From the Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA.
Sex Transm Dis. 2024 Mar 1;51(3):e1-e7. doi: 10.1097/OLQ.0000000000001920. Epub 2024 Jan 3.
Syphilis is a curable sexually transmitted infection that, untreated, is associated with significant morbidity and mortality. In people living with HIV (PLWH), syphilis carries greater risks of disease progression. We estimated syphilis prevalence among PLWH in the general population in sub-Saharan Africa and compared the prevalence among PLWH and without HIV.
We searched for studies published January 1, 2011, to March 28, 2022, reporting syphilis prevalence among PLWH in sub-Saharan Africa (PROSPERO No. CRD42020167328). We excluded studies in high-risk subpopulations. We estimated pooled syphilis prevalence among PLWH using random-effects modeling and compared the prevalence with people without HIV when included in the same study. We examined influences of region, study setting, and test type in subgroup analyses.
We identified 926 studies; 53 were included in the meta-analysis. Pooled syphilis prevalence among PLWH was 7.3% (95% confidence interval [CI], 6.3%-8.5%). Prevalence differed by region: 3.1% (95% CI, 2.2%-4.0%) in Southern, 5.5% (95% CI, 2.3%-9.3%) in West/Central, and 10.5% (95% CI, 8.0%-13.1%) in Eastern Africa. Prevalence also differed by study setting: 13.8% (95% CI, 5.7%-23.0%) in sexual and reproductive health/sexually transmitted infection care, 8.7% (95% CI, 5.0%-12.8%) in HIV care, 7.1% (95% CI, 5.8%-8.5%) in antenatal care, and 3.8% (95% CI, 2.0%-5.8%) in household/community-based settings. Syphilis prevalence was higher among PLWH than without HIV (relative risk, 3.5; 95% CI, 2.8-4.5).
Syphilis is highly prevalent among PLWH in sub-Saharan Africa and is more common among PLWH than without HIV. Integration of syphilis screening and management into HIV care may reduce complications of HIV-syphilis coinfection among PLWH in sub-Saharan Africa.
梅毒是一种可治愈的性传播感染，如果不治疗，会导致严重的发病率和死亡率。在艾滋病毒感染者（PLWH）中，梅毒会增加疾病进展的风险。我们估计了撒哈拉以南非洲普通人群中 PLWH 的梅毒患病率，并比较了 PLWH 和无 HIV 感染者的患病率。
我们搜索了 2011 年 1 月 1 日至 2022 年 3 月 28 日发表的研究，报告了撒哈拉以南非洲 PLWH 的梅毒患病率（PROSPERO 编号 CRD42020167328）。我们排除了高危亚人群的研究。我们使用随机效应模型估计了 PLWH 的梅毒总患病率，并在同一研究中比较了与无 HIV 感染者的患病率。我们在亚组分析中检查了区域、研究环境和检测类型的影响。
我们确定了 926 项研究；其中 53 项被纳入荟萃分析。PLWH 的梅毒总患病率为 7.3%（95%置信区间，6.3%-8.5%）。患病率因地区而异：南部为 3.1%（95%置信区间，2.2%-4.0%），西部/中部为 5.5%（95%置信区间，2.3%-9.3%），东部为 10.5%（95%置信区间，8.0%-13.1%）。患病率也因研究环境而异：性健康/性传播感染护理中为 13.8%（95%置信区间，5.7%-23.0%），艾滋病毒护理中为 8.7%（95%置信区间，5.0%-12.8%），产前护理中为 7.1%（95%置信区间，5.8%-8.5%），家庭/社区环境中为 3.8%（95%置信区间，2.0%-5.8%）。PLWH 的梅毒患病率高于无 HIV 感染者（相对风险，3.5；95%置信区间，2.8-4.5）。
梅毒在撒哈拉以南非洲的 PLWH 中高度流行，并且在 PLWH 中比无 HIV 感染者更为常见。将梅毒筛查和管理纳入艾滋病毒护理中，可能会降低撒哈拉以南非洲 PLWH 中艾滋病毒-梅毒合并感染的并发症。
