CBR Musings: Possibilities for Protection: HPV, HIV and MSM

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By: Joanna Mendell

You’ve likely heard that HPV (the Human Papilloma Virus) is able to cause cervical cancer… you’ve probably heard that vaccines are available to protect against HPV… and you may even know that HPV is also linked with penile, anal, and oral and head and/or neck cancers

But are you aware that biological interactions between HPV and HIV favour each other’s acquisition and progression??

People infected with any type of HPV have been shown to be twice as likely to contract HIV when exposed to the virus!1 A number of biological reactions associated with an HPV infection change the properties of mucous membranes (the tissues where HIV enters the body) making them more susceptible to infection. This includes bringing T-cells, which HIV likes to infect, close to the skin’s surface and other cellular changes that allow HIV to enter cells more readily.1

HIV infection also has the ability to enhance HPV acquisition at the molecular and cellular levels. Immune suppression during HIV course enhances HPV infection and disease progression.1 Co-infections often result in higher HPV viral loads, less clearance of the virus, more reoccurring dormant infections, and more warts and cancer.1

HPV is one of the most common sexually transmitted infections, and an estimated 75% of sexually active Canadians will acquire an HPV infection at some point in their lives in the absence of vaccine protection.2,3 HPV is even more prevalent among gay men and other men who have sex with men (MSM) than in the general population of sexually active adults.3,4 In addition, the prevalence of anal cancers (80% of which are related to strains of HPV covered by the Gardasil® vaccine) are higher in this population, especially in MSM living with HIV.5 Two studies have reported anal cancer prevalence in MSM as higher than the prevalence of cervical cancer reported in any population.3,4

Although many hold concerns about adverse reactions, the National Advisory Committee on Immunizations, Health Canada, and the BC Centre for Disease Control accept the efficacy and safety of the Gardasil® vaccine for protection against HPV types 6, 11, 16 & 18 infections in both males and females. Evidence for cost-effectiveness has been demonstrated for young female populations, and has therefore drawn Canadian public funding for a school-based female-only vaccination program. The current vaccination program may not, however, be protecting all populations experiencing high risks of HPV infection, including MSM, who do not benefit from only females being immune. In other words, while heterosexual males are provided protection against the virus if the women they are having sex with have been vaccinated, a female-only vaccination program does not directly offer protection to men who have sex with men.

To widen the scope and effectiveness of the HPV vaccine as well as decrease inequities that arise from a female-only vaccination program, it has been suggested that the program be expanded to include males as well. Inclusion of males in the vaccination strategy not only has the potential to further protect unvaccinated females, but also introduces protection to MSM populations.

Models of vaccination programs specifically targeting young MSM populations have shown to be cost-effective. However, a number of issues make the targeting of young MSM populations quite problematic. Particularly worisome, is the fact that the vaccine is most effective when administered before having sexual contact, and most boys do not disclose their sexual preference to health practitioners until years after their first sexual encounter, according to Rank et al. (2012).

Put simply, if MSM are not identifying as such, then a vaccine targeted at MSM will not be effective. Therefore, universal vaccination of all males would have the largest impact on decreasing the burden of HPV-related diseases among MSM as well as offer further protection to females and heterosexual men.6

As such, “PAN believes that providing a vaccination program to all genders, and especially to people living with HIV, will save future health care dollars. For those not living with HIV, the HPV vaccine can be one more HIV prevention tool in the effort to reduce the HIV epidemic in BC” (PAN Letter to the BC Minister of Health).

For more information about the HPV Vaccine, the relationship between HPV and HIV, and expanding the HPV vaccination program in BC to school ages boys please read PAN’s Background information on HPV, Gardasil’s HPV Vaccine, and expanding the vaccination program to include young males in BC report.

Update: on February 3, 2015 Warren O’Briain emailed a response to PAN’s letter to the BC Ministry of Health.

Works Cited

  1. Konopnicki, D., S. De Wit, and Clumeck, HPV and HIV coinfection: a complex interaction resulting in epidemiological, clinical and therapeutic implications. Future Virology, 2013. 8(9): p.903-915.
  2. Stanley, M.A., Immune responses to Human Papillomaviruses. Indian Journal of Medical Residency, 2009. 130: p. 266-267.
  3. National Advisory Committee on Immunization, Update on Human Papillomavirus (HPV) vaccines. Canadian Communicable Disease Report, 2012. 38.
  4. Jollimore, J., W. Robert, R. Gair, M. Brondani, & C. Bognar, HPV vaccination for gay men and bisexual men. Health Initiative for Men, 2013.
  5. CDC Newsroom, ACIP recommends all 11-12 year-old males get vaccinated against HPV. Press brief transcript, October 25, 2011. Available from http://www.cdc.gov/media/releases/2011/t1025_hpv_12yroldvaccine.html
  6. Rank, C., M. Gilbert, G. Ogilvie, G.C. Jayaraman, R. Marchard, T. Trussler, et al. & T. Wong. Acceptability of Human Papillomavirus vaccination and sexual experience prior to disclosure to health care providers among men who have sex with men in Vancouver, Canada: Implications for targeted vaccination programs. Vaccine, 2012. 30(39): 5755-5760.