Durability of single tablet regimen for patients with HIV infection in Southern Taiwan: data from a real-world setting

Background A single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unknown in the real-world settings. Our aim was to investigate the durability of different initial STR regimens in antiretroviral-naive patients starting STR in southern Taiwan. Method This was a retrospective study of antiretroviral-naive patients that initiated first-line antiretroviral regimens with STRs between May 2016 and December 2017. The primary endpoint was time to virological failure. Secondary endpoints were STR discontinuation due to toxicity/intolerance. Durability was defined as time from the initiation until discontinuation/modification. Kaplan- Meier curves were plotted assessing time to virological suppression, treatment failure and discontinuation for the three STRs and Cox proportional hazards model was used to analyze the factors associated with time to viral suppression, treatment failure or discontinuation. Results Two hundred and twenty-three patients were included: The median follow-up duration (IQR) was 73.9 (48–101.6) weeks, 25 patients (11%) experienced virological failure; the 48 weeks probability of treatment failure was 22.9% (16/70) for Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate (EFV/FTC/TDF), 24.1% (13/54) for Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (FTC/RPV/TDF) and 24.2% (24/99) for Abacavir/Dolutegravir/Lamivudine (ABC/DTG/3TC) (p=0.16). Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to EFV/FTC/TDF, treatment with FTC/RPV/TDF (aHR 8.39, CI 1.98–35.58, p = 0.004) and ABC/DTG/3TC (aHR 8.40, CI 2.39–29.54, p=0.001) were more likely to have treatment failure. The predictors for treatment failure included age ≦ 30 years old (aHR 3.73, CI 1.25–11.17, p = 0.018), switch between different STR (aHR 2.3, CI 1.18–4.50, p = 0.001) and free of active syphilis infection (aHR 0.24, CI 0.08–0.73, p = 0.012). The risk factor for treatment discontinuation included younger age ≦ 30 years old (aHR 3.82, CI 1.21–12.37, p = 0.023), treatment with EFV/FTC/TDF (aHR 8.65, CI 2.64–28.39, p < 0.001) and free of active syphilis infection (aHR 0.16, CI 0.04–0.62, p = 0.006). Conclusion Younger age was associated with treatment failure and drug discontinuation. Active syphilis infection s/p treatment was associated with free from treatment failure and discontinuation. This probably driven by the more frequently sexual health education and counseling when patients had syphilis infection. Treatment with ABC/DTG/3TC was associated with higher risk of treatment failure. The STR durability was dependent on the drug toxicity/intolerance, age and syphilis infection.

Syphilis Trigram: a domain-specific visualisation to combat syphilis epidemic and improve the quality of maternal and child health in Brazil

Background: The Brazilian health system is a large and complex system, especially considering its mixed public and private funding. The number of syphilis cases has been increasing greatly in the last four years, even though it has a cheap and simple treatment. Syphilis notification is compulsory by law, and public health surveillance pays great importance to syphilis notification during pregnancy. Syphilis infection can cause severe newborn conditions, premature births, and abortions. Methods: The Action Research methodology was applied to deal with the complex syphilis surveillance reality in Pernambuco, Brazil. Iterative learning cycles were used, totalling six cycles with a formal validation of an operational version of the Syphilis Trigram visualisation at the end of the process. The original data source was analysed and prepared for use without any new data or changes in the ordinary procedure of the current system. Results: The main result of this study is the Syphilis Trigram, a domain-specific infographic for presenting gestational and birth data. The second contribution of this study is the Average Trigram, an organised pie chart which synthesises the Syphilis Trigram relationship in an aggregated manner. Both visualisations are presented in an Infographic User Interface, a tool that gathers an infographic broad visualisation sense for data visualisation. These interfaces also gather selection and filter tools to assist and refine the presented information. The user can experience a specific case-by-case view and an aggregated perspective by any city monitored by the system. Conclusions: The proposed domain-specific visualisation amplifies the understanding of each syphilis case and the overall case characteristics of a city. This new information produced by the Trigram can clarify the reinfection/relapse cases, optimise resource allocation, and enhance syphilis healthcare policies without any new data. Therefore, health surveillance professionals can see the broad tendency, understand the key patterns through visualisation, and take action in a feasible time.

New Syphilis Cases in Older Adults, 2004–2019: An Analysis of Surveillance Data From South China

Background: Sexual health among older adults is a major public health concern globally. The syphilis burden is increasing in older adults in China. This study aimed to describe factors associated with syphilis infection and diagnosis among older adults in China during a 16 year period.Methods: Using 16 years of data (2004–2019) from the syphilis case report system of Guangdong, China, we compared data from older adults (aged ≥50 years) with those from younger people (aged 15–49 years). We compared the two age group with the Chi-square test for difference, and Joinpoint regression models to assess the temporal trends.Results: During the study period, 242,115 new syphilis diagnoses were reported in older adults. The mean notification rate of new diagnoses was 64.1 per 100,000 population across the entire 16-year period, which significantly increased over time (average annual percent change [AAPC] 16.2%, 95% CI 13.7–18.7). Syphilis diagnoses increased significantly over time among less developed cities and older women. In 2019, compared with younger adults, newly diagnosed older adults were more likely to be male, native to reporting city, had unknown transmission routes, and were diagnosed late.Conclusion: Our findings call for an urgent need to deliver more targeted prevention interventions for older adults, such as strengthen awareness among health care providers, and integration of syphilis services and primary health care for older adults.

Prevalence of syphilis infection and associated sociodemographic factors among antenatal-care attendees in Meghalaya, India: Revisiting HIV Sentinel Surveillance data

Background Despite relatively simple prevention and treatment, syphilis remains a major social and public health concern worldwide, particularly in developing nations. Objective To estimate the prevalence and to determine the sociodemographic factors associated with syphilis infection among antenatal-care (ANC) attendees in Meghalaya, India. Materials and Method A facility-based cross-sectional study was conducted utilizing National HIV Sentinel Surveillance of Meghalaya, January–March 2017. Pregnant women aged 15–49 years ( n = 3015) were recruited consecutively, interviewed, and tested for syphilis by Venereal Disease Research Laboratory test in eight selected ANC sites representing all districts of Meghalaya. Results Prevalence of syphilis was found to be 1.03 % (95% CI = 0.67–1.39) (31/3015). Prevalence was maximum among illiterates with gradual lowering of adjusted odds ratio (AOR) with improvement of education. Women whose husbands had no income were associated with higher risk (AOR = 4.97, 95% CI = 1.11–22.20) of syphilis. Significant risk (OR = 2.42, 95% CI = 1.02–5.74) was also observed with Jaintia Hills residents as compared to Garo Hills. Conclusions As high prevalence of gestational syphilis was identified in Meghalaya along with important sociodemographic predictors, evidence to policy translation is required at state and national level to scale up prevention, screening, and management of syphilis

The Prevalence of Anti-Syphilis Antibody in Iranian Pregnant Women

Objective: The present study aimed to determine the prevalence of anti-syphilis antibodies in Iranian pregnant women who attended antenatal care (ANC) in 21 districts affiliated to Isfahan University of Medical Sciences (MUI) from April 2017 to April 2020. Materials and methods: In a cross-sectional study in 2020, the data about anti syphilis antibody were collected from electronic health files of pregnant women. Pregnancy specific health package was delivered to Iranian pregnant women in a horizontally integrated network across the country. The electronic health file was used for every Iranian citizen and all health events were recorded by their health care providers in 2016. All health services, particularly laboratory tests that were performed either in public or private laboratories, that were given to pregnant women needed to be recorded in their electronic health files. According to the pregnancy health package, they were screened initially by Rapid Plasma Reagin (RPR) test. Results: In those years, 70512, 72298, 63272 pregnant women were screened respectively. In these intervals, using the RPR test, no positive cases of anti- syphilis antibody were found. Conclusion: It seems that syphilis infection among Iranian pregnant women who attended ANC in districts affiliated to MUI has reached the elimination phase.

Simple-to-use nomogram for predicting the risk of syphilis among MSM in Guangdong Province: results from a serial cross-sectional study

Background The purpose of this study was to develop and validate a simple-to-use nomogram for the prediction of syphilis infection among men who have sex with men (MSM) in Guangdong Province. Methods A serial cross-sectional data of 2184 MSM from 2017 to 2019 was used to develop and validate the nomogram risk assessment model. The eligible MSM were randomly assigned to the training and validation dataset. Factors included in the nomogram were determined by multivariate logistic regression analysis based on the training dataset. The receiver operating characteristic (ROC) curves was used to assess its predictive accuracy and discriminative ability. Results A total of 2184 MSM were recruited in this study. The prevalence of syphilis was 18.1% (396/2184). Multivariate logistic analysis found that age, the main venue used to find sexual partners, condom use in the past 6 months, commercial sex in the past 6 months, infection with sexually transmitted diseases (STD) in the past year were associated with syphilis infection using the training dataset. All these factors were included in the nomogram model that was well calibrated. The C-index was 0.80 (95% CI 0.76–0.84) in the training dataset, and 0.79 (95% CI 0.75–0.84) in the validation dataset. Conclusions A simple-to-use nomogram for predicting the risk of syphilis has been developed and validated among MSM in Guangdong Province. The proposed nomogram shows good assessment performance.

HIV Pre-Exposure Prophylaxis (PrEP) purchase patterns and STI occurrence among Israeli men: A cohort analysis

Background HIV Pre-exposure prophylaxis (PrEP) is the regular use of antiretroviral medication by people who are not infected with HIV to prevent seroconversion. Israel approved PrEP for continuous use in 2017, and Israeli Health Maintenance Organizations (HMO) offered PrEP with a copayment to eligible members. Methodology This retrospective cohort study included all people who were dispensed PrEP between September 2017 to June 2019 in the second largest HMO in Israel. Statistical analysis, including Kaplan Meier, was conducted to evaluate user PrEP purchase, adherence to medical follow-up, and clinical outcomes. Results In total, a cohort of 757 PrEP users were followed for 657.8 person-years. All but one user were male; median age was 35 years. At baseline, 0.8% had gonorrhea and 1.5% had chlamydia infections and 4.4% had recent syphilis infection. Continuous use of PrEP (without interruption/discontinuation) was observed in 29.9%, while 39.9% interrupted and 30.3% discontinued use. Median time to first interruption/discontinuation was 4.0 months. At 6–12 months after initiation, 79.8% of users had a documented HIV test, 77.3% a Chlamydia-Gonorrhea panel, and 78.9% a creatinine test. There was one new case of HIV among the cohort, five months after PrEP discontinuation. Estimated first-year infection rates were 5.0%, 8.6% and 6.8% for gonorrhea, chlamydia and first-time syphilis, respectively. Conclusions This study shows heterogeneous PrEP purchase patterns and required medical follow-up, and an increase in STIs among consistent PrEP users. Improving adherence to recommended medical follow-up during PrEP use is essential in PrEP’s integration into Israel’s national HIV prevention strategy.

Treponema pallidum PCR testing for diagnosis of mucocutaneous ulcers suspicious for syphilis

BackgroundPrimary syphilis is characterised by the appearance of an ulcerated lesion (chancre) on the anogenital or oral mucosa from which Treponema pallidum DNA may be detectable by PCR. Serological tests for syphilis may be non-reactive in early infection, even after the appearance of a chancre. We reviewed the use of a multiplex-PCR (M-PCR) test to determine the added value of T. pallidum DNA detection in the management of individuals presenting with mucocutaneous ulceration at a sexual health service in central London.MethodsWe performed a cross-sectional analysis of all individuals with detectable T. pallidum DNA from September 2019 to April 2020. Electronic patient records were reviewed and concomitant results for treponemal serology and/or rapid plasma reagin (RPR) extracted, along with demographic data, history of syphilis and indices of sexual behaviour including number of sexual partners contacted. Any subsequent treponemal serology and RPR results were also reviewed.ResultsM-PCR swab specimens were performed in 450 individuals, of whom 63 (14%) had detectable T. pallidum DNA; 60 of 63 (95%) were gay or bisexual men and 11 of 63 (17%) were living with HIV. A history of treated syphilis was present in 17 of 63 (27%). Same-day treponemal serology/RPR testing was performed in 58 of 63 (92%) patients. Of the 58 who had same-day syphilis serology/RPR, 9 (16%) had their syphilis infection confirmed by treponemal DNA PCR alone. A total of 165 partners were traced as contacts of infection, of whom 25 (15%) were contacts of individuals diagnosed by M-PCR testing alone.ConclusionIn individuals with T. pallidum PCR-positive lesions, around one in six in our cohort were negative on standard diagnostic serological tests for syphilis. Treponemal DNA testing is an important addition to serological assays in individuals with mucocutaneous ulceration who are at risk of recent syphilis infection and facilitates early diagnosis and contact tracing.

Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV

Background. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion. Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications.