Shilaih Mohaned, Marzel Alex, Braun Dominique L, Scherrer Alexandra U, Kovari Helen, Young Jim, Calmy Alexandra, Darling Katharine, Battegay Manuel, Hoffmann Matthias, Bernasconi Enos, Thurnheer Maria C, Günthard Huldrych F, Kouyos Roger D
aDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich bInstitute of Medical Virology, University of Zurich, Zurich cBasel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel dInfectious Diseases Department, Genève University Hospital, Genève eInfectious Diseases Department, Lausanne University Hospital, Lausanne fDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel gDivision of Infectious Diseases and Hospital Epidemiology, Kantonal Hospital St. Gallen, St. Gallen hDivision of Infectious Diseases, Regional Hospital Lugano, Lugano iDepartment of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Medicine (Baltimore). 2017 Jan;96(2):e5849. doi: 10.1097/MD.0000000000005849.
After several years of steady decline, syphilis is reemerging globally as a public health hazard, especially among people living with human immunodeficiency virus (HIV). Syphilis resurgence is observed mainly in men who have sex with men (MSM), yet other transmission groups are affected too. In this manuscript, we study the factors associated with syphilis incidence in the Swiss HIV cohort study in the era of highly effective antiretrovirals. Using parametric interval censored models with fixed and time-varying covariates, we studied the immunological, behavioral, and treatment-related elements associated with syphilis incidence in 3 transmission groups: MSM, heterosexuals, and intravenous drug users. Syphilis incidence has been increasing annually since 2005, with up to 74 incident cases per 1000 person-years in 2013, with MSM being the population with the highest burden (92% of cases). While antiretroviral treatment (ART) in general did not affect syphilis incidence, nevirapine (NVP) was associated with a lower hazard of syphilis incidence (multivariable hazard ratio 0.5, 95% confidence interval 0.2-1.0). We observed that condomless sex and younger age were associated with higher syphilis incidence. Moreover, time-updated CD4, nadir CD4, and CD8 cell counts were not associated with syphilis incidence. Finally, testing frequency higher than the recommended once a year routine testing was associated with a 2-fold higher risk of acquiring syphilis. Condomless sex is the main driver of syphilis resurgence in the Swiss HIV Cohort study; ART and immune reconstitution provide no protection against syphilis. This entails targeted interventions and frequent screening of high-risk populations. There is no known effect of NVP on syphilis; therefore, further clinical, epidemiological, and microbiological investigation is necessary to validate our observation.
经过数年的稳步下降后，梅毒作为一种公共卫生危害正在全球重新出现，尤其是在感染人类免疫缺陷病毒（HIV）的人群中。梅毒复发主要见于男男性行为者（MSM），但其他传播群体也受到影响。在本论文中，我们在高效抗逆转录病毒治疗时代的瑞士HIV队列研究中，研究了与梅毒发病率相关的因素。使用具有固定和随时间变化协变量的参数区间删失模型，我们研究了3个传播群体（MSM、异性恋者和静脉吸毒者）中与梅毒发病率相关的免疫、行为和治疗相关因素。自2005年以来，梅毒发病率每年都在上升，2013年每1000人年高达74例新发病例，MSM是负担最重的人群（占病例的92%）。虽然一般来说抗逆转录病毒治疗（ART）不影响梅毒发病率，但奈韦拉平（NVP）与较低的梅毒发病风险相关（多变量风险比0.5，95%置信区间0.2 - 1.0）。我们观察到无保护性行为和较年轻的年龄与较高的梅毒发病率相关。此外，随时间更新的CD4、最低CD4和CD8细胞计数与梅毒发病率无关。最后，检测频率高于推荐的每年一次常规检测与感染梅毒的风险高出2倍相关。在瑞士HIV队列研究中，无保护性行为是梅毒复发的主要驱动因素；ART和免疫重建并不能预防梅毒。这需要针对高危人群进行有针对性的干预和频繁筛查。目前尚不清楚NVP对梅毒有何影响；因此，需要进一步进行临床、流行病学和微生物学调查来验证我们的观察结果。
