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qHPV vaccine reduces risk, costs among older HIV-positive MSM treated for HGAIN
Quadrivalent HPV vaccination in older HIV-positive men who have sex with men after treatment for high-grade anal intraepithelial neoplasia could reduce treatment costs and the lifetime risk of anal cancer, according to recent data.
“The results were robust irrespective of reasonable changes in vaccine effectiveness and age at vaccination,” Ashish A. Deshmukh, PhD, MPH, department of health services research at The University of Texas MD Anderson Cancer Center, and colleagues wrote in Clinical Infectious Diseases. “We found that even under the worst-case assumption of vaccine effectiveness, where we assumed that the vaccine essentially becomes ineffective after the third year of treatment, vaccinating older HIV-positive MSM remained a highly cost-effective strategy.”
HIV-positive MSM are at 37-fold greater risk for developing anal cancer than the general population, primarily due to persistent HPV infection, the researchers wrote. Current CDC guidelines do not recommend quadrivalent HPV (qHPV) vaccinations for men aged older than 26 years.
In their study, Deshmukh and colleagues built a Markov model to estimate the cost effectiveness and lifetime cancer risk for qHPV vaccination after high-grade anal intraepithelial neoplasia (HGAIN) treatment. The model was designed for use with HIV-positive MSM aged 27 years or older with no vaccination after HGAIN treatment, and parameters for HPV prevalence and risk were determined using previously reported data.
The results showed that qHPV vaccination after HGAIN treatment reduced the lifetime risk for anal cancer by 63%, the authors wrote. The adjuvant vaccination also decreased lifetime treatment costs by $419 and increased quality-adjusted life years by 0.16.
Although the results of clinical trials examining the efficacy of qHPV vaccine in this setting will not be available for at least 5 years, Deshmukh and colleagues recommended extending vaccination to this older population.
“Expanding qHPV vaccination to the cohort of older HIV-positive MSM diagnosed with HGAIN sooner rather than later could reduce the incidence of anal cancer by almost threefold in those men and potentially save health care resources,” they wrote.
The qHPV vaccine should not replace the vaccine as a primary prevention strategy nor should it replace screening strategies such as cytology-based testing or digital anal exam, according to the investigators. – by Colleen Owens
Disclosure: The researchers report no relevant financial disclosures.