The epidemiology of human papillomavirus in HIV-negative and HIV-infected men who have sex with men

This thesis studied the epidemiology and seroepidemiology of human papillomavirus (HPV) among HIV-negative and HIV-infected men who have sex with men (MSM) in Amsterdam, the Netherlands. Anal, penile, and oral HPV prevalence and incidence were high, in particular among HIV-infected MSM. Clearance of anal HPV infection was lower among HIV-infected compared to HIV-negative MSM. HIV infection was strongly associated with HPV infection, independent of sexual behavior and other possible confounders. However, within HIV-infected MSM no association between increasing level of immunosuppression (i.e., low CD4 T-cell count) and HPV infection was observed. Furthermore, HPV seroprevalence was high, especially among MSM with HIV infection or anal HPV infection. In longitudinal analyses incident or persistent anal HPV infections were the main drivers of type-specific HPV seroconversion. HPV seropositivity, however, did not seem to protect adult, sexually active MSM from subsequent type-specific HPV infection. Future research should focus on increasing insight in the effect of HIV-related immunosuppression on HPV infection and sequelae, the function of naturally induced HPV antibodies, and optimizing HPV prevention strategies.