of antiretroviral therapy (ART), the distribution of low-risk types was observed to be varied by CD4+ T cell level. Almost all HIV-positive MSM were anal HPV infected in our study. It is highly recommended to consider regular active screening and preventive intervention of HPV infection among this high risk population. Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide, representing a significant health problem due to its high prevalence and transmissibility [1]. The human immunodeficiency virus (HIV) infection has been suggested to make humans more susceptible to HPV infection because of the attenuated immune system [2,3]. It has been widely accepted that men have sex with men (MSM) is a high-risk population for both HPV and HIV infection. A recent systematic review and meta-analysis included 53 studies reported that the prevalence of the HPV co-infection was 8993% in HIV infected MSM [4]. Additionally, anal HPV infection is one of the main causes of anal cancer, and the incidence of anal cancer is substantially higher in MSM than general population, especially in HIV positives [58]. It is worth to notice that the prevalence of HIV infection in MSM is increasing in China in recent years. Until 2013, it was estimated that nearly 63,730 MSM were living with HIV infection in China. The control of HPV infection and its related diseases is very important for improving the living quality of HIV-positive MSM. However, anal HPV infection and genotype distribution in the HIV-positive MSM has not been widely studied in China. Our previously studies reported around 60% HIV negatives and 90% HIV positives were anal HPV infected in MSM from China [9,10]. To improve our understanding of anal HPV infection and its related pre-cancerous diseases, we conducted a pilot study among 95 HIV-positive MSM in Beijing, and the prevalence of abnormal anal cytology was found to be 37.9% [11]. Based on such previous work, we expanded the sample size of HIV-positive MSM in Xian city to explore the prevalence and distribution of anal HPV genotypes. Xian is the capital city of Shaanxi province, more than 1700 HIV infections had been reported in Xian until the end of 2012. Between 2007 and 2012, the proportion of homosexual transmission in the total HIV infections was increased from 14.3% to 56.7%, which had become the major route of transmission in Xian [12]. Materials and Methods Ethic statement The study was approved by the Ethics Committees of the Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College. Written informed consent was obtained from each study participant before the interview and testing. The study was conducted in the Eighth Peoples Hospital in Xian from April to July 2014. Study participants were recruited through a local nongovernment organization (Xian Tongkang Volunteers Workstation). Multiple methods were used for recruitment including website advertisements, distributing flyers with study-related information at MSM frequented venues (e.g., MSM clubs, bars, parks and bathhouses), and eligible study participants were also encouraged to refer their peers to attend the study. Those eligible participants were HIV-seropositive males, at least 18 years old, ever had homosexual behaviors, willing to provide anal swabs and blood for the test, and physically able and willing to provide written informed consent. Study participants who were tested HPV positive were informed by study personnel confidentially and referred to treatment at the Institute of STD/AIDS Prevention and Treatment, Xian District Center for Disease Prevention and Control and the STD/AIDS clinic of Xian eighth hospital. Self-reported socio-demographic characteristics (e.g., age, income, education, employment, and marriage status), antiretroviral therapy (ART) status and sexual behaviors in the past 6 months data were collected through one-to-one interviews by the trained interviewer in a separate room using a standardized questionnaire. Each study participant was assigned a unique code that was used to link the questionnaire and specimens. Personal contact information, which was blinded to researchers, was kept by the Xian Tongkang Volunteers Workstation for test results feedback and data validation. CD4+ T cell counts and HPV genotypes were collected for blood test and anal swabs test, respectively. Sample collection and laboratory tests Blood samples were collected for testing CD4+ T cell counts (BD FACSCountsystem). Trained personnel collected anal samples by rotating a saline water moistened nylon flocked swab in the anal canal for about 2 minutes. The swab was then kept in 3 mL of sample transport medium for Hybribio HPV DNA Test. Hybribio HPV DNA Test is based on flow-through hybridization to identify HPV types. The denatured DNA was placed into sample wells containing specific probes on the Hybrimem HPV-37 membrane to determine HPV types. The final results were detected by colorimetric change on the membrane under direct visualization. Positive and negative controls were included in the GenoArray test kit in every PCR analysis as well as during the hybridization process for quality. Mixtures of different specific probes can be used in the same well of a 42-well plate format allowing for multiplex analysis. HPV were classified as low-risk ( (...truncated)