Factors associated with HIV/syphilis co-infection initiating of antiretroviral therapy

Acquired syphilis: update on clinical, diagnostic and therapeutic aspects⋆

Syphilis, an infection caused by Treponema pallidum, transmitted predominantly through sexual contact, affects several organs, causing skin, mucous membranes and systemic lesions. Despite being a secular disease, it still poses a major challenge for the public health system, since the number of cases continues to increase after years of warnings from the scientific community. Recognizing the clinical manifestations is essential for formulating the clinical hypothesis and diagnostic confirmation with complementary exams. However, recognizing skin lesions is not always simple, given the diversity of clinical manifestations which resemble other diseases. This review presents an overview of the disease, with current epidemiological data, a representation of the various clinical manifestations, a description of the pertinent diagnostic methods for laboratory confirmation, and appropriate therapeutic approaches for each clinical form.

Examining the Prevalence and Associated Factors of Sexually Transmitted Infections in People Living With HIV/AIDS at a Community Health Center in Bandung City, Indonesia

Purpose

This study aims to investigate the prevalence of sexually transmitted infections (STIs) and associated factors among people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWHA) registered in a community health center (CHC) with HIV/AIDS support and treatment services in Indonesia.

Methods

A cross-sectional study that included all PLWHA data from medical records registered in a CHC with HIV/AIDS support and treatment services was conducted in Bandung City, Indonesia, between March 2019 and March 2024. This CHC provides comprehensive and continuous HIV/AIDS services, including HIV testing, antiretroviral therapy (ART), and opportunistic infection management. The factors associated with the prevalence of STIs in PLWHA, including sociodemographic factors such as gender, age, education level, marital status, occupation, population group, referral origin, and clinical factors such as length of illness, duration of ART, clinical stage, and comorbidities, were analyzed by using chi-square analysis.

Results

Total 156 PLWHA data with STIs from medical records were collected (male, n = 152, 97.4%; female, n = 4, 2.6%). The prevalence of STIs among PLWHA was 32.1%, consisting of syphilis (n = 36; 72%), gonorrhea (n = 11; 22%), genital herpes (n = 2; 4%), and condyloma (n = 1; 2%). The following significant factors associated with the prevalence of STIs were population group men who have sex with men (MSM) (p = 0.046), referral origin from non-government organizations (NGOs) (p = 0.030), duration of disease (p = 0.023) and duration of ART ranging from 12 to 36 months (p = 0.023), and early clinical stage (p = 0.010).

Conclusion

STIs affected over one-third of CHC-registered PLWHA, with syphilis being the most common. MSMs and patients referred by NGOs, with illness and treatment durations ranging from 12 to 36 months, as well as the early clinical stage of HIV, are associated with STIs among PLWHA. Intervention strategies to improve STI prevention and control in these populations are urgently needed.

Prevalence and determinants associated with T. pallidum infection in adults from poor urban communities, Brazilian Amazon

BACKGROUND

In Brazil, despite the increase in coverage and access to rapid testing for syphilis in primary health care, no reduction in cases of syphilis and congenital syphilis was observed. Poor and low-educated populations are disproportionately affected by infection caused by T. pallidum. This study aims to estimate the prevalence of syphilis and associated factors among people aged 18 to 49 years old in the city of Belém, brazilian amazon.

METHODS

Observational, cross-sectional study carried out in a sanitary administrative district of a capital of the Brazilian Amazon, Belém, state of Pará, Brazil. Data collection was conducted from August 2021 to February 2022. The participantes consisted of residents of the Montese, Guamá and Condor neighborhoods. People aged 18 to 49 years were included. This variable was treated as dichotomous (reagent and non-reagent). The selected response event was 'reagent result'. The independent variables were the social factors and access to health services. To identify associated factors with the presence of markers of the bacteria studied, multiple logistic rules were performed.

RESULTS

178 people participated in the study; the median age was 35.0 years. The prevalence of IgG and/or IgM antibodies against T. pallidum was 7 % (13). In the final regression model, it was observed that participants who had sexual intercourse after using alcohol and drugs and those who did not know about the prevention of sexually transmitted infections were five times more likely to have tested positive for T. pallidum.

CONCLUSIONS

Aspects of individual vulnerability and access to health services must be managed to reduce the exposure of poor urban populations to T. pallidum.

Multimodal Imaging Features of the Posterior Segment in Ocular Syphilis and HIV Co-Infection: A Single Center Case Series

OBJECTIVE

To analyze the frequent multimodal imaging features in posterior syphilitic uveitis.

PURPOSE

Syphilis infection has re-emerged as a global health problem. Multimodal imaging approach has been proposed for diagnosis and follow-up; there are not previous reports dedicated to the anatomic and visual outcomes in patients diagnosed with ocular syphilis and concomitant HIV infection.

METHODS

All demographic information was recovered; a complete ophthalmological examination and multimodal imaging evaluation (retinal fluorescein angiography (FA), autofluorescence (AF), optical coherence tomography (OCT)) were performed on initial visit and 1 month after antibiotic therapy.

RESULTS

   18 eyes of 9 patients were included. The most frequent features observed were: Hyperfluorescence on optic disk on FA, Hyperautofluorescence punctate pattern on AF, Vitritis on SD-OCT. After treatment, there was a functional and anatomical improvement.

CONCLUSION

Ocular syphilis represents a diagnostic challenge. Multimodal imaging approach allows identification of structural changes, follow-up and early detection of complications.

Prevalence of HIV, Treponema pallidum and Their Coinfection in Men Who Have Sex with Men, Medellín-Colombia

Introduction

In Colombia, HIV and gestational syphilis are notifiable events; however, they are poorly investigated infections in men who have sex with men (MSM).

Objective

To determine the prevalence of HIV, Treponema pallidum, and their co-infection in MSM treated at a Health Services Provider Institution (HSPI) specialized in infectious diseases from Medellín.

Methods

Cross-sectional study with 3454 MSM. Prevalence was determined with its 95% confidence interval; associated factors were identified using Fisher's Exact test, Pearson's Chi-square, and trend Chi-square. Multivariate adjustment was performed using logistic regression. Analyses were performed using SPSS 29.0.

Results

The prevalence of HIV was 5.7%, T. pallidum 0.7%, and co-infection 0.6%. The prevalence of HIV was higher in MSM aged between 24-40 years (7.5%), with technical or university studies (10.0%), without health insurance affiliation (12.4%), and those who have had a sexual partner with HIV (36.2%). T. pallidum was higher in MSM without health insurance affiliation (3.4%), who had sexual relations with people diagnosed with an STI (5.9%), and a sexual partner with HIV (12.1%). Co-infection was higher in MSM without health insurance affiliation (2.7%), and those who had a partner with HIV (11.2%).

Conclusion

Compared with the general Colombian population, MSM have a higher risk of HIV, but are similar to T. pallidum. The identification of the main associated factors in each infection demonstrates the need to prioritize subgroups of MSM that show greater vulnerability to these events. This research demonstrates the urgency of implementing health education strategies in MSM who have a sexual partner with HIV or other STIs. Large gaps were also evident in the magnitude of the three events according to the health insurance affiliation regime, which demonstrates problems of social and health injustice, especially with MSM without health insurance affiliation.

Development and Evaluation of a Nomogram for Predicting the Outcome of Immune Reconstitution Among HIV/AIDS Patients Receiving Antiretroviral Therapy in China

This study aims to develop and evaluate a model to predict the immune reconstitution among HIV/AIDS patients after antiretroviral therapy (ART). A total of 502 HIV/AIDS patients are randomized to the training cohort and evaluation cohort. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis are performed to identify the indicators and establish the nomogram for predicting the immune reconstitution. Decision curve analysis (DCA) and clinical impact curve (CIC) are used to evaluate the clinical effectiveness of the nomogram. Predictive factors included white blood cells (WBC), baseline CD4+ T-cell counts (baseline CD4), ratio of effector regulatory T cells to resting regulatory T cells (eTreg/rTreg) and low-density lipoprotein cholesterol (LDL-C) and are incorporated into the nomogram. The area under the curve (AUC) is 0.812 (95% CI, 0.767∼0.851) and 0.794 (95%CI, 0.719∼0.857) in the training cohort and evaluation cohort, respectively. The calibration curve shows a high consistency between the predicted and actual observations. Moreover, DCA and CIC indicate that the nomogram has a superior net benefit in predicting poor immune reconstitution. A simple-to-use nomogram containing four routinely collected variables is developed and internally evaluated and can be used to predict the poor immune reconstitution in HIV/AIDS patients after ART.