Trends in sexually transmitted diseases and risky behaviors among HIV-infected patients at an outpatient clinic in southern Taiwan

Asymptomatic Neurosyphilis in HIV infected patients at a Brazilian HIV and AIDS specialized service: a cross sectional study

Background:

Many human immunodeficiency virus (HIV) and syphilis co-infected patients are not diagnosed, which may evolve into asymptomatic neurosyphilis (ANS). We studied the occurrence of ANS an HIV-infected population.

Methods:

This was a cross-sectional study of cerebrospinal fluid (CSF) samples collected from patients co-infected with HIV and Treponema pallidum. Social-demographic and clinical-laboratory characteristics were studied.

Results:

Of the 348 patients infected with HIV, 33 (9.5%) had reagent treponemic and non-treponemic tests. CSF was collected from 19 asymptomatic patients. Of these, 8 (42.1%) presented with laboratory alterations suggestive of ANS.

Conclusion:

Social-demographic and clinical-laboratory variables should be considered for the indication of CSF collection.

Increased repeat syphilis among HIV-infected patients: A nationwide population-based cohort study in Taiwan

Among human immunodeficiency virus (HIV)-infected individuals, syphilis is an important sexually transmitted infection (STI), and repeat infections are common. Identifying risk factors for delineating the trends in repeat syphilis are essential for STI and HIV prevention.This study is to investigate the dynamic of the syphilis epidemic among HIV-infected patients and to identify the risk factors associated with repeat syphilis.A population-based cohort design was used to analyze claim data between January 2000 and December 2010 using the Taiwan National Health Insurance Research Database. The Poisson regression test was used to identify risk factors for repeat syphilis.Of 13,239 HIV-infected patients, annual syphilis screen tests have been performed in 4,907 (37.1%) of these patients. Syphilis has been diagnosed in 956 (19.5%) patients, and 524 (10.7%) had repeat syphilis. The annual trend in repeat syphilis showed a significant increase in the study period (β = 0.23, P < .001). Younger age (adjusted incidence rate ratio [aIRR] 1.43; 95% CI 1.11-1.86), male gender (aIRR 11.14, 95% CI 4.16-29.79), a history of STIs (aIRR 1.39, 95% CI 1.21-1.59) were independently associated with repeat syphilis. The retention in HIV care and adherence to antiretroviral therapy ≥85% ([aIRR] 0.77, 95% CI 0.61-0.98; P < .001) were associated with a reduced risk of repeat syphilis.The incidence of repeat syphilis increased during 11 years of follow-up. The screening of syphilis for early diagnosis and retention in HIV care with medication adherence should be encouraged to minimize the risk of repeat syphilis in the targeted population.

Syphilis seroprevalence and seroconversion among people newly diagnosed with HIV during the pre-antiretroviral therapy period in rural China

Syphilis has a high incidence among people living with HIV (PLHIV), which may be attributable to their similar sexual transmission route. A retrospective cohort study was conducted during the period 2009-2015 to investigate the syphilis seroprevalence and incidence of syphilis seroconversion among newly-diagnosed PLHIV in rural Yunnan, China. Recent HIV infection among PLHIV was identified by BED capture enzyme immunoassay. PLHIV were followed until they initiated antiretroviral therapy. Syphilis serology was conducted at baseline and each follow-up over the study period. Among 2162 participants, the syphilis seroprevalence at baseline was 2.7%, 95% confidence interval (CI) (2.4-3.1). Single and divorced (versus married) (aOR = 2.9, [1.1-7.4]; 5.9, [2.4-14.7], respectively), employed in the service industry (versus unemployed) (2.8, [1.4-5.6]), being diagnosed with HIV in hospitals (versus voluntary counselling and testing) (5.1, [2.0-12.9]), recent HIV infection (17.9, [8.5-37.9]) and inconsistent condom use in the previous three months (versus consistent condom use) (6.2, [2.8-13.4]) were associated with higher risk of syphilis infection at baseline. Participants contributed 1955.4 person-years (PYs) of follow-up, with a median follow-up period of 0.9 years (IQR: 0.5-1.9) and the incidence of syphilis seroconversion was 2.2 (95% CI 1.5-2.9) per 100 PYs. The syphilis seroprevalence at baseline (aHR 3.7, [1.8-7.9]), had a HIV-negative partner at baseline (3.9, [1.5-9.8]) and inconsistent condom use in the last three months at baseline (6.0, [1.4-25.4]) were associated with higher risk of syphilis seroconversion. Our findings indicate that the public health response should be escalated to minimise the spread of syphilis co-infection among PLHIV and reducing condomless sexual behaviours after HIV diagnosis.

The rising trend of sexually transmitted infections among HIV-infected persons: a population-based cohort study in Taiwan, 2000 through 2010

OBJECTIVE

Positive prevention interventions for patients living with the HIV include the early detection and treatment of sexually transmitted infections (STIs). This study aimed to determine the incidence of selected STIs, including syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis, in a population-based cohort of individuals living with HIV.

METHODS

Clinical data from 2000 to 2010 were obtained from the Taiwan National Health Insurance Research Database identified 15,123 patients with HIV infection. The incidence rates were standardized by age and sex using the direct method that was based on the 2000 World Health Organization world standard population.

RESULTS

The overall rate ratio of STI episodes significantly increased [rate ratio: 34.0, 95% confidence interval (CI): 24.3 to 47.6, P < 0.01]. After an HIV diagnosis, 15.9% of patients with HIV had at least 1 of these 5 STIs. An incidence rate of 503.0 STI episodes/10,000 person-years (PYs) (95% CI: 487.1 to 519.5) was detected during the 11-year follow-up period. The most common STIs after an HIV diagnosis were syphilis (381.9 episodes/10,000 PYs; 95% CI: 368.0 to 396.3), followed by genital warts (138.9 episodes/10,000 PYs; 95% CI: 130.6 to 147.6). The incidence of STIs varied significantly according to gender. In women, the annual incidence of STIs remained stable. However, the annual incidence of syphilis, genital warts, and chlamydial infection increased in young men.

CONCLUSIONS

An increase in STIs among HIV-positive persons highlights the need to identify the causal factors of these co-infections. Routine STI screenings and early preventive interventions against STIs in HIV-infected persons are crucial.

History of syphilis in women living with AIDS and associated risk factors in São Paulo, Brazil

OBJECTIVE

to describe the epidemiological profile, risk behaviors, frequency of prior history of syphilis in women living with AIDS and to investigate associated factors.

METHODS

a cross-sectional study conducted with women living with HIV attending at Reference Center for AIDS in São Paulo. Demographic, behavioral, and clinical data were analyzed based on medical records.

RESULTS

a total of 598 women were included in the study and the prevalence of previous syphilis was 6.2% (95% CI 4,3-8,1). Seventy-three percent of women were less than 40 years of age when diagnosed with AIDS and 49.6% had more than eight years of formal education. 67.2% were white and 65.9% were not married or living with a partner, 53.2% reported that their first sexual intercourse aged more than 15 years, 56.5% reported having only one partner in the last year and 13% reported drug use. Regarding laboratory data, 83.8% had CD4+ <500 cells/ mm3 upon diagnosis of AIDS. Previous syphilis was associated with the use of crack cocaine [AOR = 6.8 (95% CI 1.7 - 27.5)], >1 sexual partner in the last year [AOR = 6.6 (95% CI 1.2 - 37.1)], CD4 + <500 cells/mm3 [AOR = 3.8 (women 1.1 - 13.6)], HIV diagnosis > 8 years [AOR = 2.4 (95% CI 1.0 - 5.8)].

CONCLUSION

a high prevalence of previous syphilis was found in the population studied, and crack use was identified among the main associated risk factors. Interventions to reduce the risk of sexual transmission of HIV and syphilis must be strengthened, with the implementation of control actions, screening strategies, early diagnosis and treatment, preventing complications, reducing morbidity and improving sexual and reproductive health.

Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence

Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009–May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.

Chlamydia trachomatis in human immunodeficiency virus-infected men treated at a referral hospital for sexually transmitted diseases in the Amazonas, Brazil

OBJECTIVES

The aim of the present study was to determine the Chlamydia trachomatis prevalence and to identify the demographic, behavioural and clinical factors associated with C. trachomatis in human immunodeficiency virus infected men.

STUDY

This was a cross-sectional study of C. trachomatis prevalence among human immunodeficiency virus-infected men enrolled at the Outpatient clinic of acquired immunodeficiency syndrome of the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado in Manaus, Amazonas, Brazil. C. trachomatis deoxyribonucleic acid from urethral samples was purified and submitted to real time polymerase chain reaction to identify the presence of C. trachomatis.

RESULTS

A total of 276 human immunodeficiency virus-infected men were included in the study. The prevalence of C. trachomatis infection was 12% (95% confidence interval 8.1%-15.7%). The mean age of the participants was 34.63 (standard deviation 10.80) years. Of the 276 human immunodeficiency virus-infected men, 93 (56.2%) had more than one sexual partner in the past year and 105 (38.0%) reported having their first sexual intercourse under the age of 15 years. Men having sex with men and bisexuals amounted to 61.2% of the studied population. A total of 71.7% had received human immunodeficiency virus diagnosis in the last three years and 55.1% were using antiretroviral therapy. Factors associated with C. trachomatis infection in the logistic model were being single (p<0.034), men having sex with men (p<0.021), and having previous sexually transmitted diseases (p<0.001).

CONCLUSION

The high prevalence of C. trachomatis infection among human immunodeficiency virus-infected men highlights that screening human immunodeficiency virus-infected men for C. trachomatis, especially among men having sex with men, is paramount to control the spread of C. trachomatis infection.

Occurrence of new sexually transmitted diseases in males after HIV diagnosis

Risk reduction following an HIV diagnosis is important for controlling the epidemic. The objective of this retrospective cohort study of 6,965 HIV-positive males was to evaluate the joint risk of new reportable STDs in males after HIV diagnosis by race/ethnicity and risk behavior. This investigation linked HIV case reports with STD surveillance, clinical care and laboratory datasets to determine new STD acquisition in HIV positive individuals.Compared to White MSM with high care engagement,Black MSM had a significantly higher rate of new reportable STDs for the full time period after HIV diagnosis, B1 year after diagnosis, and[1 year after diagnosis. High HIV care engagement was not as protective against new STD acquisition for Black MSM as it was for White MSM and reasons for this health disparity should be explored.

Unsafe Sex and STI Prevalence Among HIV-Infected Adults in Guangzhou, China: Opportunities to Deamplify Sexual HIV Transmission

This project examined sexual behavior and STI prevalence among HIV-infected individuals in South China. Adult HIV-infected outpatients in Guangzhou, Guangdong Province, China completed a self-administered survey about behaviors and antiretroviral treatment. Participants were screened for syphilis, gonorrhea, and chlamydia. Univariate and multivariate relationships with any STI were calculated using logistic regression. 810 HIV-infected individuals participated and 3 refused. 52.5 % (n = 415) of individuals reported having sex in the past 3 months, among whom 26.4 % (n = 111) reported inconsistent condom use. 10.4 % (n = 84) of all individuals had at least one sexually transmitted infection (STI). HIV-infected individuals not on antiretroviral treatment had an increased STI risk (aOR 2.5, 95 % CI: 1.4-4.5, P = 0.002). Unsafe sex was markedly reduced among HIV-infected individuals on treatment, possibly a reflection of integrated ART initiation counseling. Improved STI services among HIVinfected individuals are urgently needed to deamplify sexual HIV transmission.

Clinical and laboratory characteristics of human immunodeficiency virus-infected adolescents: experience from a single medical center

BACKGROUND

Recently, the proportion of adolescents diagnosed with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has increased. The aim of this study is to evaluate the clinical and laboratory characteristics of HIV-infected adolescents in southern Taiwan.

METHODS

From June 1997 to December 2010, a total of 40 HIV-infected adolescents who sought medical care in a university hospital in southern Taiwan were enrolled in the study. They were classified into three HIV at-risk groups, men who have sex with men (MSM), heterosexuals, and intravenous drug users (IDUs). Clinical and laboratory data were obtained from medical records.

RESULTS

The median age of the 40 HIV-infected adolescents was 19 years. The HIV at-risk groups were MSM (22/40, 55%), heterosexuals (7/40, 17.5%), IDUs (5/40, 12.5%), and unknown (6/40, 15%). The initial median CD4 count and log plasma HIV viral load were 318 cells/mm(3) and 4.61, respectively. The seroprevalence of anti-HAV, anti-HBc, anti-HCV antibodies and HBsAg was 5.3%, 26.1%, 13% and 13%, respectively. Among 17 adolescents who had regular follow-ups more than twice, 7 (41.2%) had a concurrent sexually transmitted disease (STD). The most common STD was genital warts (41.2%) followed by syphilis (11.8%). Among 7 patients who received highly active antiretroviral agents (HAART) for more than 12 months, 5 (71.4%) had sustained virologic suppression.

CONCLUSION

MSM are the largest risk group in HIV-infected adolescents in southern Taiwan and are characterized by a high prevalence of anogenital warts and low seroprevalence of anti-HAV.

Increased gonorrhoea and chlamydia testing did not increase case detection in an HIV clinical cohort 1999-2007

OBJECTIVES

Since 2003, US organisations have recommended universal screening, rather than targeted screening, of HIV-infected persons for gonorrhoea and chlamydia. The objective of this study was to determine whether wider testing resulting from these guidelines would produce an increase in gonorrhoea/chlamydia diagnoses.

METHODS

3283 patients receiving HIV care in 1999-2007 in the Johns Hopkins Hospital HIV clinic were studied. The two primary outcomes were the occurrence of any gonorrhoea/chlamydia testing in each year of care and the occurrence of any positive result(s) in years of testing. The proportion of all patients in care who were diagnosed with gonorrhoea/chlamydia was defined as the number of patients with positive results divided by the number of patients in care. Trends were analysed with repeated measures logistic regression.

RESULTS

The proportion of patients tested for gonorrhoea/chlamydia increased steadily from 0.12 in 1999 to 0.33 in 2007 (OR per year for being tested 1.17, 95% CI 1.15 to 1.19). The proportion positive among those tested decreased significantly after 2003 (OR per year 0.67, 95% CI 0.55 to 0.81). The proportion of all patients in care diagnosed with gonorrhoea/chlamydia therefore remained generally stable in 1999-2007 (OR per year 0.97, 95% CI 0.91 to 1.04).

CONCLUSIONS

Universal annual screening, as implemented, did not increase the proportion of all patients in care who were diagnosed with gonorrhoea/chlamydia. Similarly low implementation rates have been reported in cross-sectional studies. If future efforts to enhance implementation do not yield increases in diagnoses, then guidelines focusing on targeted screening of high-risk groups rather than universal screening may be warranted.

Prevalence of sexually transmitted co-infections in people living with HIV/AIDS: systematic review with implications for using HIV treatments for prevention

Sexually transmitted co-infections increase HIV infectiousness through local inflammatory processes. The prevalence of STI among people living with HIV/AIDS has implications for containing the spread of HIV in general and the effectiveness of HIV treatments for prevention in particular. Here we report a systematic review of STI co-infections in people living with HIV/AIDS. We focus on STI contracted after becoming HIV infected. Electronic database and manual searches located 37 clinical and epidemiological studies of STI that increase HIV infectiousness. Studies of adults living with HIV/AIDS from developed and developing countries reported STI rates for 46 different samples (33 samples had clinical/laboratory confirmed STI). The overall mean point-prevalence for confirmed STI was 16.3% (SD=16.4), and median 12.4% STI prevalence in people living with HIV/AIDS. The most common STI studied were Syphilis with median 9.5% prevalence, Gonorrhea 9.5%, Chlamydia 5%, and Trichamoniasis 18.8% prevalence. STI prevalence was greatest at the time of HIV diagnosis, reflecting the role of STI in HIV transmission. Prevalence of STI among individuals receiving HIV treatment was not appreciably different from untreated persons. The prevalence of STI in people infected with HIV suggests that STI co-infections could undermine efforts to use HIV treatments for prevention by increasing genital secretion infectiousness.