Testing uncovers high prevalence of active syphilis among people with HIV
Testing uncovered a high prevalence of active syphilis among HIV-positive people in four African countries, indicating a need for consistent and frequent screening for syphilis among people with HIV, researchers said.
Rose Killian, an MPH candidate at the Columbia University Mailman School of Public Health, presented findings from the study at the Conference on Retroviruses and Opportunistic Infections.
“WHO estimates that approximately 12 million new syphilis infections occur each year, with many occurring in resource-limited countries,” Killian said at the conference. “Infection with syphilis is associated with HIV infection and among people living with HIV with higher HIV viral load and decreased CD4+ cell count.”
Kilian and colleagues examined data from four nationally representative population-based HIV impact surveys conducted by ministries of health in Tanzania, Uganda, Zambia and Zimbabwe. Adults from randomly selected households provided demographic and behavioral information and blood samples for HIV and syphilis testing per each country's national guidelines, according to the researchers.
The study included 104,093 adults 9,577 of whom were HIV positive and 94,516 of whom were HIV negative.
The prevalence of active syphilis among HIV-positive participants ranged from 2.9% (95% CI, 2.3%-3.6%) in Zimbabwe to 9.6% (95% CI, 8.1%-11.0%) in Zambia. Among HIV-negative people, it ranged from 0.8% (95% CI, 0.7%-1%) in Tanzania to 2.1% (95% CI, 1.8%-2.4%) in Zimbabwe. Killian and colleagues said this corresponded to an estimated 1,017,746 adults with active syphilis in the four countries.
The researchers calculated that being HIV positive was associated with an increased risk for active syphilis, with an adjusted OR ranging from 2.5 in Uganda to 5.9 in Zimbabwe.
Behavioral characteristics such as having multiple sexual partners were also associated with syphilis, with an aOR ranging from 1.6 in Tanzania to 2 in Zimbabwe. Among HIV-negative people, older age, lower education, poverty and being divorced, widowed or separated were associated with syphilis.
Killian said the findings are unique because they are based on results from a nationally representative, random sample from the general population of the four countries.
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Killian R, et al. Abstract 141. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 12-16, 2022 (virtual meeting).