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Wu Y, Lu L, Song X, Liu X, Yang Y, Chen L, Tang J, Han Y, Lv W, Cao W, Li T. Clinical and immunological characteristics of HIV/syphilis co-infected patients following long-term antiretroviral treatment. Front Public Health 2024; 11:1327896. [PMID: 38288435 PMCID: PMC10823526 DOI: 10.3389/fpubh.2023.1327896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024] Open
Abstract
Objective This study aims to analyze the efficacy of anti-syphilis treatment and the impact of syphilis events on HIV virology and immunology in HIV/syphilis co-infected patients on long-term antiretroviral therapy (ART) and to investigate the incidence and factors of syphilis recurrence/re-infection/serofast state. The insights derived from this investigation can potentially guide strategies for preventing and managing syphilis and AIDS. Methods A retrospective case-control study was conducted at the AIDS clinic of Peking Union Medical College Hospital from January 2003 to December 2022. The study involved 86 HIV/syphilis co-infected patients and 86 HIV mono-infected patients matched based on age, baseline CD4 + T cell counts, and viral load. We examined the clinical characteristics of HIV/syphilis co-infected patients, evaluated the efficacy of anti-syphilis treatment, and analyzed the dynamic changes in HIV virology and immunology. The Generalized Estimating Equations (GEE) model investigated the factors associated with HIV/syphilis co-infection and syphilis recurrence/reinfection/serofast state. Results Syphilis serofast state was observed in 11.6% (10/86) of HIV/syphilis co-infected patients after treatment, and 33.7% (29/86) had syphilis recurrence or re-infection. The overall effectiveness of syphilis treatment stood at 76.8% (63/82). Notably, the effectiveness of syphilis treatment displayed a significant correlation with baseline syphilis titers exceeding 1:128 (p = 0.003). Over the 10-year follow-up period on ART, the HLA-DR + CD8+/CD8 + % levels in the HIV/syphilis co-infected group were markedly higher than those in the HIV mono-infected group (p < 0.05). However, no significant differences were observed between the two groups regarding HIV viral load, CD4+ T cell counts, CD8+ T cell counts, CD4/CD8 ratio, and CD38 + CD8+/CD8 + % (p > 0.05). GEE analysis model revealed that elevated HLA-DR + CD8+/CD8 + % levels were associated with HIV/syphilis co-infection (OR = 1.026, 95% CI = 1.007-1.046; p = 0.007) and syphilis recurrence/reinfection/serofast state (OR = 1.036, 95% CI = 1.008-1.065; p = 0.012). Conclusion While HIV/syphilis co-infected patients typically receive adequate treatment, the incidence of syphilis recurrence and reinfection remain notably elevated. A heightened HLA-DR + CD8+/CD8+ % is a notable risk factor for HIV/syphilis co-infection and syphilis recurrence/reinfection/serofast state. Therefore, it is advisable to reinforce health education efforts and ensure regular follow-ups for people living with HIV undergoing ART to monitor syphilis infection or increased risk of syphilis infection.
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Affiliation(s)
- Yuanni Wu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
| | - Lianfeng Lu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojing Song
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaosheng Liu
- Tsinghua-Peking Center for Life Sciences, Beijing, China
| | - Yang Yang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Chen
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Tang
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Han
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Lv
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Cao
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, and Chinese Academy of Medical Sciences, Beijing, China
- Tsinghua-Peking Center for Life Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Chromy D, Osmers AM, Bauer WM, Touzeau-Roemer V, Borst C, Esser S, Weninger W, Willinger B, Grabmeier-Pfistershammer K. Sexually Transmitted Dermatophytes Can Cause Severe Infection Among Men who Have Sex With Men as Tinea Genitalis. Open Forum Infect Dis 2023; 10:ofad519. [PMID: 38023536 PMCID: PMC10655938 DOI: 10.1093/ofid/ofad519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Indexed: 12/01/2023] Open
Abstract
Very limited data on tinea genitalis, a potentially severe dermatophytosis transmitted during sexual intercourse affecting the genital area, suggest its potential to cause outbreaks. Thus, we investigated genital dermatophyte infections at an HIV/sexually transmitted infection clinic and identified 17 men who have sex with men (all people with HIV or pre-exposure prophylaxis users) diagnosed with tinea genitalis.
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Affiliation(s)
- David Chromy
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
- Department of Dermatology and Venereology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | | | | | - Carina Borst
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Stefan Esser
- Department of Dermatology and Venereology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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Karanfilian KM, Almohssen AA, Kapila R, Schwartz RA. Malignant syphilis: a new and revised definition. Int J Dermatol 2023; 62:369-375. [PMID: 36250867 DOI: 10.1111/ijd.16444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 08/07/2022] [Accepted: 09/22/2022] [Indexed: 12/01/2022]
Abstract
Malignant syphilis is a rare, severe variant of secondary syphilis that primarily affects immunocompromised patients. Historically, the clinical presentation included a prodrome of constitutional symptoms followed by the development of characteristic skin lesions. The definition of malignant syphilis has not been updated since it was first described as only a cutaneous manifestation. In recent years, syphilis has reemerged as a major public health issue, particularly in men who have sex with men (MSM) and patients with HIV. With increasing rates of syphilis in the HIV-positive population, the systemic manifestations of malignant syphilis have become more apparent. We propose a revised definition and elucidate why the term malignant syphilis should be expanded to include systemic manifestations, stressing musculoskeletal, central nervous system, ocular, ear, cardiovascular, rectal, liver, lung, and renal involvement. This updated definition is dramatically expanded to reflect its systemic manifestations. Recognition of these manifestations may prevent devastating long-term effects.
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Affiliation(s)
| | | | - Rajendra Kapila
- Infectious Disease, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert A Schwartz
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, NJ, USA
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Aung ET, Fairley CK, Ong JJ, Chen MY, Phillips TR, Tran J, Samra R, Chow EPF. Incidence and Risk Factors for Early Syphilis Among Men Who Have Sex With Men in Australia, 2013-2019: A Retrospective Cohort Study. Open Forum Infect Dis 2023; 10:ofad017. [PMID: 36751651 PMCID: PMC9898878 DOI: 10.1093/ofid/ofad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Background We aimed to examine the incidence of syphilis in men who have sex with men (MSM) and identify subgroups of MSM at a higher risk of syphilis infection. Methods We conducted a retrospective cohort study of MSM attending a sexual health clinic in Australia, during 2013-2019, who had at least 2 syphilis serological tests during the study period. The incidence of syphilis was expressed as per 100 person-years. A cox regression analysis was conducted to identify risk factors for syphilis. Results A total of 24 391 individual MSM (75 086 consultations) were included. A total of 1404 new syphilis cases were diagnosed with an incidence of 3.7/100 person-years (95% confidence interval, 3.5-3.9). Syphilis incidence was higher in MSM with human immunodeficiency virus ([HIV] 9.3/100 person-years) than in MSM taking HIV pre-exposure prophylaxis (PrEP) (6.9/100 person-years) or HIV-negative MSM not taking PrEP (2.2/100 person-years). Risk factors associated with high incidence of syphilis included the following: MSM with HIV (adjusted hazard ratio [aHR] 2.7), MSM taking HIV PrEP (aHR 2.1), past history of syphilis infection (aHR 2.4), injecting drug use (aHR 2.7), condomless anal sex (aHR 1.7), >4 sexual partners in the last 12 months (aHR 1.2), and concurrent sexually transmitted infection (chlamydia and gonorrhoea) (aHR 1.6). Conclusions The incidence of syphilis remains high among MSM, particularly in subgroups with associated risk factors for syphilis infections. These data highlight the need for biomedical and behavioral interventions to be targeted to subgroups of MSM at the highest risk of syphilis infection.
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Affiliation(s)
- Ei T Aung
- Correspondence: Ei Thu Aung, MBChB, FAChSHM, 580 Swanston Street, Carlton, VIC 3053, Australia ( or ). A/Pro Eric Chow ()
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Tiffany R Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Julien Tran
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia,Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Ranjit Samra
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
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Syphilis Infections, Reinfections and Serological Response in a Large Italian Sexually Transmitted Disease Centre: A Monocentric Retrospective Study. J Clin Med 2022; 11:jcm11247499. [PMID: 36556115 PMCID: PMC9781386 DOI: 10.3390/jcm11247499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Syphilis infection does not confer definitive and protective immunity against reinfection, and crucial aspects of repeated episodes of syphilis are far from being understood, especially among people living with HIV (PLWH). Methods: In order to explore the burden of syphilis in a large cohort of HIV-negative patients and PLWH, this retrospective study describes the demographics, clinical presentation and treatment outcome of patients with syphilis treated at our clinic from 2013 to 2021. Results: Within the study period, 1859 syphilis episodes (827, 44.5% first infections and 1032, 55.5% reinfections) were recorded. A total of 663 patients, of whom 347 (52%) had PLWH, were considered. Syphilis was mostly diagnosed in males (77%) and European (79%) patients. More than half of syphilis episodes were recorded during the late latent stage (64%) or during follow-up/screening visits for other diseases, while symptomatic stages led to a diagnosis in almost half of HIV-negative patients (p < 0.001). PLWH with syphilis infection were predominantly homo/bisexual (p < 0.001). A significantly higher rate of syphilis reinfection was observed in PLWH, who also demonstrated a higher range of subsequent episodes. The serofast state was found to be similar at the 6- and 12-month follow-up visits. The multivariate analysis carried out in the HIV-positive group showed that an RPR titre >1:16 was an independent predictor for serological non-response. Conclusions: Syphilis reinfections are predominantly diagnosed in HIV-positive MSM. The high rate of asymptomatic presentation among PLWH supports the role of periodical syphilis screening. In PLWH, the only baseline factor associated with an increased risk of non-response was an RPR titre >1:16, while assessment at 12 months after treatment increased the possibility of detecting a serological response, indicating that PLWH have a slower serological response to treatment.
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Nieuwenburg SA, Hoornenborg E, Davidovich U, de Vries HJC, Schim van der Loeff M. Developing a symptoms-based risk score for infectious syphilis among men who have sex with men. Sex Transm Infect 2022:sextrans-2022-055550. [PMID: 36400527 DOI: 10.1136/sextrans-2022-055550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022] Open
Abstract
BackgroundSyphilis incidence is rising among men who have sex with men (MSM). An online tool based on a risk score identifying men with higher risk of infectious syphilis could motivate MSM to seek care. We aimed therefore to develop a symptoms-based risk score for infectious syphilis.MethodsWe included data from all consultations by MSM attending the Amsterdam Centre for Sexual Health in 2018–2019. Infectious syphilis (ie, primary, secondary or early latent syphilis) was diagnosed according to the centre’s routine protocol. Associations between symptoms and infectious syphilis were expressed as odds ratios (OR), with 95% confidence intervals (CI). Based on multivariable logistic regression models, we created risk scores, combining various symptoms. We assessed the area under the curve (AUC) and cut-off based on the Youden Index. We estimated which percentage of MSM should be tested based on a positive risk score and which percentage of infectious syphilis cases would then be missed.ResultsWe included 21,646 consultations with 11,594 unique persons. The median age was 34 years (IQR 27–45), and 14% were HIV positive (93% on antiretroviral treatment). We diagnosed 538 cases of infectious syphilis. Associations with syphilis symptoms/signs were strong and highly significant, for example, OR for a painless penile ulcer was 35.0 (CI 24.9 to 49.2) and OR for non-itching rash 57.8 (CI 36.8 to 90.9). Yet, none of the individual symptoms or signs had an AUC >0.55. The AUC of risk scores combining various symptoms varied from 0.68 to 0.69. For all risk scores using cut-offs based on Youden Index, syphilis screening would be recommended in 6% of MSM, and 59% of infectious syphilis cases would be missed.ConclusionSymptoms-based risk scores for infectious syphilis perform poorly and cannot be recommended to select MSM for syphilis screening. All MSM with relevant sexual exposure should be regularly tested for syphilis.
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Affiliation(s)
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Henry John Christiaan de Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
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Kamegai K, Yokoyama S, Takakura S, Takayama Y, Shiiki S, Koyama H, Narita M. Syphilitic osteomyelitis in a patient with HIV and cognitive biases in clinical reasoning: A case report. Medicine (Baltimore) 2022; 101:e30733. [PMID: 36221388 PMCID: PMC9542556 DOI: 10.1097/md.0000000000030733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Diagnosing multifactorial, multidimensional symptoms unexplained by presumptive diagnosis is often challenging for infectious disease specialists. PATIENT CONCERNS We report a rare case of a 30-year-old Japanese bisexual man with a history of virally suppressed human immunodeficiency virus and syphilis infections who developed chest pain and an erosive lesion under the lower midline jaw. DIAGNOSIS Imaging examinations revealed erosive lesions on the sternum and left the ninth rib. Biopsy and polymerase chain reaction testing of sternal tissue specimens were noncontributory. However, due to elevated rapid plasma regain levels, a diagnosis of syphilitic osteomyelitis and gumma of the jaw was made. INTERVENTIONS The patient was treated with 5 weeks of intravenous ceftriaxone and then with 8 weeks of oral amoxicillin. OUTCOME After the antibiotic treatment, bone pain disappeared. We conducted a literature review on syphilitic osteomyelitis, and all of the articles included were case reports. Approximately half of the 46 patients with syphilitic osteomyelitis had HIV coinfection, and 10 (22%) patients lacked signs of early syphilis. Given its rarity, clinical data to establish appropriate guidelines for diagnosing and treating syphilitic osteomyelitis are still lacking. Cognitive biases, such as anchoring, cognitive overload bias, and premature closure, may contribute to diagnostic delays. LESSONS In cases of idiopathic multiple bone lesions, syphilis must always be ruled out, and clinicians should guard against cognitive pitfalls when diagnosing rare diseases.
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Affiliation(s)
- Kohei Kamegai
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan
- Disease Prevention and Control Center, National Center for Global Health and Medicine, Tokyo, Japan
- *Correspondence: Kohei Kamegai, Disease Control and Prevention Center, Center Hospital of National Center for Global Health and Medicine, Tokyo 162-8655, Japan (e-mail: )
| | - Shuhei Yokoyama
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Shunichi Takakura
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Yoshihiro Takayama
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Soichi Shiiki
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Hirofumi Koyama
- Division of Pathology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Masashi Narita
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, Japan
- Division of Infectious Diseases, Department of Internal Medicine, Okinawa Prefectural Nambu Medical Center & Children’s Medical Center, Haebaru, Japan
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Correlates of prevalent syphilis infection among men who have sex with men (MSM) living with HIV attending the HIV clinic in Trinidad. PLoS One 2022; 17:e0265909. [PMID: 35358217 PMCID: PMC8970382 DOI: 10.1371/journal.pone.0265909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Syphilis among men who have sex with men (MSM) living with HIV is of public health concern, thus the objective of the study is to determine the correlates of prevalent syphilis infection in this population so that urgent interventions could be instituted.
Methods
A cross-sectional study was conducted during the period September 2020-June 2021 among MSM who attended a large HIV Clinic in Trinidad. A questionnaire was administered to obtain socio-demographic data and correlates of prevalent syphilis and patients were screened for syphilis using the traditional algorithm. Descriptive and bivariate analyses were conducted and multivariable logistic regression factors was used to assess factors significantly associated with a syphilis diagnosis.
Results
Two hundred and sixty four MSM were enrolled; age range 18–64 years, median age 33 years and 89 (34.4%) were actively bisexual. The prevalence of syphilis was 28% (74/264) and 89.2% (66/74) of these infections were asymptomatic. Multivariable logistic regression analysis showed that those patients who participated in sex with anonymous partners (OR 2.09; 95% CI, 1.03–4.26), those with a previous diagnosis of syphilis (OR 5.16; 95% CI, 1.03–25.83) and those who used marijuana in the last 12 months (OR 2.13; 95% CI, 1.14–3.96) were more likely to be diagnosed with syphilis.
Conclusion
There is a high prevalence of asymptomatic syphilis among MSM living with HIV in Trinidad. Repeat episodes of syphilis and anonymous sex may play a role in the transmission dynamics of T pallidum infection in this population, thus urgent public health prevention interventions are warranted.
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Balakrishna S, Salazar-Vizcaya L, Schmidt AJ, Kachalov V, Kusejko K, Thurnheer MC, Roth JA, Nicca D, Cavassini M, Battegay M, Schmid P, Bernasconi E, Günthard HF, Rauch A, Kouyos RD. Assessing the drivers of syphilis among men who have sex with men in Switzerland reveals a key impact of screening frequency: A modelling study. PLoS Comput Biol 2021; 17:e1009529. [PMID: 34699524 PMCID: PMC8570495 DOI: 10.1371/journal.pcbi.1009529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 11/05/2021] [Accepted: 10/05/2021] [Indexed: 01/06/2023] Open
Abstract
Over the last decade, syphilis diagnoses among men-who-have-sex-with-men (MSM) have strongly increased in Europe. Understanding the drivers of the ongoing epidemic may aid to curb transmissions. In order to identify the drivers of syphilis transmission in MSM in Switzerland between 2006 and 2017 as well as the effect of potential interventions, we set up an epidemiological model stratified by syphilis stage, HIV-diagnosis, and behavioral factors to account for syphilis infectiousness and risk for transmission. In the main model, we used ‘reported non-steady partners’ (nsP) as the main proxy for sexual risk. We parameterized the model using data from the Swiss HIV Cohort Study, Swiss Voluntary Counselling and Testing center, cross-sectional surveys among the Swiss MSM population, and published syphilis notifications from the Federal Office of Public Health. The main model reproduced the increase in syphilis diagnoses from 168 cases in 2006 to 418 cases in 2017. It estimated that between 2006 and 2017, MSM with HIV diagnosis had 45.9 times the median syphilis incidence of MSM without HIV diagnosis. Defining risk as condomless anal intercourse with nsP decreased model accuracy (sum of squared weighted residuals, 378.8 vs. 148.3). Counterfactual scenarios suggested that increasing screening of MSM without HIV diagnosis and with nsP from once every two years to twice per year may reduce syphilis incidence (at most 12.8% reduction by 2017). Whereas, increasing screening among MSM with HIV diagnosis and with nsP from once per year to twice per year may substantially reduce syphilis incidence over time (at least 63.5% reduction by 2017). The model suggests that reporting nsP regardless of condom use is suitable for risk stratification when modelling syphilis transmission. More frequent screening of MSM with HIV diagnosis, particularly those with nsP may aid to curb syphilis transmission. Syphilis, one of the most common sexually transmitted infections, remains a major public health problem. Over the last decade, a rising number of diagnoses especially in men-who-have-sex-with-men (MSM) was observed in Western Europe and Northern America. In Switzerland, the number of syphilis diagnoses in MSM tripled between 2006 and 2017. In this study, we used a mathematical model to assess the drivers of this increase among MSM in Switzerland. Our model could reproduce the increase in syphilis diagnoses in both MSM with and without HIV diagnosis between 2006 and 2017. Based on this model we found that MSM with HIV diagnosis have an over 45 times higher syphilis incidence than MSM without HIV diagnosis. Furthermore, we found that reported sex with non-steady partners is a useful proxy of behavioral risk. Considering counterfactual scenarios, we showed that increasing the screening frequency for syphilis among MSM with HIV diagnosis and with non-steady partners from once a year to twice per year can reduce syphilis incidence by 63.5% to 99.2%.
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Affiliation(s)
- Suraj Balakrishna
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Axel J. Schmidt
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Switzerland
- Sigma Research, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Viacheslav Kachalov
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Jan A. Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Division of Research and Analytical Services, Department of Informatics, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger D. Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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Tiecco G, Degli Antoni M, Storti S, Marchese V, Focà E, Torti C, Castelli F, Quiros-Roldan E. A 2021 Update on Syphilis: Taking Stock from Pathogenesis to Vaccines. Pathogens 2021; 10:1364. [PMID: 34832520 PMCID: PMC8620723 DOI: 10.3390/pathogens10111364] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
In 2021 the scientific community's efforts have been focused on solving the back-breaking challenge of the COVID-19 pandemic, but sexually transmitted infections (STI) are still one of the most common global health problems. Syphilis is a systemic disease caused by the spirochaete Treponema pallidum (TP) and is one of the oldest known diseases. Its incidence has increased in the last few years and syphilis still remains a contemporary plague that continues to afflict millions of people worldwide. Despite research improvements, syphilis pathogenesis is not completely clear; clinical presentation is very heterogeneous and the diagnosis can sometimes be difficult. Furthermore, few therapeutic options are available, and a vaccine has not been found yet. In this review, we describe the most recent evidence concerning the clinical manifestation, diagnosis, treatment and vaccine prospectives for this disease.
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Affiliation(s)
- Giorgio Tiecco
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Melania Degli Antoni
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Samuele Storti
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Valentina Marchese
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Emanuele Focà
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Francesco Castelli
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
| | - Eugenia Quiros-Roldan
- Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, ASST Spedali di Brescia, University of Brescia, 25123 Brescia, Italy; (G.T.); (M.D.A.); (S.S.); (V.M.); (E.F.); (F.C.)
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11
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Castry M, Cousien A, Bellet J, Champenois K, Pialoux G, Yazdanpanah Y, Costagliola D, Grabar S, Deuffic-Burban S. Hepatitis C virus (HCV) incidence among men who have sex with men (MSM) living with HIV: results from the French Hospital Database on HIV (ANRS CO4-FHDH) cohort study, 2014 to 2017. ACTA ACUST UNITED AC 2021; 26. [PMID: 34558403 PMCID: PMC8462035 DOI: 10.2807/1560-7917.es.2021.26.38.2001321] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BackgroundDespite the availability of highly effective direct-acting antivirals (DAAs) and the expected treatment as prevention (TasP) effect, transmission of hepatitis C virus (HCV) persists in men who have sex with men (MSM) who engage in high-risk sexual behaviours.AimWe aimed to estimate the incidence of primary HCV infection among MSM living with HIV in France when DAA was readily available.MethodsWe used data from a large French hospital cohort of persons living with HIV (ANRS CO4-FHDH) prospectively collected between 2014 and 2017. HCV incidence rates were calculated using person-time methods for HCV-negative MSM at inclusion who had serological follow-up from 1 January 2014 to 31 December 2017. Sensitivity analyses were performed by varying the main assumptions to assess their impact on the results.ResultsOf 14,273 MSM living with HIV who were initially HCV-seronegative, 330 acquired HCV during follow-up over 45,866 person-years (py), resulting in an overall estimated incidence rate of 0.72/100 py (95% CI: 0.65-0.80). HCV incidence significantly decreased from 0.98/100 py (95% CI: 0.81-1.19) in 2014 to 0.45/100 py (95% CI: 0.35-0.59) in 2017 (54% decrease; 95% CI: 36-67). This trend was confirmed by most of the sensitivity analyses.ConclusionThe primary incidence of HCV was halved for MSM living with HIV between 2014 and 2017. This decrease may be related to unrestricted DAA availability in France for individuals living with HIV. Further interventions, including risk reduction, are needed to reach HCV micro-elimination in MSM living with HIV.
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Affiliation(s)
| | | | - Jonathan Bellet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | | | - Gilles Pialoux
- Sorbonne Université, Department of Infectious Diseases, APHP, Hôpital Tenon, Paris, France
| | - Yazdan Yazdanpanah
- Service de maladies Infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France.,Université de Paris, INSERM, IAME, Paris, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Sophie Grabar
- Assistance Publique-Hôpitaux de Paris (AP-HP), Département de Santé Publique, Hôpital Saint-Antoine, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
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- The members of the ANRS CO4-FHDH cohort are acknowledged at the end of the article
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12
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Dang LVP, Nguyen QH, Ishizaki A, Larsson M, Vu NTP, Do Duy C, Olson L, Dinh TT. Prevalence of Opportunistic Infections and Associated Factors in HIV-Infected Men Who Have Sex With Men on Antiretroviral Therapy in Bach Mai Hospital, Hanoi, Vietnam: A Case-Control Study. Am J Mens Health 2021; 14:1557988320926743. [PMID: 32552402 PMCID: PMC7307406 DOI: 10.1177/1557988320926743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate the distribution of opportunistic infections (OIs) and factors associated with acquiring OIs in human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) in comparison to those of heterosexual patients. METHOD A cross-sectional study was conducted on 82 HIV-infected MSM and 120 HIV-infected heterosexual men in Bach Mai Hospital, Hanoi, Vietnam. Demographical characteristics and clinical data were collected and analyzed using appropriate statistics (Mann-Whitney, Chi-square, Fisher's exact test, and logistic regression). RESULTS The prevalence of OIs among MSM and heterosexual patients were 63.4% and 81.7%, respectively. The most frequent OI in the MSM group was human papilloma virus (HPV) (11%), followed by hepatitis B virus (8.5%), mycobacterium tuberculosis (7.3%), and Talaromycosis (2.4%). CONCLUSIONS Multivariate logistic regression analysis showed that buying sex (odds ratio (OR) = 4, 95% confidence interval (CI): 1.13-14.25) and injecting drugs (OR = 13.05, 95% CI: 2.39-71.21) were associated with increased odds of having OIs in heterosexual patients while increasing age (OR = 1.1, 95% CI: 1.01-1.24) was correlated to increased odd of acquiring OIs in the MSM group. HIV-infected MSM accumulates OIs with increasing age, while heterosexual individuals increase opportunistic infections by buying sex or injecting drugs.
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Affiliation(s)
| | - Quan Hai Nguyen
- Laboratory Centre, Hanoi University of Public Health, Hanoi, Vietnam
| | - Azumi Ishizaki
- Department of Viral Infection and International Health, Graduate School of Medical Science, Kanazawa University, Japan
| | - Mattias Larsson
- Training and Research Academic Collaboration (TRAC), Sweden, Vietnam.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Cuong Do Duy
- Centre for Tropical Diseases, Bach Mai Hospital, Hanoi, Vietnam
| | - Linus Olson
- Training and Research Academic Collaboration (TRAC), Sweden, Vietnam.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Woman's and Child's Health, Karolinska Institutet, Stockholm, Sweden
| | - Thanh Thi Dinh
- Laboratory Centre, Hanoi University of Public Health, Hanoi, Vietnam
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13
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Edwards RJ, John I, Todd S, Lavia LO, Musa D, Edwards J, Boyce G. Syphilis among men who have sex with men attending a large HIV clinic in Trinidad. Int J STD AIDS 2021; 32:830-836. [PMID: 33890834 DOI: 10.1177/0956462421997193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A chart review study was conducted to determine the prevalence of syphilis and explore the associated risk factors among men who have sex with men (MSM) who attended a large HIV clinic in Trinidad during the period January-December 2019. Patients were routinely screened for syphilis annually, and demographic, clinical, and laboratory data were extracted from the medical records. Descriptive and bivariate analyses were performed, and factors significantly associated with a syphilis diagnosis were assessed using multivariate logistic regression. During the period, 218 MSM were seen, age range 19-67 years, and median age 34.0 years. The prevalence of syphilis was 41.3% (90/218), and 71.1% (64//90) of these infections were asymptomatic. Multivariate analysis using logistic regression showed that MSM living with HIV in the 30-34 years old-age group (OR, 4.32; 95% CI, 1.04-18.02), and those with a previous history of treated syphilis (OR, 10.18; 95% CI, 4.60-22.53) were more likely to be diagnosed with syphilis. The prevalence of syphilis is high among MSM attending the HIV clinic in Trinidad, and most of these infections were asymptomatic; hence, targeted and sustained interventions to reduce syphilis transmission are urgently required. Repeat episodes of syphilis may play a role in the transmission dynamics of syphilis in MSM.
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Affiliation(s)
- Robert Jeffrey Edwards
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
- Department of Paraclinical Sciences, University of the West Indies, St Augustine, Trinidad
| | - Isshad John
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Selena Todd
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Leon-Omari Lavia
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - David Musa
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Jonathan Edwards
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
| | - Gregory Boyce
- 199168Medical Research Foundation of Trinidad and Tobago, Port of Spain, Trinidad
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14
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Chan P, Colby DJ, Kroon E, Sacdalan C, Pinyakorn S, Paul R, Robb M, Valcour V, Ananworanich J, Marra C, Spudich S. Clinical and laboratory impact of concomitant syphilis infection during acute HIV. HIV Med 2021; 22:502-511. [PMID: 33728759 DOI: 10.1111/hiv.13079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cognitive impairment has been reported in people living with HIV-1 (PLWH) with prior syphilis, while PLWH who present with incident syphilis have reduced blood CD4 T-lymphocyte and elevated HIV-1 RNA levels. However, the clinical, virological and neurocognitive effects of syphilis during acute HIV-1 (AHI) remain unknown. METHODS Pre-antiretroviral therapy laboratory outcomes and neurocognitive performance in a four-test battery in the SEARCH10/RV254 AHI cohort were compared according to syphilis status, determined by serum Treponema pallidum haemagglutination (TPHA), Venereal Disease Research Laboratory (VDRL) and syphilis treatment history. Impaired cognitive performance was defined as having z-scores ≤ -1 in at least two tests or ≤ -2 in at least one test. RESULTS Out of 595 AHI participants (97% male, median age of 26 years and estimated duration of HIV-1 infection of 19 days), 119 (20%) had history of syphilis (TPHA-positive), of whom 51 (9%) had untreated syphilis (TPHA-positive/VDRL-positive/without prior treatment). Compared with those without syphilis (TPHA-negative), individuals with untreated syphilis had higher CD8 T-lymphocyte levels but not higher plasma HIV-1 RNA or lower CD4 T-lymphocyte levels. Taking into account estimated duration of HIV-1 infection (P < 0.001), and later Fiebig stages (III-V) (P < 0.001), those with untreated syphilis had higher CD8 T-lymphocyte levels (P = 0.049). Individuals with any syphilis (TPHA-positive), but not untreated syphilis, had higher odds of impaired cognitive performance than those without (P = 0.002). CONCLUSIONS During AHI, individuals with any history of syphilis (TPHA-positive) had poorer cognitive performance than those without syphilis. However, syphilis was not associated with worsened HIV disease measures as described in chronic infection.
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Affiliation(s)
- P Chan
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - D J Colby
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - E Kroon
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - C Sacdalan
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - S Pinyakorn
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - R Paul
- Missouri Institute of Mental Health, University of Missouri-St Louis, St Louis, MO, USA
| | - M Robb
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - V Valcour
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - J Ananworanich
- SEARCH, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - C Marra
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - S Spudich
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
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