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Nevendorff L, Schroeder SE, Pedrana A, Bourne A, Stoové M. Prevalence of sexualized drug use and risk of HIV among sexually active MSM in East and South Asian countries: systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26054. [PMID: 36600479 DOI: 10.1002/jia2.26054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Sexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same-sex relationships and drug-using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy. METHODS We systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta-analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta-analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates. RESULTS AND DISCUSSION Of the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta-analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10-16%; I2 = 97.6) but higher when studies utilized self-administered surveys (15%; 95% CI = 12-19%; p<0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82-5.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27-8.21). CONCLUSIONS SDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between-study comparisons. Responses to SDU-related harms should consider local contexts, including specific drug types used and their relative risks.
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Affiliation(s)
- Laura Nevendorff
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- HIV AIDS Research Center, Atma Jaya Catholic University of Indonesia, South Jakarta, Indonesia
| | - Sophia E Schroeder
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Zhao P, Yang Z, Zhang Y, Chen J, Fu X, Tang W, Zhou J. Prevalence of syphilis and risk factors among HIV-positive men who have sex with men in Guangdong province. Front Public Health 2022; 10:1025221. [PMID: 36438237 PMCID: PMC9682027 DOI: 10.3389/fpubh.2022.1025221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background HIV-positive men who have sex with men (MSM) tend to have high syphilis incidence. Our objective is to evaluate the prevalence of syphilis and determine the risk factors of syphilis among HIV-positive MSM. Methods A cross-sectional study with convenience sampling was performed among HIV-positive MSM in six cities of Guangdong Province from June 2020 to August 2021. Participants completed a survey including social-demographic characteristics, sexual behaviors and self-reported syphilis, chlamydia, gonorrhea, herpes, human papillomavirus statuses after HIV diagnosis. Multivariate logistic regression was used to determine the factors associated with syphilis and sexually transmitted diseases (STD). Results Among 944 HIV-positive MSM, 141 (14.9, 95% CI: 12.7-17.2%) men had syphilis and 220 (23.3, 95% CI: 20.6-26.0%) men had STD. Multivariate analysis indicated that MSM who met male sexual partners mainly through traditional meeting places (spa or bath house, sauna, foot or body massage parlor) in the last 6 months [adjusted Odds Ratio (aOR) = 2.91, 95% CI: 1.09-7.79], and who were diagnosed with herps after the HIV diagnosis (aOR = 3.79, 95% CI: 1.16-12.39) were more likely to have syphilis. In addition, MSM who met male sexual partners mainly through traditional meeting places in the last 6 month (aOR = 2.55, 95% CI: 1.01-6.42), and who had more than one male sexual partner in the last 6 months (aOR = 1.88, 95% CI: 1.17-3.02) were more likely to have STD. Conclusions The prevalence of syphilis and other STDs is relatively high among HIV-positive MSM in southern China. Routine syphilis screening as a part of HIV monitoring among HIV-positive MSM will have important epidemiological significance for the management of infected patients, and can help reduce the spread of syphilis.
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Affiliation(s)
- Peizhen Zhao
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China,Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Ziying Yang
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ye Zhang
- Kirby Institute, New South Wales University, Sydney, NSW, Australia
| | - Jinmei Chen
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xuezhen Fu
- International Department of Nanjing No.13 Middle School, Nanjing, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China,University of North Carolina Project-China, Guangzhou, China,*Correspondence: Weiming Tang
| | - Jiyuan Zhou
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China,Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China,Jiyuan Zhou
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Xie N, Hu X, Yan H, Ruan L, Liu C, Hu R, Ma H, Luo Y, Liu L, Wang X. Effects of Case Management on Risky Sexual Behaviors and Syphilis Among HIV-Infected Men Who Have Sex With Men in China: A Randomized Controlled Study. Sex Transm Dis 2022; 49:22-28. [PMID: 34192724 PMCID: PMC8663520 DOI: 10.1097/olq.0000000000001502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The prevalence of syphilis is very high in human immunodeficiency virus (HIV)-positive men who have sex with men (MSM), and effective interventions are needed to educate HIV-positive individuals about behavioral and biological risk factors. Therefore, we developed a standard case management process and conducted a randomized controlled study to investigate the impact on risky sexual behaviors and syphilis in HIV-positive MSM. METHODS Men who have sex with men (n = 220) were enrolled and randomized to the case management intervention group and the control group between May 2016 and January 2017. The control group received routine HIV-related care. In addition to routine HIV-related care, those in the intervention group regularly received extended services from a well-trained case manager. Epidemiological information was collected during the baseline face-to-face interviews by a trained investigator. Serological tests for syphilis and assessments of risky sexual behaviors were performed at baseline and 6 and 12 months after the initiation of treatment. RESULTS The syphilis incidence rates in the intervention and control groups were 11.3 per 100 person-years and 20.6 per 100 person-years, respectively. The multivariable-adjusted hazard ratio (95% confidence inter) for syphilis in case management group was 0.34 (0.14-0.87). The percentages of participants who resumed risky sexual behaviors in both groups were significantly reduced (P < 0.05) but did not significantly differ between the 2 groups. CONCLUSIONS A case management intervention reduced the incidence of syphilis in HIV-positive MSM. We should further increase the content of case management on the basis of providing routine HIV-related care to those people.
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Affiliation(s)
- Nianhua Xie
- From the Department of HIV/AIDS Prevention and Control, Wuhan Center for Disease Control and Prevention
| | - Xuejiao Hu
- From the Department of HIV/AIDS Prevention and Control, Wuhan Center for Disease Control and Prevention
| | - Han Yan
- From the Department of HIV/AIDS Prevention and Control, Wuhan Center for Disease Control and Prevention
| | - Lianguo Ruan
- Department of Infectious Diseases, Wuhan Jin Yin-tan Hospital, Wuhan, Hubei, China
| | - Cong Liu
- From the Department of HIV/AIDS Prevention and Control, Wuhan Center for Disease Control and Prevention
| | - Rong Hu
- From the Department of HIV/AIDS Prevention and Control, Wuhan Center for Disease Control and Prevention
| | - Hongfei Ma
- From the Department of HIV/AIDS Prevention and Control, Wuhan Center for Disease Control and Prevention
| | - Yanhe Luo
- Department of Infectious Diseases, Wuhan Jin Yin-tan Hospital, Wuhan, Hubei, China
| | - Li Liu
- Department of Infectious Diseases, Wuhan Jin Yin-tan Hospital, Wuhan, Hubei, China
| | - Xia Wang
- From the Department of HIV/AIDS Prevention and Control, Wuhan Center for Disease Control and Prevention
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Wagner LF, Lanzl I, Rothe K, Schneider J, Zink A, Zapp D, Schwerdtfeger C, Lee M, Weidlich S, Neuenhahn M, Loos D, Spinner CD. Clinical and Ophthalmological Characteristics of Ocular Syphilis in a Retrospective Tertiary Hospital Cohort. Sex Transm Dis 2021; 48:436-442. [PMID: 33156290 DOI: 10.1097/olq.0000000000001329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Data on ocular syphilis (OS) and its clinical presentation are currently insufficient. This study aimed to investigate the characteristics of a cohort with a high OS incidence at a university hospital in Germany, focusing on the clinical presentation of OS. METHODS This single-center cohort study retrospectively analyzed data on 90 patients with 109 episodes of syphilis between 2008 and 2018. Cases of OS were identified and additionally reevaluated through a study-specific secondary assessment by an ophthalmologist specializing in uveitis. RESULTS Twenty-three patients (26%) were diagnosed with OS, 16 (70%) of whom were with binocular involvement. Uveitis, especially that of the posterior segment, showed a high prevalence. Lumbar puncture was performed in 20 OS patients (87%), of whom 17 (85% of those with lumbar puncture/74% in total) met the 2018 Centers for Disease Control and Prevention criteria for likely neurosyphilis. Five (22%) of 23 patients had HIV infection, of whom 2 did not receive antiretroviral therapy. The preferred syphilis treatment regimens were benzylpenicillin and ceftriaxone, which yielded favorable serological, clinical, and ophthalmological outcomes. CONCLUSIONS A high incidence of OS was identified, and physicians should be aware of uveitis as a manifestation of syphilis. Most patients presented with uveitis and syphilis in an early or late latent stage and showed central nervous system involvement.
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Lee NY, Chen YC, Liu HY, Li CY, Li CW, Ko WC, Ko NY. Increased repeat syphilis among HIV-infected patients: A nationwide population-based cohort study in Taiwan. Medicine (Baltimore) 2020; 99:e21132. [PMID: 32664143 PMCID: PMC7360277 DOI: 10.1097/md.0000000000021132] [Citation(s) in RCA: 2] [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] [Received: 12/28/2019] [Revised: 05/09/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Nan-Yao Lee
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Ying Liu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Wen Li
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Nai-Ying Ko
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Nath R, Grennan T, Parry R, Baharuddin F, Connell JP, Wong J, Grace D. Knowledge and attitudes of syphilis and syphilis pre-exposure prophylaxis (PrEP) among men who have sex with men in Vancouver, Canada: a qualitative study. BMJ Open 2019; 9:e031239. [PMID: 31753877 PMCID: PMC6886914 DOI: 10.1136/bmjopen-2019-031239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES In British Columbia, Canada, syphilis is at record-high rates, with over 80% of cases in 2017 seen in gay, bisexual and other men who have sex with men (GBM). The syphilis epidemic is of particular concern for those living with HIV, since syphilis may lead to more serious complications in this population. We sought to explore syphilis-related knowledge and attitudes around biomedical prevention options for syphilis, with the goal of informing effective strategies to prevent syphilis. DESIGN We conducted a qualitative study consisting of in-depth, individual interviews from December 2016 to June 2017. Our interviews focused on participants' knowledge about syphilis and perceptions regarding syphilis pre-exposure prophylaxis (PrEP). Interviews were analysed using Grounded Theory. PARTICIPANTS Twenty-five GBM were interviewed (64% white; median age: 43 years), including men living with HIV and/or with a history of syphilis. SETTING Vancouver, British Columbia. RESULTS Five interrelated themes emerged. First, GBM were aware of the local syphilis epidemic. Second, syphilis-related knowledge differed according to syphilis and HIV serostatus. Third, competing ideas emerged regarding men's concerns about syphilis. While our participants expressed concern about getting syphilis, they also described the importance of sexual pleasure. Fourth, many participants said that syphilis was not perceived to be alarming; preventing HIV infection remained a primary concern for many. Finally, while syphilis PrEP was appealing to those living with HIV or a prior syphilis diagnosis, others were concerned about antibiotic resistance, cost and side effects. CONCLUSIONS Our participants organised their safer sex strategies around HIV, not syphilis. Although syphilis-related knowledge was relatively high among GBM living with HIV and those with a prior syphilis diagnosis, this knowledge did not appear to be related with safer sexual practices, such as increased condom use. This work highlights the importance of examining other potential prevention solutions, such as syphilis PrEP.
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Affiliation(s)
- Ronita Nath
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- Department of Infectious diseases, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Troy Grennan
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Infectious diseases, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Robin Parry
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Fahmy Baharuddin
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - James P Connell
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jason Wong
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Zhang Y, Wu G, Lu R, Xia W, Hu L, Xiong Y, Xie J, Yu Q, Ye M. What has changed HIV and syphilis infection among men who have sex with men (MSM) in Southwest China: a comparison of prevalence and behavioural characteristics (2013-2017). BMC Public Health 2019; 19:1314. [PMID: 31638943 PMCID: PMC6805434 DOI: 10.1186/s12889-019-7730-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background Chongqing reportedly has a large MSM population and a high STI prevalence in previous studies. However, most studies are attributed to independent cross-sectional studies, few studies have investigated trends in the prevalence of syphilis and HIV, as well as behavioural characteristics among MSM using serial surveillance surveys. Methods Data were collected in Chongqing through face-to-face questionnaire interview and laboratory testing in Chongqing. The respondents were recruited among MSM by snowball sampling from May 2013 to December 2017. The self-report questionnaire primarily included socio-demographics, HIV knowledge, and HIV-related behaviour characteristics over the year. Blood specimens were tested to diagnose HIV and syphilis infection by Chongqing CDC. Cochran-Armitage trend test and multivariate logistic regression were conducted to compare the changes in STI prevalence and independent behavioural factors among MSM. Results There were 6568 eligible participants (98.4%). The overall HIV prevalence was 20.5% among MSM in Chongqing, with a decrease from 23.0% in 2013 to 19.2% in 2017. The overall syphilis prevalence was 5.8%, with an increase from 3.2% in 2013 to 6.7% in 2017. The proportion of consistent condom use (CCU) during anal intercourse (46.3 to 57.7%, P<0.001),CCU with regular male partners(47.7 to 59.7%, P<0.001), CCU with casual male partners (51.5 to 62.3%, P<0.001) and drug use during anal intercourse (0.3 to 1.4%, P<0.05) were increasing. By contrast, a significant decrease was reported in the percentage of MSM with more than two regular male partners (66.0 to 21.4%, P<0.001) and more than two casual male partners (38.3 to 20.7%, P<0.001). A significant difference was observed in syphilis infection, testing for HIV antibodies and drug use during anal intercourse in the past years between the HIV-positive and HIV-negative respondents. Conclusion A decreasing trend of HIV prevalence was showed during among MSM from 2013 to 2017 in Chongqing. While gradual reduction of high-risk behaviors along with HIV prevalence supported development of STI counselling and testing, increasing syphilis infection and drug use during anal intercourse warrants further understanding.
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Affiliation(s)
- Yangchang Zhang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Guohui Wu
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Rongrong Lu
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Wanyuan Xia
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Ling Hu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Yang Xiong
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Junhao Xie
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China
| | - Qiuhua Yu
- Department of Nursing, Chongqing Medical University, Chongqing, 400016, China
| | - Mengliang Ye
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China.
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Prevalence of Active Syphilis Infection and Risk Factors among HIV-Positive MSM in Zhejiang, China in 2015: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091507. [PMID: 31035429 PMCID: PMC6539918 DOI: 10.3390/ijerph16091507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 01/09/2023]
Abstract
Objectives: To determine the prevalence of active syphilis infection and explore the risk factors for active syphilis in human immunodeficiency virus (HIV)-positive men who had sex with men (MSM) in Zhejiang Province, 2015. Design: Data on HIV-positive MSM living in Zhejiang Province were obtained from the National Center for AIDS/STD Control and Prevention (NCAIDS) reporting system and the Zhejiang provincial AIDS/STD surveillance system between June and December 2015. The information included risky behavior, years with diagnosed HIV, and highly active antiretroviral therapy (HAART). SPSS 19.0 was used for the data analysis. Results: The analysis included 3616 MSM. Of these, 11.3% (407/3616) had active syphilis. Multivariate logistic regression analysis revealed that HAART was significantly associated with an increased risk of active syphilis infection (odds ratio (OR) = 1.760, 95% confidence interval (CI) 1.187–2.611). Compared with participants diagnosed with HIV for <2 years, patients diagnosed with HIV for >5 years had a higher risk of active syphilis infection (OR = 1.707, 95% CI 1.167–2.495). Age and number of sex partners were also independent risk factors for active syphilis infection. Conclusions: The incidence of active syphilis infection is high among HIV-positive MSM in Zhejiang Province; age, number of sex partners, years with diagnosed HIV, and receiving HAART were risk factors. Patients who are elderly, have lived with HIV for a longer period, have more sex partners, and receive HAART should be the focus of interventions to promote changes in behavior and decrease syphilis infection.
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Wang Z, Liu L, Shen YZ, Zhang RF, Qi TK, Tang Y, Song W, Chen J, Lu H. The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients. Medicine (Baltimore) 2018; 97:e0078. [PMID: 29489672 PMCID: PMC5851754 DOI: 10.1097/md.0000000000010078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/03/2018] [Accepted: 02/13/2018] [Indexed: 11/17/2022] Open
Abstract
Neurosyphilis (NS) is an important component of central nervous system diseases among HIV-infected patients. However, its characteristics are not very clear. A retrospective analysis of clinical and laboratory findings was performed in 92 NS patients with HIV infection from a tertiary hospital in Shanghai, China. The patients had a median age of 38 years and a median CD4 count of 198 cells/μL. In all, 44.6% (41/92) were diagnosed as asymptomatic NS (ANS), 23.9% (22/92) as syphilitic meningitis, 17.4% (16/92) as cerebrovascular NS, and 14.1% (13/92) as parenchymal syphilis. A quarter of patients (23/92) complicated with ocular syphilis (OS), 60.9% (14/23) of which were ANS. The serum tolulized red unheated serum test (TRUST) titers were ≤1:8 in 15 patients (16.3%), 1:16-1:128 in 51 patients (55.4%), and ≥1:256 in 26 patients (28.3%). Sixty-nine patients (75.0%) had both cerebrospinal fluid (CSF) TRUST and Treponema pallidum particle assay reactive. CSF pleocytosis and protein elevation were found in 58.7% and 53.3% of patients, respectively. Syphilitic meningitis was more likely to present with CSF pleocytosis than ANS (P = .001), cerebrovascular NS (P < .001), and parenchymal NS (P < .001). The proportion of patients with CSF elevated protein was lower in ANS group than that in syphilitic meningitis (P = .003), cerebrovascular NS (P = .001), and parenchymal NS groups (P = .025), and was higher in sero-TRUST titers ≤1:8 group than that in 1:16-1:128 (P = .01) and 1:256-1:1024 groups (P = .005).This study revealed that ANS was the most common clinical type of NS in HIV-infected patients, which should be considered in HIV and syphilis co-infection patients without neurologic symptoms, especially in those with OS. Different patterns of NS might have different CSF features which may also vary with sero-TRUST titers.
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Affiliation(s)
- Zhenyan Wang
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
| | - Li Liu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
| | - Yin-Zhong Shen
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
| | - Ren-Fang Zhang
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
| | - Tang-Kai Qi
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
| | - Yang Tang
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
| | - Wei Song
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
| | - Jun Chen
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
| | - Hongzhou Lu
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
- Huashan Hospital affiliated to Fudan University, Shanghai
- Medical College of Fudan University, Shanghai, China
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Valdes A, Cazanave C, Dabis F, Neau D, Lacoste D, Gaborieau V, Farbos S, Dworkin MS. Knowledge, behaviors, and attitudes of HIV-infected men about syphilis. Med Mal Infect 2017; 47:470-476. [PMID: 28943166 DOI: 10.1016/j.medmal.2017.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/30/2016] [Accepted: 07/27/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore knowledge on syphilis, sexual behaviors, and attitudes in men living with HIV in southwestern France. PATIENTS AND METHODS In the ANRS CO3 Aquitaine Cohort of people living with HIV (PLHIV), a self-administered questionnaire was proposed to all male PLHIV attending one of the seven participating clinics between September 22 and October 24, 2014. The 15 questions explored patient knowledge about syphilis disease, attitudes, and behaviors during sexual intercourse. RESULTS Among 302 patients surveyed, 101 reported at least one episode of syphilis. A history of syphilis was associated with awareness that syphilis was on the rise in men who have sex with men (MSM) in the Aquitaine region (46% vs. 22%, P<0.0001). Knowledge that syphilis could be transmitted by oral sex was low in both patients with (37%) and without (20%) a history of syphilis (P=0.0045). Patients with a history of syphilis more often used recreational drugs (RR 1.6; P=0.0028). Among 160 patients who had sexual intercourse with a man in the past 12 months, 23% reported using condoms for oral intercourse and 80% reported using condoms for anal intercourse. Sixty-two per cent of MSM declared being ready to change their practice if informed about the rise in syphilis. CONCLUSIONS This survey revealed important information gaps in PLHIV about syphilis and related behavior. The reported receptiveness of this population to behavioral change may help inform educational interventions.
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Affiliation(s)
- A Valdes
- Université de Bordeaux, Inserm U1219, ISPED, 33076 Bordeaux, France; Université de Bordeaux, ISPED, 33076 Bordeaux, France; COREVIH Aquitaine, 33076 Bordeaux, France
| | - C Cazanave
- COREVIH Aquitaine, 33076 Bordeaux, France; Service des maladies infectieuses et tropicales, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France; Université de Bordeaux, USC EA 3671, infections humaines à mycoplasmes et à chlamydiae, 33076 Bordeaux, France; Inra, USC EA3671, infections humaines à mycoplasmes et à chlamydiae, 33076 Bordeaux, France.
| | - F Dabis
- Université de Bordeaux, Inserm U1219, ISPED, 33076 Bordeaux, France; Université de Bordeaux, ISPED, 33076 Bordeaux, France; COREVIH Aquitaine, 33076 Bordeaux, France
| | - D Neau
- COREVIH Aquitaine, 33076 Bordeaux, France; Service des maladies infectieuses et tropicales, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France
| | - D Lacoste
- COREVIH Aquitaine, 33076 Bordeaux, France; Service de médecine interne, hôpital Saint-André, CHU de Bordeaux, 33075 Bordeaux, France
| | - V Gaborieau
- Service de médecine, centre hospitalier de Pau, 64000 Pau, France
| | - S Farbos
- Service de maladies infectieuses, centre hospitalier de la Côte-Basque, 64100 Bayonne, France
| | - M S Dworkin
- Université de Bordeaux, Inserm U1219, ISPED, 33076 Bordeaux, France; Université de Bordeaux, ISPED, 33076 Bordeaux, France; School of Public Health, University of Illinois, Chicago, United States
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Zhang C, Liu Y, Sun X, Wang J, Lu HY, He X, Zhang H, Ruan YH, Shao Y, Vermund SH, Qian HZ. Substance use and HIV-risk behaviors among HIV-positive men who have sex with men in China: repeated measures in a cohort study design. AIDS Care 2016; 29:644-653. [PMID: 27832699 DOI: 10.1080/09540121.2016.1255709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Global literature revealed that seropositive men who have sex with men (MSM) posed an even higher risk compared to their seronegative counterparts. Identifying risk factors that contribute to HIV-risk behaviors will help to curb the rapid HIV transmission among this group. Our hypothesis was that MSM with substance use were more likely to conduct HIV-risk behaviors, even after accounting for repeated measures. In the current study, we employed a cohort study design by following a group of 367 HIV-positive MSM up to four visits for one year to collect information regarding their sexual behaviors and history of substance use in the past three months. We used Generalized Estimating Equations (GEE) models to account both within- and between-subject variation when assessing associations between substance use and HIV-risk behaviors. A total of 367 MSM were included at the baseline with a mean age of 29.6 years. After accounting for potential confounders and time-varying effects, our models indicated that drug and alcohol use increase HIV risks at the population level by increasing risks of drinking alcohol before sex, having unprotected sex with men and seropositive partners, having more lifetime female sex partners and having a higher number of male sexual partners in the past three months. The current study is one of the first studies with repeated measures to evaluate the association between substance use and sexual risk behaviors among MSM in China. Findings in the current study have several implications for future research. We call for more rigorous study design for future research to better capture changes of risky behaviors among this at-risk population.
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Affiliation(s)
- Chen Zhang
- a Vanderbilt Institute for Global Health, Vanderbilt University , Nashville , TN , USA
| | - Yu Liu
- a Vanderbilt Institute for Global Health, Vanderbilt University , Nashville , TN , USA
| | - Xiaoyun Sun
- b Xicheng Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Juan Wang
- c Chaoyang Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Hong-Yan Lu
- d Beijing Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Xiong He
- d Beijing Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Heng Zhang
- e State Key Laboratory for Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , People's Republic of China
| | - Yu-Hua Ruan
- f Chinese Center for Disease Control and Prevention (China CDC), National Center for AIDS/STD Control and Prevention (NCAIDS) , Beijing , People's Republic of China
| | - Yiming Shao
- g Chinese Center for Disease Control and Prevention (China CDC), Beijing , People's Republic of China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health, Vanderbilt University , Nashville , TN , USA
| | - Han-Zhu Qian
- h Center for Disease Control and Prevention , Atlanta , USA
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12
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Li X, Xue Y, Lin Y, Gai J, Zhang L, Cheng H, Ning Z, Zhou L, Zhu K, Vanham G, Kang L, Wang Y, Zhuang M, Pan Q, Zhong P. Evolutionary Dynamics and Complicated Genetic Transmission Network Patterns of HIV-1 CRF01_AE among MSM in Shanghai, China. Sci Rep 2016; 6:34729. [PMID: 27698457 PMCID: PMC5048130 DOI: 10.1038/srep34729] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 09/20/2016] [Indexed: 11/25/2022] Open
Abstract
To explore the evolutionary dynamics and molecular transmission patterns of HIV-1 CRF01_AE in depth among men who have sex with men (MSM) in Shanghai, we constructed phylogenetic tree and genetic transmission networks based on 1, 152 pol sequences from MSM, 282 from other risk groups and 795 references. Phylogenetic analyses identified two distinct major CRF01_AE lineages and a Shanghai-based sub-lineage. The estimated tMRCAs for lineage 1 and 2 were 1996.0 (1992.9–1999.2) and 1997.8 (1994.3–2001.4), respectively. Of the 1, 152 MSM, 681 (59.1%) were identified as belonging to 241 separate networks. Of these 681 individuals in networks, 74.2% were linked to cases diagnosed in different years, 4.3% were linked to heterosexual women, and 0.7% were linked to persons who inject drugs. A total of 71 networks including 180 individuals diagnosed in Shanghai with the same domicile were found. Recent infection (P = 0.022) and sampling year after 2011 (P < 0.001) were significantly associated with potential transmission links among the networks. Besides, a significant transmission of viruses with drug resistant mutations at V179D/E were found in the networks. Given these findings, we propose that genetic transmission analysis is a useful tool in HIV intervention strategies to curb the spread of virus and promoting public health.
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Affiliation(s)
- Xiaoshan Li
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China.,School of Public Health, Southeast University, Nanjing, China
| | - Yile Xue
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Yi Lin
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Jing Gai
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Hua Cheng
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Zhen Ning
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Leiming Zhou
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Kexin Zhu
- School of Public Health, Nantong University, Nantong, China
| | - Guido Vanham
- Biomedical Sciences Department, Institute of Tropical Medicine of Antwerp, Belgium
| | - Laiyi Kang
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Ying Wang
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Minghua Zhuang
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Qichao Pan
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Ping Zhong
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention; Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
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A Comparison of Referred Sexual Partners to Their Community Recruited Counterparts in The BROTHERS Project (HPTN 061). AIDS Behav 2015; 19:2214-23. [PMID: 25874753 DOI: 10.1007/s10461-015-1005-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The BROTHERS Project (HPTN 061) was established to determine the feasibility and acceptability of a multi-component intervention among African American MSM to reduce HIV incidence. The goal of this analysis was to determine if the sexual partner referral approach used in HPTN 061 broadened the reach of recruitment with regards to characteristics associated with higher infection rates and barriers to quality health care. Overall, referred sexual partners had notable structural barrier differences in comparison to community-recruited participants: lower income, less education, higher unemployment, HIV positive diagnosis, incarceration history, and no health insurance. The study's findings pose implications for utilizing the sexual partner referral approach in reaching African American MSM who may not be accessed by traditional recruitment methods or who are well-integrated in health care systems.
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Lau JTF, Li D, Wang Z, Lai CHY. Repeated HIV Voluntary Counseling and Testing Increased Risk Behaviors Among Men Who Have Sex with Men in China: A Prospective Cohort Study. AIDS Behav 2015; 19:1966-77. [PMID: 25863465 DOI: 10.1007/s10461-015-1034-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
High risk MSM are recommended to take up HIV voluntary counseling and testing (VCT) once every 6 months. 809 HIV-negative MSM in Beijing, China entered the 18-month prospective cohort study; 228 joined an extended study at month 21. The majority (92.5 %) of the participants had taken up four rounds of VCT over the study period. HIV prevalence at months 0, 6, 12, 18 and 21 ranged from 2.5 to 6.3 %; HIV incidences for the four intervals between the five visits ranged from 5.00 to 14.28 per 100-person year. Despite experiencing repeated VCT, high levels of risk behaviors were reported at month 21. 18 % of the participants interviewed at month 21 self-reported increased in UAI and other risk behaviors, comparing recent and pre-baseline experiences. HIV transmission and risk behaviors had not been reduced by multiple rounds of VCT. Reasons behind apparent ineffectiveness and tailored repeated testing strategies need to be investigated.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
- CUHK Shenzhen Research Institute (SZRI), Shenzhen, China.
- Centre for Medical Anthropology and Behavioral Health, Sun Yat-sen University, Guangzhou, China.
| | - Dongliang Li
- Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- CUHK Shenzhen Research Institute (SZRI), Shenzhen, China
| | - Coco H Y Lai
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
PURPOSE OF REVIEW Benzathine Penicillin G has been used to treat syphilis for over 50 years; however, the precise regimen of penicillin for treatment of syphilis in HIV-positive individuals remains a hot topic of debate. Although international guidelines recommend the same treatment for syphilis, regardless of HIV status, there are inconsistencies in prescribing practices among clinicians. RECENT FINDINGS Two previous systematic reviews have found limited evidence for enhanced treatment of syphilis in the presence of HIV. However, a growing body of literature indicates that the rate of asymptomatic neurosyphilis may be higher in HIV, and that syphilis infection is associated with poorer long-term neurocognitive outcomes. A number of retrospective studies propose that serological response may be slower, or serological failure may be higher, among HIV-positive individuals, but these studies are limited by high loss to follow-up, high reinfection rates and a focus on serological rather than clinical response. Beyond penicillin, some evidence suggests equivalence of macrolides, cephalosporins and doxycycline, although macrolide resistance is an increasing concern. SUMMARY Until a prospective, randomized study is conducted, inconsistency with treatment will continue. We offer a pragmatic approach to recognizing patients who may require further investigation or neuropenetrative antibiotic treatment.
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Cresswell FV, Fisher M. Management of syphilis in HIV-positive individuals. Sex Health 2015; 12:135-40. [DOI: 10.1071/sh14168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/04/2014] [Indexed: 11/23/2022]
Abstract
Since the turn of the millennium a sustained outbreak of syphilis among men who have sex with men continues, approximately 20–50% of whom have concurrent HIV infection. In this paper we aim to explore the controversies that exist around the management of syphilis in HIV-positive individuals. Not only do HIV-positive people have different clinical manifestations of syphilis they have higher rates of asymptomatic neurological involvement, slower serological response to treatment and higher serological failure than HIV-negative individuals in most studies. Whether long-term clinical outcomes are different or affected by the antibiotic regimen selected remains to be established. The optimal antimicrobial regimen to treat syphilis in HIV is unknown due to a dearth of randomised controlled trial data. International guidelines state that the antibiotic management of syphilis is the same regardless of HIV status, with early syphilis treated with a single dose of benzathine penicillin G 2.4mU intrmuscularly. In practice, however, the majority of surveyed clinicians do treat HIV-positive people with more intensive antibiotics suggesting a lack of faith in guidelines. Factors which appear to affect the likelihood of developing neurological disease include CD4+ count of <350 cells/μL, absence of antiretroviral therapy, rapid plasma regain (RPR) or venereal diseases reference laboratory titre (VDRL) >1 : 32, late-latent disease or lack of response to standard antibiotic treatment. We recommend a low-threshold for offering antibiotic treatment effective against neurosyphilis in HIV-positive people with syphilis, especially if they exhibit any of the above factors.
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