Roth Jan A, Franzeck Fabian C, Balakrishna Suraj, Lautenschlager Stephan, Thurnheer Maria Christine, Trellu Laurence Toutous, Cavassini Matthias, Vernazza Pietro, Bernasconi Enos, Braun Dominique, Kouyos Roger D, Battegay Manuel
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland.
Open Forum Infect Dis. 2020 Jan 12;7(1):ofaa019. doi: 10.1093/ofid/ofaa019. eCollection 2020 Jan.
Syphilis is re-emerging globally in general and HIV-infected populations, and repeated syphilis episodes may play a central role in syphilis transmission among core groups. Besides sexual behavioral factors, little is known about determinants of repeated syphilis episodes in HIV-infected individuals-including the potential impact of preceding syphilis episodes on subsequent syphilis risk.
In the prospective Swiss HIV cohort study, with routine syphilis testing since 2004, we analyzed HIV-infected men who have sex with men (MSM). Our primary outcome was first and repeated syphilis episodes. We used univariable and multivariable Andersen-Gill models to evaluate risk factors for first and repeated incident syphilis episodes.
Within the 14-year observation period, we included 2513 HIV-infected MSM with an initially negative syphilis test. In the univariable and multivariable analysis, the number of prior syphilis episodes (adjusted hazard ratio [aHR] per 1-episode increase, 1.15; 95% confidence interval [CI], 1.01-1.31), having occasional sexual partners with or without condomless anal sex (aHR, 4.99; 95% CI, 4.08-6.11; and aHR, 2.54; 95% CI, 2.10-3.07), and being currently on antiretroviral therapy (aHR, 1.62; 95% CI, 1.21-2.16) were associated with incident syphilis.
In HIV-infected MSM, we observed no indication of decreased syphilis risk with repeated syphilis episodes. The extent of sexual risk behavior over time was the strongest risk factor for repeated syphilis episodes. The observed association of antiretroviral therapy with repeated syphilis episodes warrants further immunological and epidemiological investigation.
梅毒在全球普通人群和艾滋病毒感染人群中再度流行，而梅毒反复发病可能在核心群体的梅毒传播中起关键作用。除性行为因素外，对于艾滋病毒感染者梅毒反复发病的决定因素知之甚少，包括先前梅毒发病对后续梅毒风险的潜在影响。
在自2004年起进行常规梅毒检测的瑞士艾滋病毒前瞻性队列研究中，我们分析了男男性行为者（MSM）艾滋病毒感染者。我们的主要结局是首次和反复梅毒发病。我们使用单变量和多变量安德森-吉尔模型来评估首次和反复发生梅毒发病的危险因素。
在14年的观察期内，我们纳入了2513名梅毒检测初筛阴性的艾滋病毒感染男男性行为者。在单变量和多变量分析中，既往梅毒发病次数（每增加1次发病的调整风险比[aHR]为1.15；95%置信区间[CI]为1.01-1.31）、有偶尔性伴侣且有无无保护肛交行为（aHR为4.99；95%CI为4.08-6.11；以及aHR为2.54；95%CI为2.10-3.07），以及目前正在接受抗逆转录病毒治疗（aHR为1.62；95%CI为1.21-2.16）均与梅毒发病相关。
在艾滋病毒感染的男男性行为者中，我们未观察到梅毒反复发病会降低梅毒风险的迹象。随着时间推移性风险行为的程度是梅毒反复发病的最强危险因素。观察到的抗逆转录病毒治疗与梅毒反复发病之间的关联值得进一步的免疫学和流行病学调查。
