New research shows that adults with or at risk for HIV are less likely to get the HPV vaccine than the general public, increasing their risk of anal and cervical cancer.
During the 2019 American Association for Cancer Research (AACR) Annual Meeting in Atlanta, researchers from Texas A&M University presented new data that shows that those who participate in high-risk behaviors, particularly if they have contracted the virus that causes AIDS, are less likely to receive the recommended HPV vaccines.
HPV is a sexually transmitted infection that often is cleared from the body of a healthy patient without causing additional diseases. However, because HIV compromises the body’s immune system, a person with HIV who also obtains HPV, may not be able to fight off the infection on their own, making them prone to developing certain types of cancer.
Vaccines that target the HPV strains that are more likely to cause anal and cervical cancer have been available since 2006 and the U.S. Centers for Disease Control and Prevention (CDC) recommends that adolescents up to 15 years old should receive two doses starting at age 11 or 12. If the person starts the vaccine between ages 15 and 26, the CDC recommends three doses.
The uptake of vaccination currently is significantly below the 80 percent benchmark that public health experts have hoped for. As of 2017, approximately 49 percent of adolescents were up-to-date on their recommended dosages of the vaccine and 66 percent had received just one dose.
Using data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey, the researchers were able to assess HPV vaccinations rates in individuals who engaged in one or more high-risk behaviors in the preceding year. Of the 486,303 adults who voluntarily completed the survey, only 3.39 percent had used injection drugs and/or engaged in high-risk sexual behavior and were classified as high-risk for HIV infection. Of those 416, participants who engaged in the high-had complete data. The study that very few of those individuals were fully vaccinated against HPV.
The researchers found that about 25.7 percent of gay or bisexual males between 18 and 33 years had initiated the three-dose vaccine series, with 6.2 percent completing it. They also found that about 25 percent of high-risk heterosexual females between 18 and 36 years old had completed the requisite doses.
On the other side, only 11 percent of high-risk heterosexual males between 18 and 29 years old had even initiated the three-dose HPV series. In addition, no transgender men, transgender women and gender-nonconforming individuals had initiated HPV vaccination.
The researchers also found that vaccination rates were significantly lower for non-Hispanic black participants than any other racial or ethnic group.
“It was alarming that almost all non-Hispanic blacks in the study were unvaccinated, especially given the disproportionate burden of HIV/AIDS among this minority group,” Lisa Wigfall, PhD, assistant professor, Division of Health Education, Department of Health and Kinesiology in the College of Education and Human Development at Texas A&M University in College Station, said in a statement.
One potential cause of the low vaccinate rate in high-risk populations is that the recommendations for HIV patients were issued several years after the vaccine first became available to the general public.
Another issue is that healthcare providers may not have addressed the connections between high-risk sexual activity and the co-infection of the two diseases.
“Gender and sexual orientation are important topics that should not preclude us from identifying and targeting HPV vaccination efforts among high-risk populations,” Wigfall said.
According to Wigfall, patient-provider communication should be particularly strengthened for high-risk populations, especial HIV-positive individuals and HIV-negative gay and bisexual men and transgender individuals.
She also suggested that the wide adoption of HIV testing for all adolescents and adults should be conducted and followed through on.
