Introduction: Infection with human papillomavirus (HPV), particularly high-risk types (HR-HPV), is an important cause of anogenital and head and neck cancers among both solid organ transplant recipients and HIV-infected patients. There is little data in dually-immunosuppressed HIV-infected transplant patients. We aimed to determine the prevalence, incidence and determinants of anal HPV infection in this population.
Methods: We enrolled HIV-infected patients in a multi-center study prior to transplantation. We collected baseline demographic, medical and behavioral information. We assessed anal HPV6/11/16/18/31/33/35/39/45/51/52/56/58/59 DNA by polymerase chain reaction at baseline, then at 6, 12 and 24 months post-transplant.
Results: Of 86 HIV-infected patients, 90% were male, 53% were men who had sex with men (MSM), 79% were white; 66% underwent liver and 34% kidney transplantation. The median age was 49 (IQR, 44-54). Nineteen percent reported a prior opportunistic infection, and 48% were Hepatitis C (HCV) infected. The median CD4+ prior to transplantation was 172 (IQR, 252-563). At baseline, 71% were infected with anal HPV and 38% were infected with HR-HPV. In a multivariable model, MSM behavior was associated with baseline HR-HPV (OR 3.0, 95% CI, 1.2-7.5). Among liver recipients, HCV infection was associated with lower HR-HPV prevalence (OR 0.2, 95% CI 0.1-0.7). Of those HR-HPV uninfected at the time of transplantation, 5% (95% CI, 1-28); 43% (95% CI, 25-66) and 67% (95% CI, 43-90) were infected by 6, 12 and 24 months post-transplant. 
Conclusions: Anal HPV-infection is common in a pre-transplant population of immune reconstituted HIV-infected patients. Even if not present at the time of transplantation, by 2 years, 67% of patients had incident anal HR-HPV detected. Efforts to vaccine eligible patients prior to transplantation and anal cancer screening programs should be prioritized.