In the most recent issue of the journal Sexually Transmitted Diseases, a group of Spanish researchers published a fascinating study about the natural history of HPV in HIV positive men. The study, which followed a group of 700 men over the course of a year, looked to see how many men developed HPV infections of the anus, penis, or throat (incidence); what percentage of men came into the study with such infections (prevalence); and whether the infections men had at the beginning of the study were transient or lasted through the entire study period (clearance).
The results of the study were tabulated separately for heterosexual men and men who have sex with men, and they were quite interesting. Eighty-four percent of MSM came into the study with anal HPV infection, compared to only 42 percent of heterosexual men. Furthermore, MSM were not only more likely to be infected with HPV, they were less likely to clear an infection. This was almost certainly because infections were far more often caused by high-risk genotypes. In contrast, prevalence of penile and oral HPV infections were similar for both groups - at around 26 percent and 18 percent respectively - although MSM were more likely to get new penile HPV infections.
That said, I do want to go back to the fact that 42 percent of heterosexual HIV positive men were infected with anal HPV at the start of the study. That's a non-trivial number, far higher than the prevalence at either of the other two primary male infection sites. Although most of the infections were with low-risk subtypes, it does suggest that that doctors may want to consider broadening their anal health screenings to all HIV positive individuals, even when they don't practice receptive anal sex.