Syphilis Treatment Response Among HIV-Discordant Couples in Zambia and Rwanda

Dionne-Odom, Jodie; Karita, Etienne; Kilembe, William; Henderson, Faith L.; Vwalika, Bellington; Bayingana, Roger; Li, Zhigang; Mulenga, Joseph; Chomba, Elwyn; Rı́o, Carlos del; Khu, Naw Htee; Tichacek, Amanda; Allen, Susan

doi:10.1093/cid/cit146

Cited by 42 publications

(43 citation statements)

References 35 publications

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“…72 Similarly, penicillin therapy appeared to be effective at treating incident cases of syphilis in HIV-serodiscordant couples, irrespective of HIV status. 74 Although treatment of HSV-2 with nucleoside analogs such as acyclovir and valacyclovir has been shown to reduce the occurrence of genital ulcers among PLHIV, 73 it is unclear if these medications impact ulcer healing. 77,78 Acyclovir treatment, however, may reduce the risk of HIV disease progression (defined as CD4 <200 cells/mm 3 or WHO clinical stage 4) by as much as 16%.…”

Section: Resultsmentioning

confidence: 99%

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

Medley

Bachanas

Grillo

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction This review assesses the impact of prevention interventions for people living with HIV on HIV-related mortality, morbidity, retention in care, quality of life, and prevention of ongoing HIV transmission in resource-limited settings (RLSs). Methods We conducted a systematic review of studies reporting the results of prevention interventions for people living with HIV in RLS published between January 2000 and August 2014. Standardized methods of searching and data abstraction were used. Results Ninety-two studies met the eligibility criteria: 24 articles related to adherence counseling and support, 13 on risk reduction education and condom provision, 19 on partner HIV testing and counseling, 14 on provision of family planning services, and 22 on assessment and treatment of other sexually transmitted infections. Findings indicate good evidence that adherence counseling and sexually transmitted infection treatment can have a high impact on morbidity, whereas risk reduction education, partner HIV testing and counseling, and family planning counseling can prevent transmission of HIV. More limited evidence was found to support the impact of these interventions on retention in care and quality of life. Most studies did not report cost information, making it difficult to draw conclusions about the cost-effectiveness of these interventions. Conclusions This evidence suggests that these prevention interventions, if brought to sufficient scale and coverage, can help support and optimize the impact of core treatment and prevention interventions in RLS. Further operational research with more rigorous study designs, and ideally with biomarkers and costing information, is needed to determine the best model for providing these interventions in RLS.

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Section: Resultsmentioning

confidence: 99%

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

Medley

Bachanas

Grillo

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Several studies compared treatment responses in HIVinfected persons and HIV-uninfected persons with syphilis. The data from 2 observational cohorts in Africa suggest that HIV-infected and HIV-uninfected persons responded similarly to therapy [21]. A retrospective study by Farhi et al that compared HIV-infected and -uninfected persons with early syphilis found similar responses to therapy in both groups [26].…”

Section: Discussionmentioning

confidence: 99%

Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines: Table 1.

Ghanem¹

2015

Clin Infect Dis.

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A panel of experts generated 8 "key questions" in the management of adult syphilis. A systematic literature review was conducted and tables of evidence were constructed to answer these important questions. Penicillin is the drug of choice to treat syphilis. Doxycycline to treat early and late latent syphilis is an acceptable alternate option if penicillin cannot be used. There is no added benefit to enhanced antimicrobial therapy when treating human immunodeficiency virus-infected persons with syphilis. If a patient misses a dose of penicillin in a course of weekly therapy for late syphilis, clinical experience suggests that an interval of 10-14 days between doses might be acceptable before restarting the sequence of injections. Pharmacologic considerations suggest that an interval of 7-9 days between doses, if feasible, may be more optimal. Missed doses are not acceptable for pregnant women. A cerebrospinal fluid examination to diagnose neurosyphilis is recommended in persons diagnosed with tertiary syphilis (eg, cardiovascular syphilis or late benign syphilis), persons with neurological signs or symptoms consistent with neurosyphilis, and asymptomatic persons whose serological titers do not decline appropriately following recommended therapy and in whom reinfection is ruled out. Infection and reinfection rates, particularly among men who have sex with men, are high. Frequent serological screening of this population appears to be the most cost-efficient intervention. The Centers for Disease Control and Prevention continues to recommend the use of the traditional rapid plasma reagin-based screening algorithm. The positive predictive value for syphilis associated with an isolated unconfirmed reactive treponemal chemiluminescence assay or enzyme immunoassay is low if the epidemiological risk and clinical probability for syphilis are low. Among pregnant women with serodiscordant serologies ( positive treponemal tests and a negative nontreponemal test), the risk of vertical transmission from mother to infant is low. Several important questions regarding the management of syphilis remain unanswered and should be a priority for future research.

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“…Composite variables for genital ulceration were created from time-varying measures of chronic/recurrent or acute genital or perianal ulcers (whether diagnosed/treated at the research clinic or reported by the client); ulceration upon physical examination (including erosion or friability of the cervix or vagina in women); or newly positive rapid plasma reagin serology for syphilis [18]. Composite variables for genital inflammation were created from time-varying measures of genital inflammation, genital discharge and trichomoniasis, gonorrhea, chlamydia, candida or bacterial vaginosis [19].…”

Section: Methodsmentioning

confidence: 99%

Hormonal contraception does not increase women’s HIV acquisition risk in Zambian discordant couples, 1994–2012

et al. 2015

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Objective To determine the impact of hormonal contraceptive methods on risk of HIV acquisition among HIV-negative women cohabiting with HIV-positive male partners. Study design From 1994–2012, HIV discordant couples recruited from a couples’ voluntary HIV counseling and testing center in Lusaka, Zambia were followed longitudinally. HIV-negative partners were tested quarterly. This analysis is restricted to couples in which the man was HIV-positive and the woman was HIV-negative at enrollment and the man was not on antiretroviral treatment. Multivariate Cox models evaluated associations between time-varying contraceptive methods and HIV acquisition among women. Sensitivity analyses explored exposure misclassification and time-varying confounder mediation. Results Among 1393 couples, 252 incident infections occurred in women over 2842 couple-years (8.9 infections per 100 couple-years; 95% CI, 7.8–10.0). Multivariate Cox models indicated that neither injectable [adjusted hazard ratio (aHR)=1.2; 95% CI, 0.8–1.7], oral contraceptive pill (OCP, aHR=1.3; 95% CI, 0.9–1.8), or implant (aHR=1.1; 95% CI, 0.5–2.2) use was significantly associated with HIV acquisition relative to non-hormonal contraception controlling for woman's age, literacy and time-varying measures of genital ulceration/inflammation. This remained true when only looking at the subset of infections acquired from the spouse (82% of infections) and additionally controlling for baseline HIV viral load of the male partner, pregnancy status, and time-varying measures of sperm on a vaginal swab wet prep and self-reported unprotected sex. OCP and injectable users reported more unprotected sex (p<.001), and OCP users were more likely to have sperm on vaginal swab (p=.1) than nonhormonal method users. Conclusions We found no association between hormonal contraception and HIV acquisition risk in women. Condom use and reinforced condom counseling should always be recommended for HIV discordant couples. HIV testing of sex partners together is critical to establish HIV risk, ascertain couple fertility intentions and counsel appropriately. Implications These findings add to a controversial literature and uniquely address several common design and analytic challenges faced by previous studies. After controlling for confounders, we found no association between hormonal contraception and HIV acquisition risk in women. We support promoting condoms for HIV prevention and increasing the contraceptive method mix to decrease unintended pregnancy.

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Syphilis Treatment Response Among HIV-Discordant Couples in Zambia and Rwanda

Cited by 42 publications

References 35 publications

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

Management of Adult Syphilis: Key Questions to Inform the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines: Table 1.

Hormonal contraception does not increase women’s HIV acquisition risk in Zambian discordant couples, 1994–2012

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