The association between body mass index and anal canal human papillomavirus prevalence and persistence: the HIM study

Figures & data

Table 1. Selected baseline characteristics of men who have sex with men (MSM) and men who have sex with women (MSW) by BMI in the HIM study, No. (%).

Variable	MSM (n = 328)^a			MSW (n = 1348)^b
	Normal weight (n = 183)	Overweight (n = 102)	Obese (n = 43)	Normal weight (n = 556)	Overweight (n = 531)	Obese (n = 261)
Age, y
18–24	51 (27.9)	18 (17.6)	6 (14.0)	217 (39.0)	98 (18.5)	45 (17.2)
25–34	79 (43.2)	32 (31.4)	11 (25.6)	181 (32.6)	164 (30.9)	68 (26.1)
35–44	46 (25.1)	33 (32.4)	20 (46.5)	107 (19.2)	160 (30.1)	85 (32.6)
45–70	7 (3.8)	19 (18.6)	6 (14.0)	51 (9.2)	109 (20.5)	63 (24.1)
Median (range)	29 (18–55)	35 (18–62)	36 (18–61)	28 (18–70)	35 (18–70)	36 (18–70)
City
São Paulo	125 (68.3)	65 (63.7)	29 (67.4)	180 (32.4)	140 (26.4)	56 (21.5)
Cuernavaca	28 (15.3)	22 (21.6)	4 (9.3)	177 (31.8)	231 (43.5)	89 (34.1)
Tampa	30 (16.4)	15 (14.7)	10 (23.3)	199 (35.8)	160 (30.1)	116 (44.4)
Race
White	109 (59.6)	63 (61.8)	25 (58.1)	250 (45.0)	224 (42.2)	110 (42.1)
Black	39 (21.3)	15 (14.7)	10 (23.3)	79 (14.2)	53 (10.0)	46 (17.6)
Other	33 (18.0)	23 (22.5)	8 (18.6)	222 (39.9)	244 (46.0)	105 (40.2)
Refuse/Missing^c	2 (1.1)	1 (1.0)	0 (0.0)	5 (0.9)	10 (1.9)	0 (0.0)
Ethnicity
Hispanic	78 (42.6)	41 (40.2)	11 (25.6)	250 (45.0)	284 (53.5)	113 (43.3)
Non-Hispanic	101 (55.2)	59 (57.8)	32 (74.4)	301 (54.1)	243 (45.8)	145 (55.6)
Refuse/Missing	4 (2.2)	2 (2.0)	0 (0.0)	5 (0.9)	4 (0.8)	3 (1.1)
Duration of relationship with primary sex partner, y
No relationship	87 (47.5)	39 (38.2)	14 (32.6)	125 (22.5)	77 (14.5)	41 (15.7)
<1	39 (21.3)	13 (12.7)	8 (18.6)	126 (22.7)	77 (14.5)	37 (14.2)
1–5	32 (17.5)	21 (20.6)	7 (16.3)	123 (22.1)	120 (22.6)	58 (22.2)
>5	20 (10.9)	26 (25.5)	10 (23.3)	136 (24.5)	213 (40.1)	112 (42.9)
Refuse/Missing	5 (2.7)	3 (2.9)	4 (9.3)	46 (8.3)	44 (8.3)	13 (5.0)
Years of school
<12	31 (16.9)	19 (18.6)	9 (20.9)	105 (18.9)	131 (24.7)	47 (18.0)
12	51 (27.9)	21 (20.6)	13 (30.2)	147 (26.4)	133 (25.0)	53 (20.3)
13–15	47 (25.7)	26 (25.5)	6 (14.0)	156 (28.1)	105 (19.8)	81 (31.0)
≥16	53 (29.0)	36 (35.3)	15 (34.9)	145 (26.1)	162 (30.5)	80 (30.7)
Refuse/Missing	1 (0.5)	0 (0.0)	0 (0.0)	3 (0.5)	0 (0.0)	0 (0.0)
Cigarette smoking status
Never smoker	109 (59.6)	55 (53.9)	25 (58.1)	345 (62.1)	283 (53.3)	133 (51.0)
Former smoker	23 (12.6)	24 (23.5)	10 (23.3)	72 (12.9)	131 (24.7)	78 (29.9)
Current smoker	51 (27.9)	23 (22.5)	8 (18.6)	139 (25.0)	117 (22.0)	50 (19.2)
No. of male anal sex partners in the last 3 mo
0	61 (33.3)	40 (39.2)	21 (48.8)	552 (99.3)	527 (99.2)	256 (98.1)
1	41 (22.4)	27 (26.5)	12 (27.9)	0 (0.0)	0 (0.0)	0 (0.0)
≥2	74 (40.4)	27 (26.5)	8 (18.6)	0 (0.0)	0 (0.0)	0 (0.0)
Refuse/Missing	7 (3.8)	8 (7.8)	2 (4.7)	4 (0.7)	4 (0.8)	5 (1.9)
Median (range)	1 (0–150)	1 (0–150)	0 (0–9)	0 (0–0)	0 (0–0)	0 (0–0)
No. of female sex partners in the last 6 mo
0	115 (62.8)	59 (57.8)	28 (65.1)	158 (28.4)	158 (29.8)	68 (26.1)
1	24 (13.1)	20 (19.6)	6 (14.0)	245 (44.1)	244 (46.0)	139 (53.3)
≥2	36 (19.7)	19 (18.6)	8 (18.6)	135 (24.3)	112 (21.1)	50 (19.2)
Refuse/Missing	8 (4.4)	4 (3.9)	1 (2.3)	18 (3.2)	17 (3.2)	4 (1.5)
Median (range)	0 (0–30)	0 (0–20)	0 (0–4)	1 (0–15)	1 (0–15)	1 (0–7)

^aFor MSM, the ${\chi }^2$ or Fisher’s exact tests P values stratified by BMI were greater than 0.05 for all variables, except for age (P < 0.001), duration of relationship with primary sex partner (P = 0.02), and number of male anal sex partners in the last 3 months (P = 0.04). Responses that were “Refuse/Missing” were not included in hypothesis testing.

^bFor MSW, the ${\chi }^2$ or Fisher’s exact tests P values stratified by BMI were less than 0.05 for all variables, except for number of female sex partners in the last 6 month (P = 0.16).

^c“Other” represents: American Indian, Native Hawaiian, Asian, Mestizo, and more than one race.

^d“Refuse/Missing” were not included in hypothesis testing.

Table 2. Prevalence of anal canal HPV infection among men who have sex with men (MSM) by BMI in the HIM study.

HPV type^a	No. % (95% CI)
	Normal weight (n = 183)			Overweight (n = 102)			Obese (n = 43)			Total (n = 328)
Any HPV type	109	59.6	(52.1–66.7)	49	48.0	(38.0–58.2)	17	39.5	(25.0–55.6)	175	53.4	(47.8–58.9)
Any high-risk type	70	38.3	(31.2–45.7)	32	31.4	(22.5–41.3)	10	23.3	(11.8–38.6)	112	34.1	(29.0–39.6)
Any low-risk type	87	47.5	(40.1–55.0)	40	39.2	(29.7–49.4)	12	27.9	(15.3–43.7)	139	42.4	(37.0–47.9)
2vHPV types	32	17.5	(12.3–23.8)	10	9.8	(4.8–17.3)	5	11.6	(3.9–25.1)	47	14.3	(10.7–18.6)
4vHPV types	49	26.8	(20.5–33.8)	19	18.6	(11.6–27.6)	7	16.3	(6.8–30.7)	75	22.9	(18.4–27.8)
9vHPV types	64	35.0	(28.1–42.4)	25	24.5	(16.5–34.0)	8	18.6	(8.4–33.4)	97	29.6	(24.7–34.8)
High-risk types
16	21	11.5	(7.2–17.0)	7	6.9	(2.8–13.6)	2	4.7	(0.6–15.8)	30	9.1	(6.3–12.8)
18	12	6.6	(3.4–11.2)	3	2.9	(0.6–8.4)	3	7.0	(1.5–19.1)	18	5.5	(3.3–8.5)
31	4	2.2	(0.6–5.5)	1	1.0	(0.0–5.3)	0	0.0	(0.0–8.2)	5	1.5	(0.5–3.5)
33	6	3.3	(1.2–7.0)	1	1.0	(0.0–5.3)	0	0.0	(0.0–8.2)	7	2.1	(0.9–4.3)
45	13	7.1	(3.8–11.8)	3	2.9	(0.6–8.4)	0	0.0	(0.0–8.2)	16	4.9	(2.8–7.8)
51	10	5.5	(2.7–9.8)	7	6.9	(2.8–13.6)	3	7.0	(1.5–19.1)	20	6.1	(3.8–9.3)
52	1	0.5	(0.0–3.0)	8	7.8	(3.4–14.9)	1	2.3	(0.1–12.3)	10	3.0	(1.5–5.5)
58	4	2.2	(0.6–5.5)	2	2.0	(0.2–6.9)	1	2.3	(0.1–12.3)	7	2.1	(0.9–4.3)
Low-risk types
6	19	10.4	(6.4–15.7)	7	6.9	(2.8–13.6)	3	7.0	(1.5–19.1)	29	8.8	(6.0–12.5)
11	3	1.6	(0.3–4.7)	3	2.9	(0.6–8.4)	1	2.3	(0.1–12.3)	7	2.1	(0.9–4.3)
53	14	7.7	(4.2–12.5)	10	9.8	(4.8–17.3)	4	9.3	(2.6–22.1)	28	8.5	(5.7–12.1)
61	10	5.5	(2.7–9.8)	6	5.9	(2.2–12.4)	1	2.3	(0.1–12.3)	17	5.2	(3.0–8.2)
62	12	6.6	(3.4–11.2)	3	2.9	(0.6–8.4)	0	0.0	(0.0–8.2)	15	4.6	(2.6–7.4)
70	8	4.4	(1.9–8.4)	1	1.0	(0.0–5.3)	5	11.6	(3.9–25.1)	14	4.3	(2.4–7.1)
73	5	2.7	(0.9–6.3)	8	7.8	(3.4–14.9)	1	2.3	(0.1–12.3)	14	4.3	(2.4–7.1)
81	10	5.5	(2.7–9.8)	5	4.9	(1.6–11.1)	1	2.3	(0.1–12.3)	16	4.9	(2.8–7.8)
82	5	2.7	(0.9–6.3)	0	0.0	(0.0–3.6)	3	7.0	(1.5–19.1)	8	2.4	(1.1–4.7)
84	23	12.6	(8.1–18.3)	7	6.9	(2.8–13.6)	3	7.0	(1.5–19.1)	33	10.1	(7.0–13.8)
89	12	6.6	(3.4–11.2)	5	4.9	(1.6–11.1)	1	2.3	(0.1–12.3)	18	5.5	(3.3–8.5)

^aHPV genotypes shown are those in the 9vHPV vaccine and those with prevalence of $\ge$ 5.0% for any BMI category.

Table 3. Prevalence of anal canal HPV infection among men who have sex with women (MSW) by BMI in the HIM study.

	No. % (95% CI)
HPV type^a	Normal weight (n = 556)			Overweight (n = 531)			Obese (n = 261)			Total (n = 1348)
Any HPV type	66	11.9	(9.3–14.9)	73;13.7		(10.9–17.0)	28	10.7	(7.2–15.1)	167	12.4	(10.7–14.3)
Any high-risk type	38	6.8	(4.9–9.3)	40	7.5	(5.4–10.1)	15	5.7	(3.3–9.3)	93	6.9	(5.6–8.4)
Any low-risk type	39	7.0	(5.0–9.5)	48	9.0	(6.7–11.8)	16	6.1	(3.5–9.8)	103	7.6	(6.3–9.2)
2vHPV types	8	1.4	(0.6–2.8)	15	2.8	(1.6–4.6)	8	3.1	(1.3–5.9)	31	2.3	(1.6–3.2)
4vHPV types	13	2.3	(1.3–4.0)	23	4.3	(2.8–6.4)	13	5.0	(2.7–8.4)	49	3.6	(2.7–4.8)
9vHPV types	22	4.0	(2.5–5.9)	33	6.2	(4.3–8.6)	15	5.7	(3.3–9.3)	70	5.2	(4.1–6.5)
High-risk types
16	7	1.3	(0.5–2.6)	14	2.6	(1.4–4.4)	8	3.1	(1.3–5.9)	29	2.2	(1.4–3.1)
18	1	0.2	(0.0–1.0)	1	0.2	(0.0–1.0)	0	0.0	(0.0–1.4)	2	0.1	(0.0–0.5)
31	0	0.0	(0.0–0.7)	4	0.8	(0.2–1.9)	0	0.0	(0.0–1.4)	4	0.3	(0.1–0.8)
33	2	0.4	(0.0–1.3)	0	0.0	(0.0–0.7)	0	0.0	(0.0–1.4)	2	0.1	(0.0–0.5)
45	3	0.5	(0.1–1.6)	2	0.4	(0.0–1.4)	0	0.0	(0.0–1.4)	5	0.4	(0.1–0.9)
52	3	0.5	(0.1–1.6)	2	0.4	(0.0–1.4)	0	0.0	(0.0–1.4)	5	0.4	(0.1–0.9)
58	2	0.4	(0.0–1.3)	2	0.4	(0.0–1.4)	2	0.8	(0.1–2.7)	6	0.4	(0.2–1.0)
Low-risk types
6	6	1.1	(0.4–2.3)	10	1.9	(0.9–3.4)	4	1.5	(0.4–3.9)	20	1.5	(0.9–2.3)
11	0	0.0	(0.0–0.7)	0	0.0	(0.0–0.7)	1	0.4	(0.0–2.1)	1	0.1	(0.0–0.4)

^a HPV genotypes shown are those in the 9vHPV vaccine and those with prevalence of $\ge$ 5.0% for any BMI category.

Figure 1. Prevalence of six-month persistence for 9vHPV and 4vHPV vaccine types among men who have sex with men (MSM) and men who have sex with women (MSW) stratified by body mass index (BMI).

Table 4. Association between BMI and anal HPV prevalence in the human papillomavirus infection in men study adjusted for age, city and number of recent sexual partners.

	Men who have sex with women^a
	High risk			9vHPV			4vHPV			HPV-16
BMI	PR	aPR	95% CI	PR	aPR	95% CI	PR	aPR	95% CI	PR	aPR	95% CI
Normal	1.0	1.0	–	1.0	1.0	–	1.0	1.0	–	1.0	1.0	–
Overweight	1.10	1.21	0.76–1.93	1.57	1.73	0.98–3.06	1.85	1.97	0.96–4.01	2.09	2.40	0.93–6.15
Obese	0.84	0.95	0.52–1.74	1.45	1.41	0.71–2.79	2.13	1.82	0.82–4.04	2.43	2.23	0.81–6.12
Continuous BMI	1.00	1.01	0.96–1.06	1.03	1.03	0.98–1.08	1.05	1.04	0.98–1.09	1.05	1.03	0.96–1.11
Normal	1.0	1.0	–	1.0	1.0	–	1.0	1.0	–	1.0	1.0	–
Overweight	0.82	0.97	0.69–1.36	0.70	0.82	0.55–1.22	0.70	0.81	0.51–1.29	0.60	0.75	0.33–1.72
Obese	0.61	0.71	0.40–1.26	0.53	0.60	0.31–1.17	0.61	0.69	0.33–1.44	0.41	0.52	0.14–2.02
Continuous BMI	0.96	0.98	0.94–1.01	0.95	0.96	0.92–1.01	0.96	0.97	0.92–1.02	0.91	0.94	0.85–1.04

Figure 2. Enrollment flow chart.