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Syphilis rates high in HIV-positive women
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.
“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
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.
“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
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.
“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
REPORTING FROM CROI 2019
Point-of-care VL testing improves HIV suppression
SEATTLE – Point-of-care viral load testing improves HIV viral suppression and retention in care, according to a randomized trial of 390 subjects in South Africa.
Point-of-care (POC) testing delivers viral load results in about 2-3 hours, as opposed to the month or so patients wait to get results from a laboratory. The nearly instant turnaround gives clinicians the ability to identify patients who aren’t doing well – as indicated by high viral loads despite antiretroviral therapy (ART) – before they walk out the door, so immediate steps can be taken to address adherence or resistance problems.
However, POC viral load testing hasn’t really caught on in the United States, at least not yet, according to study leader Paul Drain, MD, assistant professor of global health at the University of Washington, Seattle.
To see if it would help, the team turned to a large public clinic in the city of Durban, and focused on adults who had been on ART for 6 months following HIV diagnosis. They randomized 195 to standard laboratory testing at study entrance, with a repeat at 6 months, at which point subjects had been on ART for 12 months; 195 others were randomized to POC testing with the Xpert HIV-1 Viral Load machine, from Cepheid, on the same schedule and with same-day counseling for those with high loads.
Treatment was otherwise similar between the groups, with clinic visits every 2 months and other measures as per South African HIV treatment guidelines.
POC testing made a difference. At study month 12,175 participants (89.7%) in the POC arm, but only 148 (75.9%) in the laboratory testing group, had reached the study’s primary endpoint: viral suppression with less than 200 copies/mL plus retention in care, meaning that subjects were still picking up their ART prescriptions.
Overall, POC testing increased viral load suppression by 10.3%, from 83.1% to 93.3% (P = .003) and retention by 7.7% from 84.6% to 92.3% (P = .03).
The investigators would like to evaluate the approach in the United States. Potentially, “POC testing will have a very important role in U.S. health care,” Dr. Drain said at the Conference on Retroviruses and Opportunistic Infections.
It “helps us identify those who are having problems right away, before they leave the clinic, because whether it’s in South Africa or Seattle, as soon as they leave, it’s very hard to get them back. The more you can do POC testing, the better we can intervene and help these people,” he said.
“You don’t need POC testing for everybody; a lot of people do just fine. They take their medications reliably. They don’t need to get their results back right away ... But there are people who have challenges and would benefit from additional adherence counseling” or who might need help overcoming drug resistance. “We want to identify” them quickly; POC testing may be the answer, he said.
The mean age in the study was 33 years, and 60% of the subjects were women. The median CD4 count at baseline was 468 cells/mm3. POC was $22 per test, versus $25 for lab testing.
The National Institutes of Health funded the work. Dr. Drain had no disclosures. Cepheid donated the POC testing machines.
SOURCE: Drain PK et al. CROI 2019, Abstract 53LB.
SEATTLE – Point-of-care viral load testing improves HIV viral suppression and retention in care, according to a randomized trial of 390 subjects in South Africa.
Point-of-care (POC) testing delivers viral load results in about 2-3 hours, as opposed to the month or so patients wait to get results from a laboratory. The nearly instant turnaround gives clinicians the ability to identify patients who aren’t doing well – as indicated by high viral loads despite antiretroviral therapy (ART) – before they walk out the door, so immediate steps can be taken to address adherence or resistance problems.
However, POC viral load testing hasn’t really caught on in the United States, at least not yet, according to study leader Paul Drain, MD, assistant professor of global health at the University of Washington, Seattle.
To see if it would help, the team turned to a large public clinic in the city of Durban, and focused on adults who had been on ART for 6 months following HIV diagnosis. They randomized 195 to standard laboratory testing at study entrance, with a repeat at 6 months, at which point subjects had been on ART for 12 months; 195 others were randomized to POC testing with the Xpert HIV-1 Viral Load machine, from Cepheid, on the same schedule and with same-day counseling for those with high loads.
Treatment was otherwise similar between the groups, with clinic visits every 2 months and other measures as per South African HIV treatment guidelines.
POC testing made a difference. At study month 12,175 participants (89.7%) in the POC arm, but only 148 (75.9%) in the laboratory testing group, had reached the study’s primary endpoint: viral suppression with less than 200 copies/mL plus retention in care, meaning that subjects were still picking up their ART prescriptions.
Overall, POC testing increased viral load suppression by 10.3%, from 83.1% to 93.3% (P = .003) and retention by 7.7% from 84.6% to 92.3% (P = .03).
The investigators would like to evaluate the approach in the United States. Potentially, “POC testing will have a very important role in U.S. health care,” Dr. Drain said at the Conference on Retroviruses and Opportunistic Infections.
It “helps us identify those who are having problems right away, before they leave the clinic, because whether it’s in South Africa or Seattle, as soon as they leave, it’s very hard to get them back. The more you can do POC testing, the better we can intervene and help these people,” he said.
“You don’t need POC testing for everybody; a lot of people do just fine. They take their medications reliably. They don’t need to get their results back right away ... But there are people who have challenges and would benefit from additional adherence counseling” or who might need help overcoming drug resistance. “We want to identify” them quickly; POC testing may be the answer, he said.
The mean age in the study was 33 years, and 60% of the subjects were women. The median CD4 count at baseline was 468 cells/mm3. POC was $22 per test, versus $25 for lab testing.
The National Institutes of Health funded the work. Dr. Drain had no disclosures. Cepheid donated the POC testing machines.
SOURCE: Drain PK et al. CROI 2019, Abstract 53LB.
SEATTLE – Point-of-care viral load testing improves HIV viral suppression and retention in care, according to a randomized trial of 390 subjects in South Africa.
Point-of-care (POC) testing delivers viral load results in about 2-3 hours, as opposed to the month or so patients wait to get results from a laboratory. The nearly instant turnaround gives clinicians the ability to identify patients who aren’t doing well – as indicated by high viral loads despite antiretroviral therapy (ART) – before they walk out the door, so immediate steps can be taken to address adherence or resistance problems.
However, POC viral load testing hasn’t really caught on in the United States, at least not yet, according to study leader Paul Drain, MD, assistant professor of global health at the University of Washington, Seattle.
To see if it would help, the team turned to a large public clinic in the city of Durban, and focused on adults who had been on ART for 6 months following HIV diagnosis. They randomized 195 to standard laboratory testing at study entrance, with a repeat at 6 months, at which point subjects had been on ART for 12 months; 195 others were randomized to POC testing with the Xpert HIV-1 Viral Load machine, from Cepheid, on the same schedule and with same-day counseling for those with high loads.
Treatment was otherwise similar between the groups, with clinic visits every 2 months and other measures as per South African HIV treatment guidelines.
POC testing made a difference. At study month 12,175 participants (89.7%) in the POC arm, but only 148 (75.9%) in the laboratory testing group, had reached the study’s primary endpoint: viral suppression with less than 200 copies/mL plus retention in care, meaning that subjects were still picking up their ART prescriptions.
Overall, POC testing increased viral load suppression by 10.3%, from 83.1% to 93.3% (P = .003) and retention by 7.7% from 84.6% to 92.3% (P = .03).
The investigators would like to evaluate the approach in the United States. Potentially, “POC testing will have a very important role in U.S. health care,” Dr. Drain said at the Conference on Retroviruses and Opportunistic Infections.
It “helps us identify those who are having problems right away, before they leave the clinic, because whether it’s in South Africa or Seattle, as soon as they leave, it’s very hard to get them back. The more you can do POC testing, the better we can intervene and help these people,” he said.
“You don’t need POC testing for everybody; a lot of people do just fine. They take their medications reliably. They don’t need to get their results back right away ... But there are people who have challenges and would benefit from additional adherence counseling” or who might need help overcoming drug resistance. “We want to identify” them quickly; POC testing may be the answer, he said.
The mean age in the study was 33 years, and 60% of the subjects were women. The median CD4 count at baseline was 468 cells/mm3. POC was $22 per test, versus $25 for lab testing.
The National Institutes of Health funded the work. Dr. Drain had no disclosures. Cepheid donated the POC testing machines.
SOURCE: Drain PK et al. CROI 2019, Abstract 53LB.
REPORTING FROM CROI 2019