ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

Day 1- Re-thinking HPV and related disease prevention.

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Amber D'Souza, Associate Professor, Johns Hopkins Bloomberg School of Public Health, USA gave a fantastic talk in the opening plenary today in Adelaide.

She talked about HPV causing >5% of cancers worldwide, >600,000 globally mainly cervical cancer.

12/100,000 - Cervical

8/100,000 - Oral

2/100,000 - Anal

She told us that the uptake of the HPV vaccine in Australia is 71.2%, UK is 60.4% but only 33.4% in US were there is no school based program and in 2014 the vaccine was available in over 75 countries but many low income countries are still missing the vaccine program.

Interestingly in the US they've seen a growing number of HPV positive oropharyngeal cancers especially in men. 2.4% per year in men 45 years and older but only 1% per year in women 45-64 years but all other head and neck squamous cell carcinomas have reduced ?due to reduction in smoking.

She said the lifetime risk of oral HPV infections in men was 3-30% but only 1-8% in women and one of the reasons why could be that cervical fluid has a higher viral load than the throat?

Risk factors were recent oral sex in last 3 months and the risk increased if the man had performed oral sex on a woman rather than a man. But interestingly, HPV is low in lesbian women which suggests that women get an auto immune response to previous HPV infections.

Gender - there is a 5 fold infection rate in men compared to women.

Race - HPV is higher  in white men compared to black or Mexican American men, does this mean that white men have more oral sex?

So with the same number of lifetime partners, men have a higher risk of orophryngeal HPV and a lower rate of clearing the virus.

Then she told us about Anal cancer that effects 2/100,000

Risk factors include receptive anal sex and in MSM 10-20/100,000 are +ve for anal HPV, that number is higher in HIV+ve MSM and these figures are increasing by 4-5% per year in US and Australia

Clearance usually takes 1-2 years 

She then went on to talk about the effects of HIV on HPV were the acquisition of HPV is higher in anyone with immuno suppression and clearance is less likely. The rate of HPV in people with HIV is 60%

In 2001-2005 29% of men with anal cancer also had HIV, making anal cancer the 4th most common type of cancer in HIV +ve men 

She summarized by saying that the changing landscape of HPV and related diseases needs to focus on prevention and screening for HPV DNA.

 

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