U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA.
BMC Infect Dis. 2021 Oct 30;21(1):1123. doi: 10.1186/s12879-021-06668-6.
Each year, 5.6 million new syphilis cases are diagnosed globally. Guidelines for people living with HIV (PLWH) in low-income countries (LIC) recommend STI testing for symptomatic persons and those newly diagnosed with HIV; routine STI testing is less clear. Here we provide updated syphilis prevalence and identify co-infection risk factors in PLWH in the African Cohort Study (AFRICOS) to understand these rates as they relate to syndromic treatment.
AFRICOS is a study enrolling PLWH and HIV-uninfected individuals in four African countries. Participant study enrollment information was used to determine syphilis prevalence and co-infection risk factors. Inclusion criteria consisted of adults 18 years or older receiving care at a participating clinic as a long-term resident who consented to data and specimen collection. Exclusion criteria consisted of pregnancy and/or imprisonment. Screen-positive syphilis was defined as a reactive rapid plasma regain (RPR) upon study enrollment whereas confirmed syphilis included a reactive RPR followed by reactive treponemal test. Multivariate analyses was performed to determine HIV and syphilis co-infection risk factors.
Between 2013 and March 1, 2020, 2939 PLWH enrolled and 2818 were included for analysis. Screen-positive and confirmed syphilis prevalence were 5.3% (151/2818) and 3.1% (87/2818), respectively. When the analysis was restricted to PLWH with an RPR titer of greater than, or equal to, 1:8, 11/87 (12.6%) participants were included. No PLWH and confirmed syphilis had documented genital ulcers. In the multivariate model, participants with confirmed syphilis co-infection were more likely to have none or some primary education [aOR 3.29 (1.60, 6.74)] and consume alcohol [aOR 1.87 (1.16, 3.03)] compared to those without syphilis. Antiretroviral therapy (ART) with suppressed viral load (VL) was protective in the unadjusted model but not adjusted multivariate model.
Our findings show that syphilis rates in sub-Saharan Africa remain elevated where diagnosis remains challenging, and that both lower education level and alcohol consumption are significantly associated with HIV/syphilis co-infection in AFRICOS. Based on our analysis, current STI guidelines targeting testing for African individuals with either new HIV diagnosis or syndromic symptoms may be inadequate, highlighting the need for increased testing and treatment strategies in resource-limited settings.
每年，全球有 560 万例新的梅毒病例被诊断出来。在低收入国家（LIC），针对艾滋病毒感染者（PLWH）的指南建议对有症状者和新诊断为 HIV 的患者进行性传播感染（STI）检测；常规 STI 检测则不太明确。在这里，我们提供了更新的梅毒患病率，并确定了 AFRICOS 中 PLWH 中的合并感染危险因素，以了解这些与综合征治疗相关的比率。
AFRICOS 是一项在四个非洲国家招募 PLWH 和 HIV 未感染者的研究。参与者的研究登记信息用于确定梅毒的患病率和合并感染的危险因素。纳入标准包括在参与诊所接受长期护理的年龄在 18 岁或以上的成年人，他们同意进行数据和标本采集。排除标准包括怀孕和/或监禁。筛查阳性梅毒定义为研究登记时的快速血浆反应素（RPR）呈阳性，而确诊梅毒包括 RPR 阳性后出现梅毒螺旋体试验阳性。进行多变量分析以确定 HIV 和梅毒合并感染的危险因素。
2013 年至 2020 年 3 月 1 日，共有 2939 名 PLWH 登记，2818 名符合条件进行分析。筛查阳性和确诊梅毒的患病率分别为 5.3%（151/2818）和 3.1%（87/2818）。当分析仅限于 RPR 滴度大于或等于 1:8 的 PLWH 时，有 11/87（12.6%）的参与者被纳入。没有 PLWH 和确诊梅毒有记录的生殖器溃疡。在多变量模型中，合并感染确诊梅毒的参与者更有可能接受过无或部分小学教育[aOR 3.29（1.60，6.74）]和饮酒[aOR 1.87（1.16，3.03）]，而未感染梅毒的参与者则更有可能接受过无或部分小学教育[aOR 3.29（1.60，6.74）]和饮酒[aOR 1.87（1.16，3.03）]。未调整的模型显示，接受抗逆转录病毒治疗（ART）并抑制病毒载量（VL）具有保护作用，但在调整后的多变量模型中则没有。
我们的研究结果表明，撒哈拉以南非洲地区的梅毒发病率仍然很高，而诊断仍然具有挑战性，而且在 AFRICOS 中，较低的教育水平和饮酒均与 HIV/梅毒合并感染显著相关。基于我们的分析，目前针对非洲新诊断为 HIV 或出现综合征症状的个体的性传播感染检测指南可能不够充分，这突出表明在资源有限的情况下需要增加检测和治疗策略。
