Robert Zangerle (Austrian Society of Dermatology and Venereology) found thatanal cancer is 300x more common in HIV+ MSM in Austria. He studied the extensive database of the HIV cohort 2003-2015 where he identified invasive anal Ca in 47/7500 patients; of these, 7 died of their cancer and 4 of AIDS related illness. There was no information available on sexual habits and HPV vaccination rates (assumed to be very low.)
Carmen Hidalgo-Tenorio (Infectious Disease Unit, University Hospital Virgen de las Nieves, Granada, Spain) looked at HSIL in HIV +ve women in Spain. Of the 95 women, 28.4% had had anal intercourse. Anal cytology was normal in 46%, 22.1% were positive for HPV with a negative smear, and 13% were atypical. She found HSIL IN 16/100,000. Significant predictors for HSIL were number of sexual partners >3 and abnormal cytology. Interestingly atypical anal cytology was commoner than cervical in HIV positive women.
Alessandra Vergori (Rome, Italy) reminded us that PLWH have 15-25 x rate for anal ca and 2.1 x that for oral. She studied 395 HIV +ve men. 96% were on ART, 47% were smokers. The average number of sexual partners were 100 for MSM and 12% in heterosexual men. HPV was present in 20% oral, 83% anal testing and 50% of anoscopy samples showed atypia. Significant associations were the number of sexual partners and a low CD4 count.
Deborah Konopnicki (Centre Hospitalier Universitaire Saint-Pierre, Brussels) gavethe stark statistic that the mortality rate for invasive anal Ca is 31%. Screening for anal and oral HPV is difficult and a more practical approach is vaccination. HPV vaccines are virus-like particles and completely non- infectious. 9vHPV is now available covering serotypes 16/18/31/33/45/52/58/6/11. Good AB levels persist for at least 12 yrs following vaccination. Vaccination has been proved to be safe and effective in HIV+ Patients but vaccination is much more effective in everyone when given before significant HPV exposure ie. in early teens. EACS recommendations are to vaccinate all women up to age 26y and all MSM to 40y if HIV +ve or 26 if -ve
Vaccination reduces relapses in treated HPV by 65% in women and 50% in men.
It has been shown that if vaccinated under 15yrs, 2 doses and probably 1 dose are as effective as the triple dose regime. The consensus appears to be that single dose vaccination will be recommended in primary vaccination of teens but 3 doses are still required in HIV patients.