Incidence and Clearance of Anal Human Papillomavirus Infection in 16 164 Individuals, According to Human Immunodeficiency Virus Status, Sex, and Male Sexuality: An International Pooled Analysis of 34 Longitudinal Studies

Feixue Wei, Marc T. Goodman, Ningshao Xia, Jun Zhang, Anna R. Giuliano, Gypsyamber D'Souza, Nancy A. Hessol, Maarten F. Schim van der Loeff, Jianghong Dai, Karin Neukam, Alexandra de Pokomandy, I. Mary Poynten, Ronald B. Geskus, Joaquin Burgos, Isabelle Etienney, Anna-Barbara Moscicki, Maria Gabriella Donà, Maura L. Gillison, Alan G. Nyitray, Rebecca G. NowakEvy Yunihastuti, Huachun Zou, Carmen Hidalgo-Tenorio, Nittaya Phanuphak, Jean-Michel Molina, Alice M. Schofield, Stephen Kerr, Song Fan, Yong Lu, Jason J. Ong, Admire T. Chikandiwa, Sirinya Teeraananchai, Nicola Squillace, Dorothy J. Wiley, Joel M. Palefsky, Damien Georges, Catharina J. Alberts, Gary M. Clifford

Research output: Contribution to journalArticleAcademicpeer-review

11 Citations (Scopus)


Background: Understanding the natural history of anal high-risk human papillomavirus (hrHPV) infection is key for designing anal cancer prevention programs but has not been systematically characterized. Methods: We reanalyzed data from 34 studies including 16 164 individuals in 6 risk groups defined by human immunodeficiency virus (HIV) status, sex, and male sexuality: men who have sex with men (MSM) and people with HIV (MSMWH), HIV-negative MSM, women with HIV (WWH), HIV-negative women, men who have sex with women (MSW) with HIV (MSWWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their determinants. Results: Human papillomavirus (HPV) 16 had the highest incidence-clearance ratio of the hrHPV types. MSMWH had the highest hrHPV incidence (eg, 15.5% newly HPV-16 infected within 2 years), followed by HIV-negative MSM (7.5%), WWH (6.6%), HIV-negative women (2.9%), MSWWH (1.7%), and HIV-negative MSW (0.7%). Determinants of HPV-16 incidence included HIV status and number of sexual partners for MSM, women, and MSW, and anal sex behavior for MSM only. HPV-16 clearance was lower for people with HIV (PWH) and lower for prevalent than incident infection. Among MSM, increasing age was associated with lower clearance of prevalent, but not incident, HPV-16 infection. Conclusions: This robust and unifying analysis of anal hrHPV natural history is essential to designing and predicting the impact of HPV vaccination and HPV-based screening programs on anal cancer prevention, particularly in MSM and PWH. Importantly, it demonstrates the higher carcinogenic potential of longstanding anal prevalent hrHPV infection than more recent incident infection.
Original languageEnglish
Pages (from-to)E692-E701
JournalClinical Infectious Diseases
Issue number3
Publication statusPublished - 1 Feb 2023


  • HIV
  • HPV
  • anus
  • clearance
  • incidence

Cite this