Open AccessHigh-Risk Human Papillomavirus Persistence and Anal Microbiota Among Nigerian Men Who Have Sex With Men Living With or At Risk for HIV
Author(s) -
Rebecca G. Nowak,
Jacques Ravel,
Søren M. Bentzen,
Lisa M. Schumaker,
Nicholas P. Ambulos,
Nicaise Ndembi,
Wuese Dauda,
Andrew Mitchell,
Trevor J. Mathias,
Trevor A Crowell,
Stefan Baral,
William A. Blattner,
Manhattan Charurat,
Joel M. Palefsky,
Kevin J. Cullen
Publication year - 2020
Publication title -
jco global oncology
Language(s) - English
Resource type - Journals
ISSN - 2687-8941
DOI - 10.1200/go.20.22000
Subject(s) - men who have sex with men , persistence (discontinuity) , prevotella , anal cancer , medicine , interquartile range , bacterial vaginosis , logistic regression , cohort , demography , human immunodeficiency virus (hiv) , immunology , human papillomavirus , gynecology , biology , syphilis , bacteria , geotechnical engineering , sociology , engineering , genetics
PURPOSE Noninvasive therapies, such as probiotics that promote local immunity and reduce persistence of high-risk human papillomavirus (HR-HPV), would circumvent challenges in implementing anal cancer screening where same-sex behavior is stigmatized and criminalized. We describe the persistence of HR-HPV and its relationship with the anal microbiota among Nigerian men who have sex with men (MSM).METHODS Anal swabs from HIV-uninfected and -infected MSM who were enrolled in the TRUST/RV368 cohort were HPV genotyped at enrollment and at 3 and 12 months. Participants who presented with the same type(s) of HR-HPV across all visits were categorized as having persistent infections. The anal microbiota composition at baseline of HR-HPV–positive individuals was evaluated. Unsupervised K-means clustering of the 15 most abundant bacterial taxa identified 2 microbial clusters (MC-1 and MC-2). Unadjusted associations of 12-month HR-HPV persistence was evaluated by MC membership and HIV status using χ 2 tests and logistic regression.RESULTS One hundred nine HIV-infected and 41 HIV-uninfected participants—contributing 284 baseline HR-HPV infections—were observed for a median of 12 months (interquartile range, 11.5-12.6 months). MC-1 was dominated by Prevotella and MC-2 consisted of a diverse set of anaerobic bacteria ( Finegoldia, Corynebacterium, Peptoniphilus, and Anerococcus). At 12 months, 45% (67 of 150) of MSM had 86 persistent HR-HPV and 55% (83 of 150) cleared all baseline HR-HPV. HPV16 (21%), HPV45 (13%), and HPV51 (12%) were the most persistent. Persistence of any HR-HPV was nonsignificantly higher in MC-1 (odds ratio [OR], 1.6; 95% CI, 0.8 to 3.1). Persistent HPV16 was more abundant in MC-2 versus MC-1 (OR, 3.9; 95% CI, 1.2 to 12.0), whereas HPV45 and HPV51 were similarly distributed across both MCs. Compared with HIV-uninfected, persistence (OR, 1.6; 95% CI, 0.8 to 3.3) and MC-2 membership (OR, 1.3; 95% CI, 0.8 to 2.0) were nonsignificantly higher among HIV-infected participants.CONCLUSION Anal HPV16 has the highest annual persistence and is associated with a low Prevotella anal microbiota, a potentially modifiable cofactor.