Results of a 25-Year Longitudinal Analysis of the Serologic Incidence of Syphilis in a Cohort of HIV-Infected Patients With Unrestricted Access to Care

Abstract

Background The well described biological and epidemiologic associations of syphilis and HIV are particularly relevant to the military, as service members are young and at risk for sexually transmitted infections. We therefore used the results of serial serologic testing to determine the prevalence, incidence, and risk factors for incident syphilis in a cohort of HIV-infected Department of Defense beneficiaries. Methods Participants with a positive non-treponemal test at HIV diagnosis that was confirmed on treponemal testing were categorized as prevalent cases, whereas participants with an initial negative non-treponemal test who subsequently developed a confirmed positive non-treponemal test as incident cases. Results At HIV diagnosis the prevalence of syphilis was 5.8% (n=202). 4239 participants contributed 27,192 person years (PY) to the incidence analysis and 347 (8%) developed syphilis (rate 1.3/100 PY; [1.1, 1.4]). Syphilis incidence was highest during the calendar years 2006 - 2009 (2.5/100 PY; [2.0, 2.9]). In multivariate analyses, younger age (per 10 year increase HR 0.8;[0.8-0.9]); male gender (HR 5.6; [2.3-13.7]); non European-American ethnicity (African-American (HR 3.2; [2.5-4.2]; Hispanic HR 1.9; [1.2-3.0]); history of hepatitis B (HR 1.5; [1.2-1.9]) or gonorrhea (HR 1.4; [1.1 −1.8]) were associated with syphilis. Conclusions The significant burden of disease both at and after HIV diagnosis, observed in this cohort, suggests that the cost-effectiveness of extending syphilis screening to at risk military members should be assessed. In addition, HIV infected persons continue to acquire syphilis, emphasizing the continued importance of prevention for positive programs.

Gonorrhoea or chlamydia in a US military HIV-positive cohort

“…Our overall findings are consistent with reported occurrences of other STIs among HIV-positive persons in the NHS cohort, such as syphilis,28 and are consistent with STI rates in the US military 29. A recent study of the general US military population found a similar rate of CT at 11.4 per 1000 PY and a lower rate of GC at 1.98 per 1000 PY 2–10.…”

Highly Active Antiretroviral Therapy is Associated with Decreased Incidence of Sexually Transmitted Diseases in a Taiwanese HIV-Positive Population

“…In addition, enrolled subjects may visit other clinics for STD treatments, lowering the estimated STD incidence. Nevertheless, the STD rate reported here is similar to that reported in previous studies, 12,14,15,21,24,25,42,43 and represents the current scenario in Taiwan.…”

“…In addition, several reports of increasingly risky sexual behaviors in the HIV-positive population in the post-HAART era have been published. [9][10][11][12][13][14][15] Therefore, the use of HAART for HIV prevention is facing significant challenges.…”

Early syphilis affects markers of HIV infection

“…10-12 A long-term study conducted among US military personnel found that 5.8% of 4239 newly diagnosed HIV infections also had serological evidence of syphilis infections. 13 Increased prevalence of syphilis-HIV coinfections in young MSM was also reported in other regions of the world. [14][15][16][17] Whilst HIV is known to affect the course of syphilis, early syphilis also affects markers of HIV infection.…”