Syphilis Predicts HIV Incidence Among Men and Transgender Women Who Have Sex With Men in a Preexposure Prophylaxis Trial
Open Access
- 13 June 2014
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 59 (7), 1020-1026
- https://doi.org/10.1093/cid/ciu450
Abstract
Syphilis infection was associated with HIV incidence in an HIV-prevention trial that randomized participants to once-daily emtricitabine/tenofovir (FTC/TDF) vs placebo. FTC/TDF had no effect on the association between incident syphilis and HIV acquisition; syphilis infection did not decrease FTC/TDF efficacy. Background. Syphilis infection may potentiate transmission of human immunodeficiency virus (HIV). We sought to determine the extent to which HIV acquisition was associated with syphilis infection within an HIV preexposure prophylaxis (PrEP) trial and whether emtricitabine/tenofovir (FTC/TDF) modified that association. Methods. The Preexposure Prophylaxis Initiative (iPrEx) study randomly assigned 2499 HIV-seronegative men and transgender women who have sex with men (MSM) to receive oral daily FTC/TDF or placebo. Syphilis prevalence at screening and incidence during follow-up were measured. Hazard ratios for the effect of incident syphilis on HIV acquisition were calculated. The effect of FTC/TDF on incident syphilis and HIV acquisition was assessed. Results. Of 2499 individuals, 360 (14.4%) had a positive rapid plasma reagin test at screening; 333 (92.5%) had a positive confirmatory test, which did not differ between the arms (FTC/TDF vs placebo, P = .81). The overall syphilis incidence during the trial was 7.3 cases per 100 person-years. There was no difference in syphilis incidence between the study arms (7.8 cases per 100 person-years for FTC/TDF vs 6.8 cases per 100 person-years for placebo, P = .304). HIV incidence varied by incident syphilis (2.8 cases per 100 person-years for no syphilis vs 8.0 cases per 100 person-years for incident syphilis), reflecting a hazard ratio of 2.6 (95% confidence interval, 1.6–4.4; P < .001). There was no evidence for interaction between randomization to the FTC/TDF arm and incident syphilis on HIV incidence. Conclusions. In HIV-seronegative MSM, syphilis infection was associated with HIV acquisition in this PrEP trial; a syphilis diagnosis should prompt providers to offer PrEP unless otherwise contraindicated.Keywords
This publication has 42 references indexed in Scilit:
- Pharmacokinetics and Pharmacodynamics of the Reverse Transcriptase Inhibitor Tenofovir and Prophylactic Efficacy against HIV-1 InfectionPLOS ONE, 2012
- Repeat Syphilis Among Men Who Have Sex With Men—San Diego County, 2004–2009Sexually Transmitted Diseases, 2011
- Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with MenThe New England Journal of Medicine, 2010
- Contribution of sexually transmitted infections to the sexual transmission of HIVCurrent Opinion in HIV and AIDS, 2010
- Etiology of Genital Ulcer Disease. A Prospective Study of 278 Cases Seen in an STD Clinic in ParisSexually Transmitted Diseases, 2010
- HIV/STD Prevalence Among Men Who Have Sex With Men in Chengdu, China and Associated Risk Factors for HIV InfectionJAIDS Journal of Acquired Immune Deficiency Syndromes, 2010
- Sexual transmission of HIV-1Antiviral Research, 2010
- Commercial sex venues: a closer look at their impact on the syphilis and HIV epidemics among men who have sex with menSexually Transmitted Infections, 2006
- Metaanalysis and Metaregression in Interpreting Study Variability in the Impact of Sexually Transmitted Diseases on Susceptibility to HIV InfectionSexually Transmitted Diseases, 2005
- OverviewAIDS, 1990