Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional study
Abstract Background 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 update...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-021-06668-6 |
| _version_ | 1818892348754493440 |
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| author | Laura Gilbert Nicole Dear Allahna Esber Michael Iroezindu Emmanuel Bahemana Hannah Kibuuka John Owuoth Jonah Maswai Trevor A. Crowell Christina S. Polyak Julie A. Ake the AFRICOS Study Group |
| author_facet | Laura Gilbert Nicole Dear Allahna Esber Michael Iroezindu Emmanuel Bahemana Hannah Kibuuka John Owuoth Jonah Maswai Trevor A. Crowell Christina S. Polyak Julie A. Ake the AFRICOS Study Group |
| author_sort | Laura Gilbert |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-12-19T17:55:17Z |
| format | Article |
| id | doaj.art-15339518b8bb406399d1c3e664483979 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-19T17:55:17Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-15339518b8bb406399d1c3e6644839792022-12-21T20:11:50ZengBMCBMC Infectious Diseases1471-23342021-10-012111710.1186/s12879-021-06668-6Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional studyLaura Gilbert0Nicole Dear1Allahna Esber2Michael Iroezindu3Emmanuel Bahemana4Hannah Kibuuka5John Owuoth6Jonah Maswai7Trevor A. Crowell8Christina S. Polyak9Julie A. Ake10the AFRICOS Study GroupU.S. Military HIV Research Program, Walter Reed Army Institute of ResearchU.S. Military HIV Research Program, Walter Reed Army Institute of ResearchU.S. Military HIV Research Program, Walter Reed Army Institute of ResearchU.S. Military HIV Research Program, Walter Reed Army Institute of ResearchU.S. Military HIV Research Program, Walter Reed Army Institute of ResearchMakerere University-Walter Reed ProjectU.S. Army Medical Research Directorate – AfricaU.S. Military HIV Research Program, Walter Reed Army Institute of ResearchU.S. Military HIV Research Program, Walter Reed Army Institute of ResearchU.S. Military HIV Research Program, Walter Reed Army Institute of ResearchU.S. Military HIV Research Program, Walter Reed Army Institute of ResearchAbstract Background 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. Methods 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. Results 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. Conclusions 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.https://doi.org/10.1186/s12879-021-06668-6Human immunodeficiency virus (HIV)SyphilisAfrica |
| spellingShingle | Laura Gilbert Nicole Dear Allahna Esber Michael Iroezindu Emmanuel Bahemana Hannah Kibuuka John Owuoth Jonah Maswai Trevor A. Crowell Christina S. Polyak Julie A. Ake the AFRICOS Study Group Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional study BMC Infectious Diseases Human immunodeficiency virus (HIV) Syphilis Africa |
| title | Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional study |
| title_full | Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional study |
| title_fullStr | Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional study |
| title_full_unstemmed | Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional study |
| title_short | Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional study |
| title_sort | prevalence and risk factors associated with hiv and syphilis co infection in the african cohort study a cross sectional study |
| topic | Human immunodeficiency virus (HIV) Syphilis Africa |
| url | https://doi.org/10.1186/s12879-021-06668-6 |
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