Risk factors for anal HPV-16/18 infection in Mexican HIV-infected men who have sex with men Leticia Torres-Ibarra a , Carlos J. Conde-Glez a , Jorge Salmerón a,b , Joel Palefsky c , Pilar Hernández-Nevares a , Miguel Angel Sánchez-Alemán d , Carlos Magis-Rodríguez e , Eduardo Lazcano-Ponce a, ⁎ a Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, 62508 Cuernavaca, Mexico b Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, 62450 Cuernavaca, Mexico c Department of Medicine, University of California, San Francisco, 94143 San Francisco, CA, USA d Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, 62508 Cuernavaca, Mexico e Dirección de atención integral, Centro Nacional para la Prevención y el Control del VIH y el SIDA, 11590 Ciudad de Mexico, Mexico abstract article info Available online 22 September 2014 Keywords: Human papillomavirus HIV Anal canal Oncogenic human papillomavirus Men who have sex with men Objective. To describe the prevalence of specific HPV types among HIV-positive men who have sex with men (MSM), particularly the presence of HPV-16 and/or -18, and to determine the factors associated with anal HPV- 16/18 infections. Methods. This is a cross-sectional study from a baseline cohort of 525 HIV-positive MSM, who attended an HIV Clinic in Mexico City. Socio-demographic characteristics, sexual behaviors and HIV-related parameters were assessed. Anal samples were tested for HPV DNA using the Linear Array HPV genotyping assay. Results. The overall prevalence of any HPV type in the anal canal among 446 participants was 93.1%. At least one oncogenic HPV type was detected in 72.2% of the subjects and HPV-16 and/or18 were detected in 30.7%. Additionally, 76.9% of patients were infected with multiple HPV types. Having more than 10 receptive sexual partners in the last 6 months (OR = 2.30; 95% CI 1.12–4.74) and a CD4 cell count ≤350 cells/μL (OR = 1.97; 95% CI 1.26–3.09) were factors positively associated with HPV-16/18 infection in the anal canal. Conclusion. Co-infection with HPV-16/18 and other oncogenic types are predominant in this group of HIV-positive MSM. The recognition of infection with specific oncogenic types will be of aid in designing future preventive strategies that target this high-risk population. © 2014 Elsevier Inc. All rights reserved. Introduction Anal HPV infections represent a major health burden for HIV- positive men, particularly for men who have sex with men (MSM) (Critchlow et al., 1998; Chin-Hong and Palefsky, 2002; Palefsky, 2007). The prevalence of anal HPV infections in this population is over 90% (de Pokomandy et al., 2009; Palefsky et al., 1998; Salit et al., 2009) including a high frequency of infection with multiple HPV types (Chin-Hong et al., 2008; Goldstone et al., 2009; Hagensee et al., 2004; Parisi et al., 2011; Sirera et al., 2006). HPV-16 is the most prevalent type, followed by HPV-18 (de Pokomandy et al., 2009; Gao et al., 2010; Guimaraes et al., 2011; Palefsky et al., 1998; Parisi et al., 2011). Oncogenic HPV infections, particularly type 16, are characterized by greater persistence, higher risk of progression to high-grade intraepithelial neoplasia (HGAIN) (Schiffman et al., 2005), and are associated with 70-percent of anal carcinomas (Hoots et al., 2009; Wong et al., 2010). While earlier studies reported the prevalence of HPV in HIV-positive MSM in North America and some countries in Europe and Asia, there is little data on anal HPV infection and related disease among MSM in Latin American countries like Mexico, resulting in a lack of recognition of the health problem and delays in health intervention. Since HIV-positive men in Mexico have high coverage of antiretroviral treatment, anal cancer morbidity may pose a significant problem for this population. This is the case in the US, where anal cancer incidence rates have increased in the post-highly active antiretroviral therapy (HAART) era (ranging from 75/100,000 to 137/100,000) compared to the pre-HAART era (D'Souza et al., 2008; Patel et al., 2008; Piketty et al., 2008). Researchers are currently evaluating quadrivalent vaccine immunization to prevent HPV infections in HIV-positive MSM. Recent results have demonstrated the safety and immunogenicity of this vaccine in said population (Wilkin et al., 2010), and a clinical phase III trial is being developed to evaluate the vaccine's efficacy in preventing anal HPV Preventive Medicine 69 (2014) 157–164 ⁎ Corresponding author at: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad 655, Colonia Sta. María Ahuacatitlán, 62100 Cuernavaca, Morelos, México. E-mail addresses: leticia.torres@insp.mx (L. Torres-Ibarra), cjconde@insp.mx (C.J. Conde-Glez), jsalme@prodigy.net.mx (J. Salmerón), jpalefsky@medicine.ucsf.edu (J. Palefsky), mpnevar@insp.mx (P. Hernández-Nevares), msanchez@insp.mx (M.A. Sánchez-Alemán), carlos.magis@gmail.com (C. Magis-Rodríguez), elazcano@insp.mx (E. Lazcano-Ponce). http://dx.doi.org/10.1016/j.ypmed.2014.09.011 0091-7435/© 2014 Elsevier Inc. All rights reserved. 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