Pre-exposure prophylaxis (PrEP) for HIV prevention has been shown to be an effective strategy and is indicated for people at increased risk for infection from sexual contact or injection drug use. “Rates of HPV disease, specifically oropharyngeal and anal cancer, are higher among men who have sex with men (MSM),” says Paul B. Rotert, DO, MPH, AAHIVS. “However, rates of HPV vaccination and knowledge of vaccine benefits are lower among MSM than among other populations. Patients on PrEP show a strong desire to prevent HIV infection and could benefit from clinicians partnering HIV and HPV prevention efforts.”

For a study published in the Journal of Primary Care Community Health, Dr. Rotert and colleagues performed a retrospective chart review of patients on PrEP to determine vaccine status and their history of HPV-related disease. The authors also reviewed the relationships between vaccination status and age, provider type, and insurance coverage. “The goal of our analysis was to better understand HPV vaccination and disease rates for patients on PrEP,” Dr. Rotert says. “We wanted to highlight this opportunity to capitalize on the culture of prevention among patients on PrEP to help prevent HPV-associated disease.”

Vaccination Rates Suboptimal Despite Frequent Encounters

According to the study results, just 21.8% of the patients on PrEP identified in the study were vaccinated for HPV. “Only 28.8% of patients on PrEP who were younger than 45 were vaccinated against HPV,” says Dr. Rotert (Figure). “In addition, people aged 9-26 were three times more likely to be vaccinated against HPV than those aged 27-45 (56.3% vs 18.6%). This occurred despite ongoing risk of HPV infection among this patient population and frequent interactions with the healthcare system during PrEP appointments.”

Findings from the study suggest that, despite frequent interactions with the medical system during PrEP appointments, many of these individuals are still not being vaccinated against HPV. This is a significant missed opportunity to partner HIV and HPV prevention efforts and to help avoid HPV complications for patients taking PrEP, according to Dr. Rotert. These data can help clinicians and insurance companies recognize the continued need to promote use of the HPV vaccine to this vulnerable patient population.

Targeting HPV Vaccination to Patients on PrEP Warranted

Based on the study results, clinicians are urged to take steps to increase knowledge on the health effects of HPV infection, especially among MSM, to increase HPV vaccination uptake. Furthermore, interventions like decision aids and other patient education tools can facilitate shared clinical decision making. HPV vaccination should be encouraged in all eligible patients on PrEP, says Dr. Rotert.

“Healthcare professionals should be aware that the HPV vaccine is FDA approved for individuals aged 9-45, but many people aged 27-45 years missed the HPV vaccination during their adolescence,” Dr. Rotert explains. “Primary care clinics can benefit from instituting HPV vaccination programs that target patients on PrEP and individuals aged 27-45 at risk for ongoing HPV exposure.” These patients should be informed about the availability of HPV vaccination and collaborate with their healthcare professionals when deciding on care. In addition, PrEP education on anal cancer risk factors, prevention, and the availability of secondary screening may be required for MSM.

Dr. Rotert expects future research to identify and evaluate HPV vaccine implementation strategies that address patient and provider education, clinic workflows, and insurance coverage. “This is especially important for individuals aged 27-45,” He adds. “Uncertainty in insurance approval can also lead to delayed or incomplete vaccination. As such, research is needed on how these factors can affect HPV vaccination efforts.” Interventions are also needed to address gaps in vaccine surveillance among PrEP patients.