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Open Access Publications from the University of California

Scholarly Works (12 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2011)

Abstract

Human papillomavirus infection in HIV-seropositive men who have sex with men in both the United States and India:

Prevalence, incidence, and risk factors for infection

by

Alexandra Lydia Hernandez

Doctor of Philosophy in Epidemiology

University of California, Berkeley

Professor Arthur Reingold, Chair

Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at high risk of anal cancer compared with the general population. Human papillomavirus (HPV) infection, particularly HPV 16, causes anal cancer. The prevalence of anal HPV infection among HIV-infected men in the US is >90% but little is known about the risk factors for prevalence, and incidence of or the risk factors for type-specific anal HPV infection . There is also limited knowledge about anal HPV infection among HIV-infected MSM in India, although the background incidence of HPV-related cancers in both men and women is high in India. Indian HIV-infected MSM may be at especially high risk for anal HPV infection and HPV-associated disease.

My aim was to determine the prevalence and incidence of and risk factors for anal HPV infection among two populations of HIV-infected MSM, one from San Francisco and the second from India. The San Francisco population was two-year longitudinal study and allowed for both prevalence and incidence analysis; the India study was cross-sectional in design and allowed only for a prevalence analysis.

The prevalence of anal HPV infection among HIV-infected MSM in San Francisco was 92%, 80% had oncogenic types and 42% had HPV 16. A higher number of total life-time partners was associated with increased prevalence of HPV 16. The incidence of any anal HPV infection was 21.3 per 100 person-years (PY) and 3.5/100 for HPV 16. A higher number of recent partners with whom the participant was the receptive partner was associated with a higher incidence of any anal HPV infection. New receptive partners, more frequent receptive sex, and new oral-anal contact partners was also associated with a higher incidence of any anal HPV infection. The prevalence of anal HPV infection among HIV-infected Indian MSM was 71%, and ever having receptive anal intercourse and higher number of receptive partners increased prevalence. "Almost always" condom use with receptive anal intercourse decreased prevalence of anal HPV infection among HIV-infected Indian MSM.

In conclusions, HIV-infected MSM in both San Francisco and India have high prevalences of anal HPV infection and the incidence of anal HPV among these men in San Francisco is also high. The most important risk factors for infection are total number of male partners and receptive anal intercourse. Condoms may protect against anal HPV infection, but further research is needed to confirm results. HIV-infected MSM should be counseled on safe sex practices with all partners and encouraged to receive the recently recommended HPV vaccine.

    Cover page: Human papillomavirus infection in HIV-seropositive men who have sex with men in both the United States and India: prevalence, incidence, and risk factors for infection
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2022)
    Anal human papillomavirus (HPV) disproportionately affects men who have sex with men (MSM), particularly those who are older and those living with HIV. After experiencing difficulty recruiting older MSM into a study on aging and anal HPV, we conducted a sub-study to gain feedback on our recruitment methods and explore barriers and facilitators to participating in anal HPV research. We conducted focus groups with 30 men who have sex with men (MSM), both HIV-negative and MSM living with HIV, ages 50-75. We identified multiple themes that were barriers to participation including: (1) lack of knowledge about human papillomavirus and anal cancer; (2) research focused on anal cancer or discomfort with topics or procedures concerning the anus; (3) stigma including stigma associated with being men who have sex with men, being out, being a receptive partner, and being considered "older" in the gay community; and (4) confidentiality concerns including a fear of breach of confidentiality. Facilitators to participation were also identified; these motivational factors include altruism, wanting recommendations from a doctor, and desire to receive the best available care. Researchers seeking to enroll older men who have sex with men should be aware of these barriers and facilitators to participation in order to maximize recruitment.
      Cover page: “The problem is that our culture is just so messed up about aging.” Recruiting older men who have sex with men (MSM) into research studies: an example from a study of aging, HIV, and anal HPV.
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2014)

      Objective

      HIV-positive MSM are at increased risk of anal human papillomavirus (HPV) infection compared with men in the general population, and little is known about the natural history of anal HPV infection in this population. The objective of this study was to determine the incidence of and risk factors for anal type-specific HPV infection.

      Design

      Prospective cohort study.

      Methods

      HIV-positive MSM were evaluated for anal HPV DNA, lifestyle factors, and sexual risk behaviors every 6 months for at least 2 years.

      Results

      The overall incidence rate of detectable type-specific anal HPV infection was 21.3 per 100 person-years [95% confidence interval (CI) 17.7-25.4] and was 13.3/100 person-years (10.5-16.6) for oncogenic HPV types. The most common incident infections were HPV 18 (3.7/100 person-years) and HPV 16 (3.5/100 person-years). An increased number of recent partners with whom the participant was the receptive partner [odds ratio (OR) 2.9 (1.6-5.1) 8+ partners vs. 0-1], an increased number of new partners in which the participant was the receptive partner [OR 1.03 (1.01-1.1) per partner], an increased number of new oral-anal contact partners in which the participant was the receptive partner [OR 1.1 (1.03-1.1) per partner], and the frequency of receptive anal intercourse [OR 1.1 (1.03-1.1) per act] all significantly increased the odds of incident HPV infection (P ≤ 0.05).

      Conclusion

      HIV-positive MSM have a high incidence of oncogenic anal HPV infection. Recent receptive anal sexual behaviors, including receptive anal intercourse and receptive oral-anal contact, are the most important risk factors for incident anal HPV infection.
        Cover page: Incidence of and risk factors for type-specific anal human papillomavirus infection among HIV-positive MSM
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2012)

        Background

        Studies exploring the relationship between foreign-born status and mental health among Latinos in the United States have varied in their conclusions. We examined 2000-2002 MESA data on Latinos and compared responses between immigrants and non-immigrants on the Center for Epidemiologic Studies Depression (CES-D) scale and the Spielberger anxiety and anger scales.

        Methods

        We used logistic and linear regression to examine whether immigrant status was associated with these psychological outcomes in Latinos-overall, Mexicans-only and Other-Latinos (non-Mexicans).

        Results

        Compared with U.S.-born Latinos, foreign-born Latinos had significantly higher odds of meeting CES-D caseness- a score above 16, classifying depressive symptoms (p≤.05), higher anger scores (p≤.001) and a trend towards higher anxiety. These associations were similar within the Mexicans-only subgroup.

        Discussion

        When examining self-reported distress symptoms as outcomes, our findings do not coincide with the paradoxical effect of immigration on mental health. Furthermore, associations between immigrant status and psychological outcomes differed among the Latino subgroups.
          Cover page: A Long Way from Home: Comparing Mental Health Measures between Foreign and U.S.-born Latinos in the Multi-Ethnic Study of Atherosclerosis (MESA)
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2013)

          Background

          HIV-positive men who have sex with men (MSM) are at high risk of anal cancer compared with the general population. Human papillomavirus (HPV) infection, particularly HPV 16, is causally associated with anal cancer. However, the risk factors for anal HPV 16 infection are poorly understood. We determined the prevalence and risk factors for anal HPV 16 infection in a population of HIV-positive MSM, most of whom were being treated with antiretroviral therapy.

          Design

          Cross-sectional data from the baseline visit of a 4-year prospective cohort study.

          Methods

          Three hundred forty-eight HIV-positive MSM were recruited in San Francisco, and they received a detailed sexual behavior risk factor questionnaire. An anal swab was used to collect specimens for HPV type-specific DNA testing using L1 HPV DNA polymerase chain reaction. We used log-binomial multivariable models to determine the risk factors for anal HPV 16 infection.

          Results

          Ninety-two percent of HIV-positive MSM had at least 1 anal HPV type, 80% had at least 1 oncogenic HPV type, and 42% had HPV 16. Non-Hispanic white race and higher level of education were associated with a decreased risk of HPV 16 infection. A higher number of total male partners was associated with HPV 16 (relative risk: 1.6, 95% confidence interval 1.1 to 2.4, P = 0.01) for 201-1000 partners compared with 1-200. Injection drug use was independently associated with anal HPV 16 infection (relative risk: 1.5, 95% confidence interval 1.2 to 1.9, P = 0.003).

          Conclusions

          The prevalence of anal HPV infection, including HPV 16, is high in HIV-positive MSM. HIV-positive MSM should be counseled about the risk associated with increased partners and injection drug use.
            Cover page: Risk Factors for Anal Human Papillomavirus Infection Type 16 Among HIV-Positive Men Who Have Sex With Men in San Francisco
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2016)

            Background

            India has a large population of HIV-positive individuals, including men who have sex with men (MSM), and the incidence of human papillomavirus (HPV)-related cancers is high. In developed countries, HIV-positive MSM exhibit the highest prevalence of anal HPV infection and incidence of anal cancer. Little is known about anal HPV infection in HIV-positive Indian MSM.

            Methods

            We evaluated 300 HIV-positive MSM from 2 cities in India. Men were tested for anal HPV infection using L1-HPV DNA polymerase chain reaction with probes specific for 29 types and a mixture of 10 additional types. CD4 level and plasma HIV viral load were measured. Participants completed an interviewer-administered questionnaire including a sexual history.

            Results

            The prevalence of anal HPV was 95% (95% confidence interval: 91% to 97%). The 3 most common types were HPV 35 (20%), HPV 16 (13%), and HPV 6/11 (13%). History of taking antiretroviral medications decreased risk of anal HPV 16 infection [relative risk (RR): 0.6 (0.4-1.0)]. Having an increased number of vaginal sex partners lowered risk of any anal HPV infection. Ever having receptive sex increased risk of any anal HPV [RR: 1.2 (1.1-1.4)] and anal HPV 16 [RR: 6.5 (1.8-107)].

            Conclusions

            Almost all Indian HIV-positive MSM had anal HPV infection. The prevalence of HPV 16 was lower and the prevalence of other oncogenic HPV types was higher than in similar populations in North America and Europe. Vaccine-based prevention strategies for HPV infection in India should consider potential differences in HPV type distribution among HIV-infected MSM when designing interventions.
              Cover page: Prevalence of Anal HPV Infection Among HIV-Positive Men Who Have Sex With Men in India
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2012)

              Purpose

              To assess the prevalence and degree of lumbosacral transitional vertebrae (LSTV) in the Osteoarthritis Initiative (OAI) cohort, to assess whether LSTV correlates with low back pain (LBP) and buttock pain, and to assess the reproducibility of grading LSTV.

              Materials & methods

              Institutional review board approval was obtained, and informed consent documentation was approved for the study protocol. Standard standing pelvic radiographs that included the transverse processes of L5 were graded according to Castellvi classification of LSTV in 4636 participants (1992 men and 2804 women; aged 45-80 years) from the OAI cohort. These data were correlated with prevalence and severity of LBP and buttock pain.

              Results

              Prevalence of LSTV was 18.1% (841 of 4636), with a higher rate in men than in women (28.1% vs 11.1%, respectively; P<.001). Of the 841 individuals with LSTV, 41.72% were type I (dysplastic enlarged transverse process), 41.4% were type II (pseudoarticulation), 11.5% were type III (fusion), and 5.2% were type IV (one transverse process fused and one with pseudoarticulation). Of the participants without LSTV, 53.9% reported LBP, while the prevalence of LBP for types I, II, III, and IV was 46%, 73%, 40%, and 66%, respectively (P<.05, χ2 test). Types II and IV had higher prevalence and severity of LBP and buttock pain (P<.001).

              Conclusion

              LSTV types II and IV positively correlate with prevalence and severity of LBP and buttock pain.
                Cover page: Lumbosacral Transitional Vertebrae: Association with Low Back Pain
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2022)
                INTRODUCTION: More than half of people living with HIV in the US are 50+ years old. Despite the benefits of antiretroviral therapy, older individuals with HIV are at higher risk for illnesses than their HIV-negative counterparts. Anal cancer, anal high-grade squamous intraepithelial lesions (HSIL), and anal HPV-16 infection occur most frequently among men who have sex with men living with HIV (MSMLWH). Men aged 60+ are 3-fold more likely to be diagnosed with anal cancer compared with younger men. Despite the increasing risk of anal cancer with age and HIV, little is known about the relationships among aging, HPV infection, HSIL and HIV. METHODS AND ANALYSIS: The Anal HPV, HIV, and Aging (AHHA) Study is a two-stage project to evaluate the relationships among anal HPV infection, HSIL, HIV infection, and biomarkers of biological aging in MSM or trans women over the age of 50 years. Stage 1 will estimate the cross-sectional prevalence of both anal HPV infection and HSIL, based on outcomes of anal HPV DNA testing, and high-resolution anoscopy with biopsy. We will also study associations with study outcomes and serological biomarkers of inflammation (interleukin-6, C-reactive protein, D-dimer) and with the Veterans Aging Cohort Study Index and the Fried Frailty Phenotype using multivariable models. Participants living with HIV (n = 150) and HIV-negative participants (n = 150) will be enrolled. The 3-year Stage 2 longitudinal sample restricted to HSIL-negative and anal HPV-16 DNA-negative participants will estimate the 3-year incidence of both anal HSIL and anal HPV, stratified by HIV status through Cox proportional hazards regression. The effect of biomarkers of inflammation and markers of aging on study outcomes will be evaluated through multivariable repeated measures models stratified by HIV status. ETHICS AND DISSEMINATION: This protocol was approved by the University of California, San Francisco Institutional Review Board (IRB: 16-18966). Results will be disseminated through presentations at national/international scientific conferences and publication in peer-reviewed journals.
                  Cover page: Rationale and design of the Anal HPV, HIV and Aging (AHHA) study: Protocol for a prospective study of anal HPV infection and HSIL among men who have sex (MSM) or trans women living with and without HIV, ages 50 and older.
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2017)

                  Background

                  The incidence of penile cancer in Indian men is high. Little is known about genital human papillomavirus (HPV) infection in Indian HIV-seropositive men who have sex with men (MSM), a population that may be at particularly high risk for genital HPV infection and, potentially, penile cancer. In this study, we assessed the prevalence and risk factors for genital HPV infection in this population.

                  Design and methods

                  Three hundred HIV-seropositive MSM were recruited from 2 clinical sites in India. They were tested for genital HPV infection using L1 HPV DNA polymerase chain reaction with probes specific for 29 types and a mixture of 10 additional types. Participants received an interviewer-administered questionnaire that included questions on demographics and behaviors.

                  Results

                  Human papillomavirus data were available from 299 participants. The prevalence of any HPV type in the penis and scrotum was 55% and 54%, respectively. Human papillomavirus type 35 was the most common oncogenic HPV type followed by HPV-16. In multivariate analysis, being the insertive partner with 100+ male partners increased the odds of any penile HPV infection compared with not being insertive with any partners (odds ratio, 2.5; 95% confidence interval, 1.3-5.1). Circumcision was protective against penile HPV infection (odds ratio, 0.39; 95% confidence interval, 0.19-0.76).

                  Conclusions

                  The prevalence of penile and scrotal HPV infection was high among Indian HIV-seropositive MSM. The most common oncogenic HPV type in this population, HPV-35, is not included in any currently available HPV vaccines. Insertive anal sex with men and lack of circumcision were the primary risk factors for penile HPV infection in this population.
                    Cover page: Genital Human Papillomavirus Infection in Indian HIV-Seropositive Men Who Have Sex With Men
                    • Article
                    • Peer Reviewed
                    UC Berkeley Previously Published Works (2002)
                    We investigated the evidence of a familial contribution to urinary methylation patterns in families ingesting arsenic in drinking water. Arsenic methylation can be assessed by measuring urinary levels of inorganic arsenic (InAs) and its methylated metabolites, monomethylarsonate (MMA), and dimethylarsinate (DMA). Methylation activity is reflected in the ratios: InAs/methylated arsenic (InAs/metAs) and MMA/DMA. Eleven families from Chile were selected because of their long-term exposure to very high levels of arsenic in drinking water (735-762 microg/L). Each family consisted of a father, a mother, and two children. We measured urinary arsenic and its methylated metabolites for each participant (n = 44). The intraclass correlation coefficients showed that 13-52% of the variations in the methylation patterns were from being a member of a specific family. Family correlations were calculated for father-mother, parent-child, and sibling-sibling pairs. Methylation patterns correlated strongly between siblings [r = 0.78 for InAs/metAs, 95% confidence interval (CI), 0.34-0.94; r = 0.82 for MMA/DMA, 95%CI, 0.43-0.95] compared to lower correlations in father-mother pairs (r = 0.18, r = -0.01, respectively), after adjustment for total urinary arsenic, age, and sex. Family correlations were not notably altered when adjustments were made for specific blood micronutrients (methionine, homocysteine, folate, vitamin B6, selenium, and vitamin B12 potentially related to methylation. We also report on a family pedigree with high prevalence of arsenic-induced effects. Participants from this family had low InAs/metAs values, which is consistent with increased toxicity of trivalent methylated arsenic species. Despite our small sample size, we observed that methylation patterns aggregate in families and are correlated in siblings, providing evidence of a genetic basis for the variation in arsenic methylation. Larger studies with more extensive pedigrees will need to be conducted to confirm these findings.
                      Cover page: Family correlations of arsenic methylation patterns in children and parents exposed to high concentrations of arsenic in drinking water.
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