The prevalence of human papillomavirus infections and associated risk factors in men-who-have-sex-with-men in Cape Town, South Africa.
The prevalence of human papillomavirus infections and associated risk factors in men-who-have-sex-with-men in Cape Town, South Africa.
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DOI：
10.1186/s12879-016-1706-9
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发表时间：
2016-08-22
影响因子：
3.7
通讯作者：
Lewis DA
中科院分区：
文献类型：
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作者：
Müller EE;Rebe K;Chirwa TF;Struthers H;McIntyre J;Lewis DA
我们调查了在南非开普敦接受临床服务的男男性行为者(MSM)中人乳头瘤病毒(HPV)感染的流行率和相关的行为危险因素。男男性接触者在开普敦的伊万·汤姆斯男性健康中心登记。每个参与者都完成了心理社会和性行为风险问卷，并收集了尿液、口咽和肛门拭子进行HPV检测，采用线性阵列HPV基因分型试验。应用Logistic回归分析确定与三个解剖部位HPV感染相关的性危险因素。所有200名参与者的年龄中值为32岁(IQR 26-39.5)，其中黑人占31.0%，种族/有色人种混合占31.5%，白人占35.5%。大多数参与者(73.0%)已完成高中学业，42.0%具有大专学历，69.0%已就业。HPV基因分型在肛门、口咽和尿液标本中分别为72.8%[95%CI：65.9~79.0%]、11.5%[95%CI：7.4~16.8%]和15.3%[95%CI：10.5~21.2%]。高危HPV型的患病率在肛门样本中为57.6%[95%CI：50.3-64.7%]，口咽样本中为7.5%[95%CI：4.3-12.1%]，尿样中为7.9%[95%CI：4.5-12.7%]，其中HPV-16型是所有地点检测到的最常见的HR-HPV类型。HPV-6/11/16/18在肛门、口咽和尿液中的阳性率分别为40.3%[95%CI：33.3~47.6%]、4.5%[95%CI：2.1~8.4%]和3.2%[95%CI：1.2~6.8%]。男男性接触者肛管HPV感染以多种类型多见，口咽和尿液HPV感染以单一HPV类型为主。在88名HIV阳性的MSM中，91.8%[95%CI：83.8~96.6%]为肛门HPV感染，81.2%[95%CI：71.2~88.8%]为肛门HR-HPV感染，85.9%[95%CI：76.6~92.5%]为多种类型。仅与男性发生性关系、终生从事群体性行为、携带艾滋病毒和进行接受性肛交是唯一与肛门HPV感染独立相关的因素。肛门HPV感染在开普敦的男男性接触者中很常见，在感染艾滋病毒的男男性接触者、只与男性发生性行为的男性和那些进行接受性肛交的人中，HPV负担最高。迫切需要采取行为干预战略，并可能在所有男孩中推广HPV疫苗，以解决南非男男性接触者中HPV和艾滋病毒混合感染的高流行率问题。
We investigated the prevalence of human papillomavirus (HPV) infection and associated behavioural risk factors in men-who-have-sex-with-men (MSM) attending a clinical service in Cape Town, South Africa. MSM were enrolled at the Ivan Toms Centre for Men’s Health in Cape Town. A psychosocial and sexual behavioral risk questionnaire was completed for each participant and urine, oro-pharyngeal and anal swabs were collected for HPV testing using the Linear Array HPV Genotyping Test. Logistic regression analyses were performed to determine sexual risk factors associated with HPV infection at the three anatomical sites. The median age of all 200 participants was 32 years (IQR 26-39.5), of which 31.0 % were black, 31.5 % mixed race/coloured and 35.5 % white. The majority of the participants (73.0 %) had completed high school, 42.0 % had a tertiary level qualification and 69.0 % were employed. HPV genotypes were detected in 72.8 % [95 % CI: 65.9–79.0 %], 11.5 % [95 % CI: 7.4–16.8 %] and 15.3 % [95 % CI: 10.5–21.2 %] of anal, oro-pharyngeal and urine specimens, respectively. Prevalence of high-risk (HR)-HPV types was 57.6 % [95 % CI: 50.3–64.7 %] in anal samples, 7.5 % [95 % CI: 4.3–12.1 %] in oro-pharyngeal samples and 7.9 % [95 % CI: 4.5–12.7 %] in urine, with HPV-16 being the most common HR-HPV type detected at all sites. HPV-6/11/16/18 was detected in 40.3 % [95 % CI: 33.3–47.6 %], 4.5 % [95 % CI: 2.1–8.4 %] and 3.2 % [95 % CI: 1.2–6.8 %] of anal, oro-pharyngeal and urine samples, respectively. Multiple HPV types were more common in the anal canal of MSM while single HPV types constituted the majority of HPV infections in the oropharynx and urine. Among the 88 MSM (44.0 %) that were HIV positive, 91.8 % [95 % CI: 83.8–96.6 %] had an anal HPV infection, 81.2 % [95 % CI: 71.2–88.8 %] had anal HR-HPV and 85.9 % [95 % CI: 76.6–92.5 %] had multiple anal HPV types. Having sex with men only, engaging in group sex in lifetime, living with HIV and practising receptive anal intercourse were the only factors independently associated with having any anal HPV infection. Anal HPV infections were common among MSM in Cape Town with the highest HPV burden among HIV co-infected MSM, men who have sex with men only and those that practiced receptive anal intercourse. Behavioural intervention strategies and the possible roll-out of HPV vaccines among all boys are urgently needed to address the high prevalence of HPV and HIV co-infections among MSM in South Africa.