SEATTLE – The frequency of syphilis in HIV-infected women is unusually high, prompting concerns about congenital syphilis among newborns. The finding comes from a Centers for Disease Control analysis of the U.S. Center for Aids Research Clinical Network of Integrated Clinical Systems (CNICS) cohort.
Jim Kling/MDedge News
Dr. Jodie Dionne-Odom
“We found significant associations [between syphilis infection] and drug use and hepatitis C infection, which adds to some information from the CDC that what’s driving the epidemic in women is drug use – it’s a very different epidemic potentially in women with HIV than in men with HIV,” said Jodie Dionne-Odom, MD, chief of women’s health services at the University of Alabama, Birmingham’s 1917 Clinic. She described the results of her study at a press conference at the Conference on Retroviruses and Infectious Diseases.
“These predictors are important to understand so that we can come up with interventions to try to reduce the problem. Syphilis screening is relatively easy to do. USPSTF [U.S. Preventive Services Task Force] doesn’t even have a recommendation for that periodicity of screening frequency, so we have a ways to go to define how often we need to be looking, particularly in high-risk groups,” she said.
The likely force driving the increased incidence of syphilis is transactional sex. To explore that possibility, the researchers examined the number of sexual partners and found that more partners were linked to greater likelihood of having syphilis. “So I don’t think it’s the drug use itself – it’s the behavior that comes with the drug use,” Dr. Dionne-Odom said.
The findings shed more light on the interplay between drug use epidemics and disease epidemics. “As we have an increasing opioid epidemic and methamphetamine abuse that we’re all seeing in our clinics, it’s interesting to see this intersection between the drug use problem and the syphilis problem in this country. I think they’re not unrelated,” she said.
She believes the results should have broad implications for screening programs. Women admitted to drug treatment programs should be tested for syphilis. And women who abuse drugs and are pregnant should be screened repeatedly – at entry to care, at their 20-week scan, and at delivery. “We know we have about 6,000 women with HIV who deliver each year, so this is potentially very impactful,” Dr. Dionne-Odom said.
The researchers extracted data from the CNICS cohort, including 4,795 women with records between 2005 and 2016. They defined incident syphilis as a newly positive nontreponemal serologic test or a 300% titer increase, followed by a confirmatory test.
After adjustment, factors associated with syphilis included prior intravenous drug abuse (adjusted odds ratio, 2.3; 95% confidence interval, 1.3-3.9), hepatitis C antibody positivity (aOR, 2.1; 95% CI, 1.3-3.7), as well as black race (aOR, 2.3; 95% CI, 1.4-3.9). There was no association between age and HIV viral load with respect to risk of syphilis.
The frequency appears to be rising, with later entry into the CNICS cohort assorted with a more than doubled risk of syphilis (aOR, 2.3; 95% CI, 1.4-3.9 for 2011-2016, compared with 1994-2004).
The study was funded by the National Institute of Child Health and Human Development. Dr. Dionne-Odom reported no relevant conflicts of interest.
SOURCE: J Dionne-Odom et al. CROI 2019, Abstract 47