Prevalence and risk factors associated with HIV and syphilis co‑infection in the African Cohort Study: a cross‑sectional study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Infectious Diseases
Abstract
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.
Description
Keywords
Human immunodeficiency virus (HIV), Syphilis, Africa
Citation
Gilbert, L., Dear, N., Esber, A., Iroezindu, M., Bahemana, E., Kibuuka, H., ... & Ake, J. A. (2021). Prevalence and risk factors associated with HIV and syphilis co-infection in the African Cohort Study: a cross-sectional study. BMC Infectious Diseases, 21(1), 1-7. https://doi.org/10.1186/s12879-021-06668-6