Background Anogenital infection with human papillomavirus (HPV) disproportionately affects men who have sex with men (MSM), especially those living with HIV. It remains unclear whether HPV vaccination of older MSM and/or MSM living with HIV is beneficial in terms of preventing new HPV infections, reinfections with the same HPV subtype, new diagnoses or recurrence of HPV-related lesions or anal cancer.

Results HPV16 causes most anal squamous cell cancer worldwide. However, other high-risk HPV (hrHPV) types contained in the 9-valent vaccine (9vHPVvax) cause a substantial minority of anal cancers in HIV-positive MSM. In the landmark quadrivalent HPV vaccination (qHPVvax) randomised controlled trial in MSM aged 16–26 years, qHPVvax significantly reduced the risk of anal warts, persistent anal HPV infection and anal precancerous lesions. An RCT of qHPVvax among HIV-positive individuals aged over 26 years was stopped early due to futility, largely due to lack of statistical power. Current evidence suggests little benefit of vaccination for established HPV infections. Nonetheless, qHPVvax has been shown to be safe and highly immunogenic among older HIV-positive MSM. Findings from cohort studies suggest potential benefits of vaccination beyond 26 years of age. Among HIV-negative MSM (median age 35), HPV16 seroincidence did not decline until after 35 years of age. A cohort of HIV-negative and HIV-positive MSM (median age 49) found anal HPV16 was only detected in one-third of men at baseline, and acquisition of new 9vHPVvax types occurred at a rate of almost 20 per 100 person-years. A similar-aged cohort of HIV-positive MSM suggested potential protection of almost 30% of participants against acquisition of new hrHPV types contained in the 9vHPVvax.

Conclusion Despite a lack of evidence of HPV vaccine efficacy in older/HIV-positive MSM, some existing data theoretically support a role of vaccination. Further studies are required to confirm whether any benefit exists.

Disclosure No significant relationships.