1. High-risk vaccine-specific HPV infection in HIV-infected and HIV-uninfected, vaccine-naïve Asian female adolescents (Abstract no. MOAB0206)
Sricharoenchai S, Bunupuradah T, Hansudewechakul R, Le HD, Ngoc HD T, Kerr S, Chalermchockcharoenkit A, Teeratakulpisarn N, Achalapong J, Ngoc DY, Termrungruanglert W, Chaithongwongwatthana S, Singtoroj T, Pankam T, Phanuphak N, Sohn AH, Chokephaibulkit K 
TREAT Asia/ amfAR - The Foundation for AIDS Research
Thailand: Faculty of Medicine Siriraj Hospital, Mahidol University, HIV Netherlands-Australia-Thailand Research Collaboration (HIV-NAT), Chiangrai Prachanukroh Hospital, Thai Red Cross AIDS Research Centre, Faculty of Medicine, Chulalongkorn University
Vietnam: Hung Vuong Hospital, Children’s Hospital 1

2. Disclosures
None to report

3. Background & Objectives
Human papillomavirus (HPV) vaccine uptake has been
inconsistent in resource-limited settings.
It is unclear how well current vaccines would cover
common HPV genotype infections among perinatally HIV-infected and HIV-uninfected adolescents and young adult (AYA) females in Southeast Asia.
We studied high-risk vaccine-specific HPV types in the nonavalent vaccine, neutralizing antibody (NAb) to HPV-16 or 18, and factors associated with orogenital HPV infection in HPV vaccine-naïve AYA.

4. Methods Study design From 2013 to 2015
Prospective cohort study
Study design
From 2013 to 2015
At 5 sites in Vietnam (2) and Thailand (3)
Perinatally HIV +ve & HIV- ve females
Study population
Age years, sexually active and naïve to HPV vaccine
No pregnancy and symptomatic STI at enrollment
Matching criteria
Age group
Number of lifetime sex partners

5. Study procedures HPV infection Behavioral risks STI
HPV genotyping (samples: oral rinse, swabs from cervical, vaginal, anal sites)
Serum neutralizing Ab - HPV 16 & 18
HPV infection
ACASI (audio-computer assisted self-interview)
Behavioral risks
Cervical: C. trachomatis, N. gonorrhoeae, herpes simplex virus-2
Serum VDRL: Syphilis
STI

6. Statistical analysis Participant characteristics
Descriptive statistics
Fisher’s exact test, Mann-Whitney U test
HPV 16,18,31, 33,45,52, 58
HPV , 11
High-risk vaccine-specific genotypes (HRVS-9)
7 of 9 included in the vaccine
Excluded: types associated with genital warts
Associations with orogenital HPV infection, HRVS-9 genotypes at any site, positive NAb to HPV-16 or -18
Multiple logistic regression

7. Participant characteristics
Characteristics at enrollment
HIV-positive (n=93)
N (%) or median (IQR)
HIV-negative (n=99)
P-value
Age (years)
19 (17 to 20)
19 (18 to 20)
0.27
Lifetime sex partners, range (min-max)
2 (1-3), 1-22
2 (1-3), 1-50
0.76
Age at first sex
16 (15-17)
15 (14-17)
0.05
Asymptomatic STI
C. trachomatis
24 (26%)
20 (20%)
0.39
N. gonorrhoeae
5 (5%)
0 (0%)
0.03
HSV-2
3 (3%)
0.25
Syphilis
2 (2%)
1.00
Always use condom when having sex?
31 (35%)
12 (12%)
<0.001
STI: sexually transmitted infection; HSV: herpes simplex virus

8. Prevalence of HPV infection by HRVS-9 & HPV-16,18 NAb
49 (53%)
49 (49%)
43 (46%)
39 (39%)
26 (28%)
19 (22%)
P=0.34
P=0.30
P=0.66
HRVS-9
genotypes
Positive
HPV-16,18 NAb
HRVS-9 genotypes or
Positive HPV-16,18 NAb

9. Prevalence of HPV infection by HRVS-9 & HPV-16,18 NAb stratified by AGE
20 (61%)
19 (58%)
28 (52%)
50 (48%)
42 (40%)
21 (39%)
17 (33%)
9 (27%)
19 (20%)
P=0.16
P=0.18
P=0.42
HRVS-9 genotypes
Positive
HPV-16,18 NAb
HRVS-9 genotypes or
Positive HPV-16,18 NAb

10. Prevalence of HPV infection by HRVS-9 stratified by anatomical site
37 (41%)
34 (37%)
26 (28%)
29 (30%)
23 (23%)
17 (17%)
3 (3%)
3 (3%)
Oral rinse
Anus
Cervix
Vagina

11. Multivariate analysis
Factors associated with infection with HRVS-9 at any site or NAb to HPV 16,18
Covariate
Univariate analysis
Multivariate analysis
OR (95% CI)
P-value
aOR (95% CI)
>1 asymptomatic STI
3.95 ( )
<0.001
3.39 ( )
0.002
Ever used amphetamine-type stimulant
2.83 ( )
0.03
1.79 ( )
0.30
Ever been pregnant
0.63 ( )
0.12
0.54 ( )
0.06
Number of lifetime sex partners 1 2 ≥3
Ref.
2.58 ( )
4.63 ( )
1.83 ( )
3.34 ( )
0.006
Subgroup: HIV-positive
HIV RNA >40 copies/ml
2.88 ( )
5.85 ( )
0.02
0.001
2.57 ( )
5.39 ( )
0.05
0.003
STI: sexually transmitted infection

12. Limitations
Cross-sectional analysis, and age at HPV acquisition not known
Recently acquired vs. persistent infection undistinguishable
Neutralizing antibody was not measured against other vaccine types

13. Conclusions
Half of all HPV vaccine-naïve female AYA in our study had evidence of prior vaccine-preventable HPV orogenital infection
While HIV-uninfected AYA were more likely to engage high-risk behaviors, perinatally HIV-infected AYA had similar prior HPV infection and more cervical infection with HRVS-9 types
In perinatally HIV-infected AYA, HIV-RNA >40 copies/mL and any non-HPV STI independently predicted increased HPV risk
Greater access to HPV vaccination is needed in early adolescence in the region to prevent future cancer risk

14. Acknowledgements
All patients, study staff, and participating sites in Thailand and Vietnam
Eunice Kennedy Shriver National Institute of Child Heath and Human Development, National Institutes of Health, USA (R01HD073972)
Joel Palefsky, University of California, San Francisco

15. Prevalence of HPV infection by each vaccine-specific genotype
23% 8%
22% 18%
10% 13%
10% 13%
11% 11%
5% 6 %
4% 0%
3% 2%
2% 1%
HPV HPV HPV HPV HPV HPV HPV HPV HPV58