HPV Infection and Prevention of HPV Infection in Men Who Have Sex with Men (MSM)

Abstract

The research landscape in relation to human papillomavirus (HPV) infection has evolved rapidly since the causal association between the virus and cervical cancer was made in the 1970s. Cervical screening programmes have resulted in a dramatic decrease in the incidence of cervical cancer. The first vaccine for HPV was licensed in 2006 with real-world data demonstrating high levels of vaccine efficacy.In the setting of decreased rates of cervical cancer, the burden of HPV-associated disease in men (including genital warts, anal cancer, penile cancer and oropharyngeal cancer) has become more apparent. The incidence of anal cancer is increasing steadily. Men who have sex with men (MSM) in particular HIV-infected MSM are disproportionately affected. In contrast to the successes observed with cervical screening programmes, anal cancer screening tools have not demonstrated improvements in morbidity or mortality, and while many experts recommend screening high-risk groups for anal cancer, no consensus recommendations exist.HPV vaccine has potential to decrease HPV-related malignancies including anal cancer. The majority of countries including Ireland offer HPV vaccine to females through national immunization programmes. However, only a minority of countries have extended the HPV vaccine recommendation to include males. The HPV vaccine is most effective prior to sexual debut; thus, immunisation programmes, including boys and girls, offer the greatest preventative opportunity. However, such programmes will not impact the high burden of HPV-associated disease currently observed in groups at high risk of HPV infection and HPV-associated disease such as men who have sex with men (MSM).This chapter focuses on HPV infection and associated disease in MSM with particular focus on HIV-infected MSM. Host and viral factors influencing HPV infection and progression to disease are reviewed.The potential for primary preventative strategies such as vaccination as well as secondary preventative strategies such as screening to impact on the burden of anal cancer in this cohort are reviewed.