The present study aimed to assess the relationship between infection with multiple human papillomavirus (HPV) types and abnormal anal cytology in HIV-infected men.

There is still a limited understanding of anal HPV infection and abnormal anal cytology in MSM of Asian ethnicity who live in conservative societies with traditional societal norms, like Taiwan.

Moreover, there is a paucity of research exploring the relationship between the number of HPV types present and anal cellular dysplasia. In addition, although HPV vaccination programme have been launched (primarily among the young female population) in Asian regions, there are no data to support HPV vaccination of men, especially MSM. 

This study aimed to assess the relationship between infection with multiple HPV types and abnormal anal cytology; this information could assist the proposal for an HPV vaccination programme for HIV-infected Taiwanese men.

An observational, cross-sectional study. A regional referral hospital in Taiwan. In total, 714 HIV-infected men were enrolled between March 2011 and June 2016. Thin preparation anal Pap smears were interpreted according to the 2001 Bethesda System. Thirty-seven types of HPV were detected by reverse line blotting, including 13 oncogenic types and 24 non-oncogenic types.

The relationship between anal HPV infection and abnormal anal cytology in people of Asian ethnicity and the coverage efficacy in HPV-vaccinated HIV-infected men.

On anal cytology, 175 (24.5%) subjects had atypical squamous cells of undetermined significance (ASCUS) or higher grades of dysplasia, including 87 (49.7%) with ASCUS, 73 (41.7%) with low-grade squamous intraepithelial lesions (LSILs) and 15 (8.6%) with high-grade squamous intraepithelial lesions (HSILs).

A higher proportion of subjects with those without LSIL/HSIL (93.1% vs 67.3%, P<0.0001) had multiple HPV types. The odds of having LSIL/HSIL increased with an increasing number of HPV types: the ORs ranged from 1 for no HPV types to 6.96 (95% CI 2.38 to 20.37) for more than five types (Ptrend <0.0001).

Multivariate logistic regression analysis showed a significant association between LSIL/HSIL and the number of HPV genotypes present (OR 1.20; 95% CI 1.02 to 1.42, P<0.05). HPV types covered by the nonavalent HPV vaccine (types 6/11/16/18/31/33/45/52/58) were detected in 70.1% of the patients in this study.

The study demonstrates that the risk of having anal LSIL/HSIL is seven times greater in HIV-infected men with six or more types of any HPV and oncogenic HPV detected on anal swabs than those without HPV.

Hence, anal infection with multiple HPV types in this population deserves aggressive follow-up; the contribution of the interaction between multiple HPV and other bacteria for the development of anal cancers warrants further research. In addition, HPV vaccination programme requires scaling up.