Mediation Analysis Of HPV Persistent Infection And Influencing Factors Among Men Who Have Sex With Men

Objective:To understand the current situation of persistent infection of Human papillomavirus(HPV),and Hepatitis B virus(HBV),among HIV-negative Men who have sex with men(MSM)in Urumqi,and to analyze the influencing factors of persistent infection of HPV by using mediation-effect analyze method.Methods:From March 1,2016 to March 31,2017,HIV-negative MSM were recruited by snowballing method in Urumqi.Based on the enrollment time,follow-up was conducted every 6 months until December 31,2018.Baseline questionnaire survey,HPV,HBV and HIV testing,follow-up questionnaire survey and HPV testing were conducted during this period.The demographic and sexual behavior characteristics,recreational drug use history were collected by questionnaire.At the same time,the exfoliated cells of anal canal were collected by cotton swab to detect HPV,and 3 tubes of elbow venous blood were collected for HIV and HBV detection.Two consecutive follow-up visits by MSM with positive HPV DNA means persistent HPV infection.The risk factors of HPV persistent infection were preliminarily analyzed by multi-factor Logistic regression.Based on this,the mediating factors of HPV persistent infection were analyzed by using the mediating analysis model with causal logic,and the mediating effect value was calculated.Results:A total of 678 HIV-negative MSM were recruited at baseline,and 517 HBV serological tests were completed.The baseline HPV infection rate was 49.3%(334/678),the high-risk type HPV infection rate was 22.4%(152/678),the low-risk type HPV infection rate was 13.0%(88/678),HPV mix infection rate was 13.9%(94/678),and the baseline HBsAg-positive rate was 37%(accounting for 7.1%).427 MSM were followed up for two consecutive times,with a total of 135(31.6%)cases of persistent infection.There was a statistical difference between HPV persistent infection and non-infection in different nationalities,multiple sexual partners in recent 6 months,sexual roles and recreational drug use(respectively x~2=9.810,P=0.002;x~2=7.916,P=0.005;x~2=14.602,P<0.01;x~2=4.660,P=0.031);according to specific types of distribution:the persistent infection rates of HPV16,HPV39 and HPV52 were 3.0%,1.9%and 1.6%,respectively in high-risk group,while the persistent infection rates of HPV6,HPV11 and HPV61 were3.2%,1.2%,0.9%,respectively in low-risk group.Multivariate logistic regression analysis showed that education level above undergraduate level(aOR=0.549,95%CI:0.315~0.958),in the sex behavior,mainly insertive of MSM compared with the mainly receptive have low risk of HPV persistent infection(aOR=0.438,95%CI:0.286~0.671);multiple sexual partners(aOR=1.789,95%CI:1.170~2.737)in the past 6 months were risk factors for HPV persistent infection.Mediation analysis showed that the use rate of recreational drugs was33.5%(143/427).The use rate of recreational drugs had a significantly statistical difference among the different educational levels,age of first sexual behavior,multiple sexual partners in recent 6 months,anal intercourse with homosexuals and persistent HPV infection(P<0.05).There was a mediating effect between the use of recreational drugs and persistent HPV infection.The median effect value was 54.97%.Conclusion:HIV-negative MSM in Urumqi have a higher HPV infection rate and HBV infection rate than those in the normal people,and have higher persistent HPV infection rate.Education level,sexual role and multiple sexual partners are risk factors for HPV persistent infection.Multiple sexual partners play an intermediary role between recreational drug use and HPV persistent infection.