Factors associated with syphilis incidence in the HIV-infected in the era of highly active antiretrovirals.

Details

Ressource 1Download: BIB_33AF1062402A.pdf (293.93 [Ko])
State: Public
Version: Final published version
License: Not specified
Serval ID
serval:BIB_33AF1062402A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Factors associated with syphilis incidence in the HIV-infected in the era of highly active antiretrovirals.
Journal
Medicine
Author(s)
Shilaih M., Marzel A., Braun D.L., Scherrer A.U., Kovari H., Young J., Calmy A., Darling K., Battegay M., Hoffmann M., Bernasconi E., Thurnheer M.C., Günthard H.F., Kouyos R.D.
Working group(s)
and the Swiss HIV Cohort Study
ISSN
1536-5964 (Electronic)
ISSN-L
0025-7974
Publication state
Published
Issued date
01/2017
Peer-reviewed
Oui
Volume
96
Number
2
Pages
e5849
Language
english
Notes
Publication types: Journal Article ; Observational Study
Publication Status: ppublish
Abstract
After several years of steady decline, syphilis is reemerging globally as a public health hazard, especially among people living with human immunodeficiency virus (HIV). Syphilis resurgence is observed mainly in men who have sex with men (MSM), yet other transmission groups are affected too. In this manuscript, we study the factors associated with syphilis incidence in the Swiss HIV cohort study in the era of highly effective antiretrovirals. Using parametric interval censored models with fixed and time-varying covariates, we studied the immunological, behavioral, and treatment-related elements associated with syphilis incidence in 3 transmission groups: MSM, heterosexuals, and intravenous drug users. Syphilis incidence has been increasing annually since 2005, with up to 74 incident cases per 1000 person-years in 2013, with MSM being the population with the highest burden (92% of cases). While antiretroviral treatment (ART) in general did not affect syphilis incidence, nevirapine (NVP) was associated with a lower hazard of syphilis incidence (multivariable hazard ratio 0.5, 95% confidence interval 0.2-1.0). We observed that condomless sex and younger age were associated with higher syphilis incidence. Moreover, time-updated CD4, nadir CD4, and CD8 cell counts were not associated with syphilis incidence. Finally, testing frequency higher than the recommended once a year routine testing was associated with a 2-fold higher risk of acquiring syphilis. Condomless sex is the main driver of syphilis resurgence in the Swiss HIV Cohort study; ART and immune reconstitution provide no protection against syphilis. This entails targeted interventions and frequent screening of high-risk populations. There is no known effect of NVP on syphilis; therefore, further clinical, epidemiological, and microbiological investigation is necessary to validate our observation.
Keywords
Adult, Anti-HIV Agents/therapeutic use, Antiretroviral Therapy, Highly Active, Comorbidity, Female, HIV Infections/drug therapy, HIV Infections/epidemiology, Heterosexuality/statistics & numerical data, Homosexuality, Male/statistics & numerical data, Humans, Incidence, Male, Middle Aged, Nevirapine/therapeutic use, Risk Factors, Substance Abuse, Intravenous/epidemiology, Syphilis/epidemiology, Unsafe Sex
Pubmed
Web of science
Open Access
Yes
Create date
24/01/2017 19:47
Last modification date
09/04/2020 6:26
Usage data