CROI 2019—Syphilis rates balloon in HIV-positive women


  • Jim Kling
  • Conference Reports
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Takeaway

  • Syphilis infection nears 1% in HIV-infected women.
  • History of intravenous (IV) drug use and HCV infection are the best predictors of incident infection.

Why this matters

  • Heightened risk suggests all pregnant women abusing drugs should be screened for syphilis.

Study design

  • Retrospective study of the US Center for Aids Research Clinical Network of Integrated Clinical Systems Cohort, including 4795 women (27,249 woman-years).
  • Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Key results

  • Median age; 47 years; 63% of women were black and 75% had acquired HIV infection through heterosexual sex.
  • There were 760 cases of syphilis per 100,000 woman-years compared with 2.6 cases per 100,000 woman-years in the general population.
  • After adjustment, factors associated with syphilis risk included prior IV drug abuse (aOR, 2.3; 95% CI, 1.3-3.9), presence of HCV antibodies (aOR, 2.1; 95% CI, 1.3-3.7), later year of entry to care (aOR, 2.3; 95% CI, 1.4-3.9 for 2011-2016 vs 1994-2004), and black race (aOR, 2.3; 95% CI, 1.4-3.9 vs white).
  • The authors believe that the increased risk is likely a result of a high frequency of transactional sex.

Limitations

  • Retrospective analysis.

Expert Commentary

  • "Finding the risk factors for these women and making sure that we're doing testing and treatment to catch people early is quite important." Susan Buchbinder, University of California, San Francisco.