HPV and anal cancer in HIV+ gay men: new campaign in Manchester: anal HPV in gay men on PrEP
7 February 2026. Related: Journal scan, Coinfections and complications, Cancer and HIV.
Simon Collins, HIV i-Base
Three recent papers – from Belgium, Taiwan and Chad – report on different issues relating to HPV-related infections in gay and bisexual men and the impact of HPV vaccination. [1, 2, 3]
These are all of interest given a new community campaign in Manchester raising awareness of anal health in gay men living with HIV. [4]
The first study is an exploratory analysis of a cross-sectional study in Belgium in men who have sex with men. The paper reports similar rates of high risk HPV infections and histologically confirmed high-grade squamous intraepithelial lesions (HSIL) in men living with HIV (n=85) and HIV negative men on PrEP (n=93). [1]
The study compared rates of anal HSIL detected by high resolution anoscopy (HRA) together with predictive factors for HSIL and the most effective approaches to detecting lesions. Samples were collected from 2020 to 2023 and screened for HPV genotype/ Participants with HSIL after an anal swab were referred for HRA, performed by a single practitioner. HSIL was histologically confirmed by biopsy.
The study prospectively screened 150 HIV positive men on ART and 148 HIV negative men on PrEP. In the HIV positive group, 118/150 (78%) had an indication for HRA: 75% had high risk HPV and 55% due to atypical squamous cells of undetermined significance (ASCUS). Of these, 92/118 (78%) underwent HRA with 22% lost to follow up. In the HIV negative PrEP group, 88/148 (60%) had an indication for HRA: 30% had high risk HPV and 52% due to ASCUS. Of these, 77/88 (78%) underwent HRA with 12% lost to follow up.
Importantly, there were no significant differences in rates of HSIL between the two groups, with both groups reporting significantly higher rates than expected. This suggests that health campaigns developed for men living with HIV should perhaps be extended to sexually active men on PrEP. The only factor significantly associated with HSIL was a history of gonorrhoea.
A second HPV study looked at the dynamics of anal HPV infection in gay men living with HIV after a three course 9vHPV vaccination. This prospective controlled study enrolled 95 men in Taiwan aged 20 to 45 (medium age 35), with a median CD4 count of 682 cells/mm3 and 99% had viral load <200 copies/mL. Of these, 39 participants accepted vaccination and the remainder declined, becoming a control group. At baseline, almost half (46/95) had HPV infection, with 36/46 and 18/46 having high-risk and low-risk genotypes, respectively. Overall, 13/46 and 38/48 were covered by the quadrivalent and 9vHPV vaccine respectively. Baseline cytology reported abnormalities in 11/95, with 7/11 and 4/11 having low grade (LSIL) and high grade (HSIL) respectively.
The primary outcomes in this study were incidence and clearance rates of HPV covered by the 9vHPV vaccine but vaccination was not associated with either enhanced clearance or decreased incidence of vaccine-type HPV compared to the unvaccinated group.
At month 3, 75% of vaccinees with prevalent HPV infection had cleared at least one genotype and 85% of those with abnormal baseline cytology experienced regression. Clearance rates (per 1000 person-months) were 46.3 (vaccine type) and 56.0 (non-vaccine type) in vaccinees vs 64.1 and 91.8 in controls (p=0.456 and 0.371). HPV incidence was 19.5 (vaccine type) and 15.1 (non-vaccine type) in vaccinees versus 12.4 and 12.4 in controls (p=0.378 and 0.710).
Study limitations included this being a relatively small, non-randomised study and that the median age of 35 was relatively late for vaccination. It was not clear why so many men declined vaccination although vaccinees were slightly younger, more sexually active, but also reported higher condom use. This shows the importance of health campaigns encouraging earlierHPV vaccination in gay men living with HIV.
Finally, a study recently published in PLoS One reported high acceptability of self-sampling anal swabs in MSM in Chad as part of an educational project that that also reported anal HPV shedding and genotypes. [3]
This study is importance for showing the importance of raising awareness of anal health in HIV positive gay men even in settings with many challenges.
This was a prospective cross-sectional study in 70 participants (mean age 37, range 18 to 50) randomly selected from 21 community clinics in the capital city. Importantly, participants were recruited by HIV positive peer educators from the main HIV community organisation in Chad (RNTAP+) which is dedicated to providing health care for key populations. Five initial participants were selected and each was asked to recruit another three people from their trusted MSM network (including cruising spots, community churches or other MSM networks), who in turn recruited new trusted participants. Self-sampling was carried out after a short explanation by a study nurse.
This project involved a high level of sensitivity to the vulnerability of participants, and of the issues involved in sexual health. Same-sex activity was criminalised in Chad in 2017, Most participants only had primary school eduction (55%) and 22% had never been to school and 65% were not in work (only 18% were employed and 15% were in college). Most were single (88%), with 55% only having 1-5 partners in the previous 6 months, sometimes using condoms. Only 4 men (5%) were HIV positive. None had previous had an anal examination, HPV vaccine or HPV testing.
HPV shedding was reported by 44/70 participants (62%), nearly all 38/70 (54%) with one or more high risk strains. This included HPV-33 (30/70, 42.9%), HPV-68 (16/70, 22.9%), HPV-18 (4/70, 5.7%), HPV-35 (3/70, 4.3%), HPV-58 (2/70, 2.9%) and HPV-45 (1/70, 1.4%). Roughly half the men had more than one strain (range 1 to 8).
The study reported that only 10% (7/70) and 45% (32/70) of men in the study were shedding HPV covered by the 4vHPV and 9vHPV vaccines, respectively, although the highest risk strains were all covered.
Acceptability for the veil-based self-sampling was >95%, with high levels of satisfaction related to feeling respected and with a lack of shame.
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These results show the importance a new community campaign that has just been launched by George House Trust in partnership with the NHS Cheshire and Merseyside Cancer Alliance: “HIV and anal health: We’ve got your back”. [4]
The campaign was developed with people with lived experience of anal cancer and plans to raise awareness of the symptoms in gay and bisexual men living with HIV – and to increase uptake of the HPV vaccine.
A new initiative on anal cancer for people living with HIV is also being run by Dr Emma Hainsworth at the Royal Marsden Hospital in London. This group is developing new support resources and welcomes involvement of anyone with direct experience who would like to connect and to help. Emma.Hainsworth@rmh.nhs.uk
Although anal cancer is a rare in the general population (1.7 per 100,000 PY), rates are higher in gay and bisexual men and higher still in people living with HIV. Over 90% of cases are caused by high-risk HPV strains and although HSIL is a precancer stage, only a small percentage of people with HSIL develop anal cancer.
For example, only 30/4500 HIV positive people with HSIL in the large US phase 3 ANCHOR study progressed to invasive cancer over two years. Treating HSIL however reduced this risk by 57% with 9 vs 21 cases in the treatment vs monitoring arms. However, more than half (52%) of the 10,700 people living with HIV screened for the study had biopsy confirmed HSIL which was similar in all groups (gay men, women and transgender people). [5]
Hopefully the campaign in Manchester includes an option for anal smear testing, maybe with self-sampling, and encourages early uptake of HPV vaccination.
References
- Surmont M et al. HPV-Related Anal Precancerous Lesions in MSM: A Comparative Study of PrEP Users and HIV-Positive Individuals, Clinical Infectious Diseases, 2026;, ciaf724.
https://doi.org/10.1093/cid/ciaf724 - Lin K-Y et al. Dynamics of anal HPV infection after 9vHPV vaccination in men who have sex with men (MSM) with HIV: A prospective controlled cohort study. Human Vaccines & Immunotherapeutics. DOI: 10.1080/21645515.2026.2618876. (26 January 2026).
https://doi.org/10.1080/21645515.2026.2618876 - Koyalta D et al. Anal HPV shedding assessed by self-sampling and multiplex real-time PCR among men who have sex with men in N’Djamena Chad: a feasibility and acceptability study. PLoS One21(1): e0340799.
https://doi.org/10.1371/journal.pone.0340799 - GHT. HIV and anal health: We’ve got your back.
https://ght.org.uk/about-us/latest-news/hiv-anal-health-weve-got-your-back - CROI 2022: ANCHOR study reduces anal cancer by 57% and supports screening for people living with HIV. HTB (01 March 2022).
https://i-base.info/htb/42226