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Musema GMA, Akilimali PZ, za Balega TKN, Tshala-Katumbay D, Lusamba PSD. Predictive Factors of HIV-1 Drug Resistance and Its Distribution among Female Sex Workers in the Democratic Republic of the Congo (DRC). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042021. [PMID: 35206211 PMCID: PMC8872192 DOI: 10.3390/ijerph19042021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 01/27/2023]
Abstract
The predictive factors of HIV-1 drug resistance and its distribution are poorly documented in female sex workers (FSWs) in the Democratic Republic of the Congo (DRC). However, the identification of predictive factors can lead to the development of improved and effective antiretroviral therapy (ART). The objective of the current study was to determine the predictive factors of HIV-1 drug resistance and its distribution based on FSWs in the studied regions in the Democratic Republic of the Congo (DRC). HIV-positive FSWs who were diagnosed as part of the DRC Integrated Biological and Behavioral Surveillance Survey (IBBS) were included in this study. A total of 325 FSWs participated. The HIV-1 viral load (VL) was measured according to the Abbott m2000sp and m2000rt protocols. The homogeneity chi-square test was conducted to determine the homogeneity of HIV-1 drug resistance distribution. Using a significance level of 0.05, multivariate analyses were performed to identify factors associated with HIV-1 drug resistance to ART. HIV drug resistance mutation (HIVDRM) distribution was homogeneous in the three study regions (p = 0.554) but differed based on the HIV-1 VLs of the FSWs. FSWs with high HIV-1 VLs harbored more HIVDRMs (p = 0.028) of predominantly pure HIV-1 strains compared with those that had low HIV-1 VLs. Sexually transmitted infection (STI) history (aOR [95%CI] = 8.51 [1.62, 44.74]), high HIV-1 VLs (aOR [95%CI] = 5.39 [1.09, 26.74]), and HIV-1-syphilis coinfection (aOR [95%CI] = 9.71 [1.84, 51.27]) were associated with HIV drug resistance among FSWs in the DRC. A history of STIs (e.g., abnormal fluid) in the 12 months prior to the survey, a high HIV-1 VL, and HIV-1-syphilis coinfection were associated with HIV-1 drug resistance among FSWs in the DRC. Efforts should be made to systematically test for other infections which increase the HIV-1 VL, in the case of HIV-1 coinfection, in order to maintain ART effectiveness across the DRC.
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Affiliation(s)
- Godefroid Mulakilwa Ali Musema
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo; (G.M.A.M.); (P.-S.D.L.)
| | - Pierre Zalagile Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo; (G.M.A.M.); (P.-S.D.L.)
- Correspondence: ; Tel.: +24-38-1580-0288
| | | | - Désiré Tshala-Katumbay
- Department of Neurology, School of Medicine and School of Public Health, Oregon Health & Science University, Portland, OR 97239, USA;
- Department of Neurology, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
- Institut National de Recherches Biomédicales, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
| | - Paul-Samson Dikasa Lusamba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo; (G.M.A.M.); (P.-S.D.L.)
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Neto PLF, Fonseca RRDS, Avelino MEDS, Vilhena EM, Barbosa MDADAP, Lopes CAF, Gomes STM, Sequeira BJ, Laurentino RV, Freitas FB, Oliveira-Filho AB, Machado LFA. Prevalence and Factors Associated With Syphilis in People Living With HIV/AIDS in the State of Pará, Northern Brazil. Front Public Health 2021; 9:646663. [PMID: 34434909 PMCID: PMC8381150 DOI: 10.3389/fpubh.2021.646663] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/30/2021] [Indexed: 11/20/2022] Open
Abstract
Syphilis continues to be a public health problem worldwide and its incidence has increased in people living with HIV/AIDS in recent years. This study determined the prevalence and factors associated with syphilis in people living with HIV/AIDS in the city of Belém, northern Brazil. A cross-sectional study was conducted from June to November 2018. A total of 500 people living with HIV/AIDS attended at a specialized unit of the public health network of the State of Pará were studied. Questionnaires were used to collect socio-demographic data and potential risk factors for syphilis. Blood samples were collected from all subjects and screened for syphilis using VDRL, and the seropositive were confirmed using FTA-abs. Logistic regressions were used to identify the factors associated with syphilis. Most subjects were male (56.8%), had more than 40 years (54.0%), single (63.0%), had finished high school (54.2%), had monthly income ≤1 minimum wage (72.4%), and had been born to the city of Belém (59.8%). Prevalence of syphilis was 6.4%. Eight characteristics/behaviors associated with syphilis: male, young adults, single, studied at least high school, monthly income >1 minimum wage, homosexual/bisexual, does not use or sporadically use condoms during sexual intercourse, and have had more than one sexual partner in the last three months. The prevalence of syphilis in people living with HIV/AIDS in Belém is low when compared to other Brazilian states. However, there is a need for public policies and actions to monitor, control and prevent these two sexually transmitted infections.
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Affiliation(s)
- Pedro Leão Fontes Neto
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém, Brazil
| | - Ricardo Roberto de Souza Fonseca
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém, Brazil.,Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belem, Brazil
| | - Maria Eduarda de Sousa Avelino
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém, Brazil.,Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belem, Brazil
| | | | | | | | | | - Bianca Jorge Sequeira
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belem, Brazil
| | | | | | - Aldemir Branco Oliveira-Filho
- Study and Research Group on Vulnerable Populations, Institute for Coastal Studies, Federal University of Pará, Bragança, Brazil
| | - Luiz Fernando Almeida Machado
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém, Brazil.,Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belem, Brazil
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Fan L, Yu A, Zhang D, Wang Z, Ma P. Consequences of HIV/Syphilis Co-Infection on HIV Viral Load and Immune Response to Antiretroviral Therapy. Infect Drug Resist 2021; 14:2851-2862. [PMID: 34335031 PMCID: PMC8318222 DOI: 10.2147/idr.s320648] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/10/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Although syphilis is a frequent co-infection in patients with human immunodeficiency virus (HIV) infection, the influence of syphilis on immune response and virologic failure in HIV-infected patients following initiation of antiretroviral therapy (ART) is not well-defined. Methods A retrospective study was conducted at Tianjin Second People's Hospital to evaluate the prevalence of syphilis and immune status in 4171 ART-naïve patients. The study included patients who initiated ART between August 2009 and June 2019. Results The prevalence of syphilis was 40.1% in all ART-naïve patients and 42.5% in ART-naïve men who have sex with men. HIV/syphilis co-infection was associated with higher virologic failure (odds ratio (95% confidence interval): 1.30 (1.04, 1.63)). Patients with HIV/syphilis co-infection had lower median CD4+ T cell counts and CD4/CD8 ratios at baseline. After initiation of ART, patients co-infected with HIV/syphilis had smaller increases in CD4+ T cell counts and CD4/CD8 ratios than patients infected only with HIV. The rate of recurrence of syphilis or reinfection was 9% (n = 128) during seven years of ART. Conclusion HIV/syphilis co-infection had a negative impact on immune recovery and antiretroviral effectiveness. RPR titer and HIV viral load should be monitored in patients co-infected with HIV/syphilis, especially in patients with high RPR titers.
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Affiliation(s)
- Lina Fan
- Department of Infectious Diseases, Tianjin Second People's Hospital, Nankai University, Tianjin, 300192, People's Republic of China
| | - Aiping Yu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Nankai University, Tianjin, 300192, People's Republic of China
| | - Defa Zhang
- Department of Infectious Diseases, Tianjin Second People's Hospital, Nankai University, Tianjin, 300192, People's Republic of China
| | - Ziyu Wang
- Department of Infectious Diseases, Tianjin Second People's Hospital, Nankai University, Tianjin, 300192, People's Republic of China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Nankai University, Tianjin, 300192, People's Republic of China
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Santos AMG, Souza Júnior VRD, Melo FLD, Aquino AECDA, Ramos MOA, Araújo LM, Lira CRD, Sobral PM, Figueiroa F, Melo HRLD, Araújo PSRD. Prevalence and risk factors of syphilis and human immunodeficiency virus co-infection at a university hospital in Brazil. Rev Soc Bras Med Trop 2019; 51:813-818. [PMID: 30517536 DOI: 10.1590/0037-8682-0097-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/06/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The incidence of syphilis has increased since the 1970s. METHODS This was a descriptive and analytical cross-sectional study with a non-probabilistic sample. RESULTS Of 973 patients with human immunodeficiency virus, 179 (18.4%) tested positive for both human immunodeficiency virus and syphilis, 84.8% were men, 50.9% were aged between 36 and 50 years, 47.8% with syphilis were diagnosed with human immunodeficiency virus for 10-20 years, and 40.3% received antiretroviral therapy for 10-20 years. CONCLUSIONS The prevalence of syphilis in patients with human immunodeficiency virus is higher than expected, making it urgent to adopt efficient public health measures.
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Affiliation(s)
| | | | - Fábio Lopes de Melo
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | | | | | - Lucas Marinho Araújo
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | | | - Patrícia Maria Sobral
- Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | | | | | - Paulo Sérgio Ramos de Araújo
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil.,Instituto Aggeu Magalhaes, Fundação Oswaldo Cruz, Recife, PE, Brasil
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Chumakov EM, Petrova NN, Rassokhin VV. MENTAL DISORDERS AND THEIR INFLUENCE ON THE COMMITMENT TO OBSERVATION IN THE INFECTIONIST IN HIVINFECTED PATIENTS WITH EARLY SYPHILIS. ACTA ACUST UNITED AC 2018. [DOI: 10.22328/2077-9828-2018-10-2-69-80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV and syphilis have similar epidemiological characteristics which causes a high level of combined infection. Both STDs affect the central nervous system early after infection. Mental disorders occur with a high incidence in HIV-infected patients and patients with syphilis, but data on the effect of combined HIV and syphilis infection on mental disorders are found only in single articles. Objectives. The goal is to study mental disorders and their effect on the commitment to observation in the infectionist in HIV-infected patients with early syphilis. Materials and methods. A comparative study of 148 patients (65 HIV-infected patients with syphilis, 50 patients with syphilis monoinfection, 33 HIV-infected patients, seronegative for syphilis) was carried out. We used clinical, psychopathological, follow-up, psychometric, laboratory and statistical methods of investigation. Results. It was found that mental disorders occur in the majority (83%) of HIV-infected patients with syphilis with the predominance of affective (54%) and addictive (48%) disorders. In HIV-infected patients with early neurosyphilis, psychogenic reactions developed statistically significantly more often than in HIV-infected patients with early syphilis. In contrast, there were no statistically significant differences in the incidence of addictive, affective, personality disorders and mental disorders due to organic brain damage in patients with early neurosyphilis and early syphilis in the case of co-infection with HIV infection. Mental disorders due to organic brain damage had a mixed genesis (including infectious) in all cases and were associated and caused by the already existing HIV infection. HIV-infected patients with syphilis, in general, were characterized by the low commitment to observation in the infectionist which were influenced by the following factors: social maladjustment, drug abuse and criminal activity. Discussion. The frequency of detected mental disorders in the examined HIV-infected patients with syphilis (83,1%) corresponded to the literature on the incidence of mental illness in HIVinfected patients inSt. Petersburg(85,6%), but was higher than the prevalence of mental disorders in patients with syphilis (68%). Given the established influence of neurosyphilis mono-infection on the development of mental disorders due to organic brain damage, it can be concluded that the disease with early neurosyphilis is important in the development of mental disorders of organic genesis. But the weight of this factor is insufficient in case of co-infection with HIV and early neurosyphilis and can only have additional significance in the development of mental disorders and the key factor is HIV-infection action. Mental disorders (addictive disorders and cognitive impairment) adversely affect the commitment to observation in the infectionist of HIV-infected patients with syphilis, therefore timely correction of mental disorders may be one of the factors improving compliance of patients. Conclusions. The study found a minor role of early neurosyphilis (as opposed to HIV infection) on the formation of mental disorders in the case of a combination of these infections. At the same time, it was found that addictive and cognitive symptomatic complexes have a negative impact on the probability of reference to an infectious disease specialist for initiating therapy in HIV-infected patients with syphilis.
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[Nonviral sexually transmitted infections-epidemiology, clinical manifestations, diagnostic workup, therapy : Part 3: Treponemes, Gardnerella and trichomonads]. Hautarzt 2017; 68:136-148. [PMID: 28058468 DOI: 10.1007/s00105-016-3917-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In Germany, the reported syphilis prevalence has increased continuously since 2010, with a total of 6834 syphilis cases being reported in 2015. The largest increase of reported syphilis occurred in men who have sex with men (MSM). The antibiotic agent of choice for treatment of syphilis is still penicillin. There are no penicillin-resistant Treponema pallidum strains. Alternatives are ceftriaxone and doxycycline. In Germany, azithromycin is not approved for treatment of syphilis; however, therapy failures are increasingly reported. Bacterial vaginosis is accompanied by vaginal discharge. The vaginal secretion exhibits an increased pH value higher than 4.5. Clinical symptoms are pruritus, burning, and the characteristic amine odor. The probability for bacterial vaginosis is highest in women with higher numbers of sexual partners, unmarried women, early first sexual intercourse, in commercial female sex workers, and those women who regularly apply vaginal douches. The main pathogen of bacterial vaginosis is Gardnerella vaginalis. For oral therapy metronidazole is given, alternatively clindamycin; the latter should be applied additionally as topical agent. Trichomoniasis is considered as the nonviral sexually transmitted infection with the highest prevalence worldwide. Other than direct microscopic detection of the protozoa (trophozoites) in vaginal secretion or urine, PCR has been approved as the diagnostic method with the highest sensitivity. Oral metronidazole represents the therapy of choice in trichomoniasis.
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Esser S, Krotzek J, Dirks H, Scherbaum N, Schadendorf D. Sexualverhalten, STIs und HIV-Übertragungsrisiken bei HIV-positiven MSM - Ansätze für die ärztliche Präventionsarbeit. J Dtsch Dermatol Ges 2017; 15:421-429. [PMID: 28378480 DOI: 10.1111/ddg.13217_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/14/2016] [Indexed: 12/01/2022]
Abstract
HINTERGRUND Steigende Inzidenzen von HIV-Infektionen und STIs (sexually transmitted infections) bei MSM (men having sex with men) seit 2001 in Deutschland erfordern neue Ansätze in der ärztlichen Präventionsarbeit. Diese Studie befasst sich mit geeigneten Parametern für gezielte ärztliche Angebote an HIV-positive MSM mit hohem Risiko für die Übertragung von HIV und STIs. METHODIK UND PATIENTEN In einem zweijährigen Beobachtungszeitraum wurden 233 HIV-positive MSM in der HIV-Ambulanz des Universitätsklinikums Essen zu ihrem Sexualverhalten, Suchtmittelkonsum und psychischem Befinden im vorhergehenden Jahr systematisch befragt. Die dokumentierten Labordaten und klinische Verläufe wurden von der Erstdiagnose der HIV-Infektion bis zum Januar 2014 ausgewertet. ERGEBNISSE Drogengebrauch, Promiskuität, jüngeres Lebensalter und bekannte STIs in der Vorgeschichte waren bei HIV-positiven MSM mit häufigerem ungeschützten Geschlechtsverkehr und einer höheren STI-Inzidenz assoziiert. Zusätzliche HIV-spezifische Parameter für ein erhöhtes HIV-Transmissionsrisiko waren neben einer nachweisbaren HIViruslast unbehandelte HIV-Infektionen, Therapieadhärenzprobleme, Wechsel der antiretroviralen Therapie in den letzten zwölf Monaten, bekannte HIV-Multiresistenz und ein höherer CD4-Zell-Nadir. Obwohl die HIViruslast in der Routineversorgung quartalsweise bestimmt und anschließend vom Arzt mitgeteilt wird, schätzten nur 60 % der HIV-positiven MSM ihr HIV-Transmissionsrisiko korrekt ein. SCHLUSSFOLGERUNGEN Aus Routineuntersuchungen ergeben sich bei HIV-positiven MSM Profile, die auf ein Sexualverhalten mit hohem Risiko für die Übertragung von HIV und STIs hinweisen und Ansätze für die ärztliche Präventionsarbeit bieten.
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Affiliation(s)
- Stefan Esser
- Universitätsklinikum Essen, HPSTD-Ambulanz, Klinik für Dermatologie und Venerologie, Essen
| | - Judith Krotzek
- Universität Witten/Herdecke, Vestische Kinder- und Jugendklinik, Datteln
| | - Henrike Dirks
- Klinik für Abhängiges Verhalten und Suchtmedizin, LVR-Klinikum Essen, Kliniken der Universität Duisburg-Essen, Essen
| | - Norbert Scherbaum
- Klinik für Abhängiges Verhalten und Suchtmedizin, LVR-Klinikum Essen, Kliniken der Universität Duisburg-Essen, Essen
| | - Dirk Schadendorf
- Universitätsklinikum Essen, HPSTD-Ambulanz, Klinik für Dermatologie und Venerologie, Essen
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Esser S, Krotzek J, Dirks H, Scherbaum N, Schadendorf D. Sexual risk behavior, sexually transmitted infections, and HIV transmission risks in HIV-positive men who have sex with men (MSM) - approaches for medical prevention. J Dtsch Dermatol Ges 2017; 15:421-428. [PMID: 28294529 DOI: 10.1111/ddg.13217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/14/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rising incidence rates of HIV and STIs (sexually transmitted infections) among MSM (men who have sex with men) in Germany since 2001 call for new approaches in medical prevention. The present study addresses appropriate parameters to identify those HIV-positive MSM who are at high risk for transmitting HIV and STIs. PATIENTS AND METHODS Over a two-year period, 223 HIV-positive MSM attending the HIV outpatient clinic at the University Medical Center Essen (Germany) were systematically surveyed with respect to their sexual behavior, substance abuse, and psychological well-being in the preceding year. Data analyzed included laboratory and clinical data from the time of the initial HIV diagnosis until January 2014. RESULTS In HIV-positive MSM, a history of substance abuse, promiscuity, younger age, and known STIs was associated with a greater incidence of unprotected sexual intercourse and STIs. Apart from a detectable viral load, additional HIV-specific parameters associated with an increased HIV transmission risk included untreated HIV infection, adherence problems, changes in antiretroviral treatment over the preceding twelve months, known multiresistant HIV infection, and a higher CD 4 nadir. Despite routine quarterly monitoring of viral loads - the result thereof was communicated to patients - only 60 % of individuals assessed their HIV transmission risk correctly. CONCLUSIONS In HIV-positive MSM, patient history and routine laboratory tests allow for the establishment of patient profiles that suggest sexual behavior associated with a high risk of HIV and STI transmission, thus offering new approaches for medical prevention.
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Affiliation(s)
- Stefan Esser
- Department of Dermatology and Venereology, Outpatient Clinic for HIV and STIs, University Medical Center Duisburg-Essen, Essen, Germany
| | - Judith Krotzek
- Children's Hospital Datteln, University Witten/Herdecke, Germany
| | - Henrike Dirks
- Addiction Research Group at the Department of Psychiatry and Psychotherapy, University Medical Center Duisburg-Essen, LVR Hospital Essen, Essen, Germany
| | - Norbert Scherbaum
- Addiction Research Group at the Department of Psychiatry and Psychotherapy, University Medical Center Duisburg-Essen, LVR Hospital Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology and Venereology, Outpatient Clinic for HIV and STIs, University Medical Center Duisburg-Essen, Essen, Germany
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Sahin O, Ziaei A. Clinical and laboratory characteristics of ocular syphilis, co-infection, and therapy response. Clin Ophthalmol 2015; 10:13-28. [PMID: 26730177 PMCID: PMC4694667 DOI: 10.2147/opth.s94376] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the clinical presentation of patients diagnosed with presumed latent ocular syphilis and congenital ocular syphilis at tertiary referral center in Turkey, and to compare the clinical findings with patients described in other studies, specifically focusing on demographics and co-infections. Methods This is a retrospective study reviewing the medical records of patients diagnosed with ocular inflammation between January 2012 and June 2014 at a tertiary referral center in Turkey. Ocular syphilis was diagnosed on the basis of non-treponemal and treponemal antibody tests, and cerebrospinal fluid analysis. All the patients diagnosed with ocular syphilis were tested for human immunodeficiency virus (HIV), Toxoplasma gondii, rubella, cytomegalovirus, and herpes. Results A total of 1,115 patients were evaluated between January 2012 and June 2014, and 12 patients (1.07%) were diagnosed with ocular syphilis based on the inclusion criteria. None of the patients were seropositive for HIV. Two patients were seropositive for T. gondii-specific IgG. Clinical presentations include non-necrotizing anterior scleritis, non-necrotizing sclerokeratitis, anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis, and optic neuritis. All of the patients showed clinical improvement in the level of ocular inflammation with intravenous penicillin 24 million U/day for 10 days. Three patients received additional oral methotrexate as an adjunctive therapy. Two cases received low-dose trimethoprim–sulfamethoxazole. Conclusion Ocular syphilis is an uncommon cause of ocular inflammation in HIV-negative patients. Central retinochoroiditis is the most common ocular manifestation, and it is the most common cause of visual impairment. Ocular syphilis might present associated with co-infections such as T. gondii in developing countries. Oral methotrexate might be beneficial as an adjunctive therapy for ocular syphilis in resolving the residual intraocular inflammation and cystoid macular edema after specific therapy with intravenous penicillin.
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Affiliation(s)
- Ozlem Sahin
- Department of Ophthalmology/Uveitis, Dunya Goz Hospital, Ankara, Turkey
| | - Alireza Ziaei
- Department of Ophthalmology/Uveitis, Dunya Goz Hospital, Ankara, Turkey; Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA; Department of Ophthalmology, Dunya Eye Hospital Ltd, Ankara, Turkey
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High Prevalence and High Incidence of Coinfection with Hepatitis B, Hepatitis C, and Syphilis and Low Rate of Effective Vaccination against Hepatitis B in HIV-Positive Men Who Have Sex with Men with Known Date of HIV Seroconversion in Germany. PLoS One 2015; 10:e0142515. [PMID: 26555244 PMCID: PMC4640863 DOI: 10.1371/journal.pone.0142515] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/22/2015] [Indexed: 12/14/2022] Open
Abstract
Objectives Men who have sex with men (MSM) are at higher risk for coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis than the general population. HIV infection and these coinfections accelerate disease progression reciprocally. This study evaluated the prevalence and incidence of these coinfections in HIV1-positive MSM in Germany. Materials and Methods As part of a nationwide, multicenter, prospective cohort study of HIV-infected MSM, plasma samples collected yearly were screened for HBsAg and antibodies to HBc, HBs, HCV, and syphilis. Samples with indications of active HBV or HCV infection were confirmed by polymerase chain reaction. Prevalence and incidence of each infection and incidence rates per study participant were calculated, and incidences over 4-year time intervals compared. Results This study screened 5,445 samples from 1,843 MSM. Median age at HIV seroconversion was 33 years. Prevalences of active, cleared, and occult HBV, and of active/cleared HCV were 1.7%, 27.1%, 0.2%, and 8.2%, respectively, and 47.5% had been effectively vaccinated against HBV. Prevalence of antibodies to Treponema pallidum and of triple or quadruple sexually transmitted infections (STIs) were 39.6% and 18.9%, respectively. Prevalence of STI, cleared HBV, HBV vaccination, and history of syphilis differed significantly among age groups. Incidences of HBV, HCV, and syphilis were 2.51, 1.54, and 4.06 per 100 person-years, respectively. Incidences of HCV and syphilis increased over time. HCV incidence was significantly higher in MSM coinfected with syphilis and living in Berlin, and syphilis incidence was significantly higher for MSM living in Berlin. Discussion Despite extensive HBV vaccination campaigns, fewer than 50% of screened MSM were effectively vaccinated, with a high proportion of HIV-positive MSM coinfected with HBV. High rates of STI coinfections in HIV-positive MSM and increasing incidences emphasize the need for better tailored campaigns for HBV vaccination and STI prevention.
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Chen Y, Shen Z, Morano JP, Khoshnood K, Wu Z, Lan G, Zhu Q, Zhou Y, Tang S, Liu W, Chen J, Tang Z. Bridging the epidemic: a comprehensive analysis of prevalence and correlates of HIV, hepatitis C, and syphilis, and infection among female sex workers in Guangxi Province, China. PLoS One 2015; 10:e0115311. [PMID: 25723548 PMCID: PMC4344209 DOI: 10.1371/journal.pone.0115311] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/21/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Female sex workers (FSWs) are at highest risk for contracting HIV and facilitating the current heterosexual HIV epidemic in Guangxi, China, yet little is known of the impact of recent harm reduction campaigns in the province. We analyzed sentinel surveillance data collected between 2010 and 2012 in Guangxi to explore correlations between the prevalence of HIV, hepatitis C (HCV), and syphilis and risk behaviors of different categories of FSWs in Guangxi. METHODS The sentinel surveillance data for 5,1790 FSWs in all 14 prefectures and 64 city/county regions of Guangxi, China from 2010 to 2012 were collected. Differences between three categories of FSWs (grouped by venue) and disease trends (HIV, HCV, and syphilis) by year were analyzed using bivariate and multivariate logistic regression analyses as to evaluate risk factors correlated with HIV, HCV, or syphilis infection. RESULTS HIV and HCV prevalence remained constant across the three FSW categories; however, syphilis prevalence showed a significant increase from 5.7% to 7.3% for low-tier FSWs. Most cases with HIV, HCV, syphilis and intravenous drug use were seen in low-tier FSWs. Testing positive for HIV and syphilis were most correlated with being HCV positive (AOR 4.12 and AOR 4.36), only completing elementary school (AOR 3.71 and AOR 2.35), low tier venues (AOR 2.02 and AOR 2.00), and prior STI (AOR 1.40 and AOR 3.56), respectively. HCV infection was correlated with ever injecting drugs (AOR 60.65) and testing positive for syphilis (AOR 4.16) or HIV (AOR 3.74). CONCLUSIONS This study highlights that low tier FSWs with lower formal education levels are the most vulnerable population at risk for acquiring and transmitting HIV, HCV, and syphilis in Guangxi, China. Condom distribution with evolution to safer sex practices are the reasons to explain the non-increasing prevalence of HIV, HCV in Guangxi for 2010-2012.
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Affiliation(s)
- Yi Chen
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Zhiyong Shen
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Jamie P. Morano
- University of South Florida, Morsani College of Medicine, Division of Infectious Disease and International Medicine, and College of Public Health, Tampa, Florida, United States of America
| | - Kaveh Khoshnood
- Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, China Centers for Disease Control and Prevention, Beijing, China
| | - Guanghua Lan
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Qiuying Zhu
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Shuai Tang
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Wei Liu
- Guangxi Centers for Disease Control and Prevention, Nanning, China
| | - Jie Chen
- Health and Family Planning Commission of Guangxi, Zhuang Autonomous Region, Nanning, China
| | - Zhenzhu Tang
- Guangxi Centers for Disease Control and Prevention, Nanning, China
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