The role of incident syphilis infection on HIV transmission in Zambian HIV discordant couples, 1994-2012 Open Access

Abstract

 

 

 

 

Abstract

 

 

Background: Syphilis has been shown to be associated with an increased likelihood of HIV infection in multiple studies. However, little is understood about the role of incident syphilis infection measured at different titer cutoffs on risk of HIV transmission or acquisition in heterosexual serodiscordant couples.

 

Methods: Sexual health-related longitudinal data was collected from a cohort of heterosexual HIV serodiscordant couples in Lusaka, Zambia from 1994 to 2012. Multivariable models assessed the effect of syphilis titer on both linked and non-linked HIV transmissions using adjusted Cox models.

 

Results: A total of 168 HIV infections originating in the study partner (“linked” infections) out of 204 total infections occurred in women (82%) and 139 linked out of 181 total infections occurred in men (77%).  For initially HIV-negative women in the cohort, women’s RPR-positivity at any titer cutoff was associated with linked or unlinked HIV acquisition (aHR = 2.88, 95% C.I. 1.3 2- 6.26) but not linked acquisition alone.   For initially HIV-negative men in the cohort, men’s RPR-positivity at any titer cutoff was associated with linked or unlinked HIV acquisition (aHR = 3.79, 95% C.I. 1.35 - 10.62) as well as linked acquisition alone (aHR = 4.45, 95% C.I. 1.91 – 10.37). These associations remained at different RPR titer cutoffs. RPR positivity in HIV positive partners was not associated with onward HIV transmission to negative partners.

 

Conclusions: Our findings confirm syphilis infection at any titer as a risk factor for HIV acquisition among both HIV-negative men and women. In the future, treatment should be conservatively initiated for any positive RPR titer if a confirmatory TPHA test cannot be conducted. The association between RPR positivity and unlinked HIV infections warrant further investigation, particularly for HIV-negative women.

 

 

 

Table of Contents

 

Table of Contents

 

Background …………………..…………………………………………………………… 1

Methods …………………………….…………………………………………………….. 4

 

2.1 Study cohort & data collection ………………….…………………………………... 4

 

2.2 Exposures, covariates, & outcome of interest ……………………………………….. 5

 

2.3 Descriptive analyses …………………………………………………………………. 6

 

2.4 Multivariable models ………………………………………………………………... 6

 

3. Results ……………………………………………………………………………………… 8

 

        3.1 Descriptive analyses …………………………………………………………………. 8

 

        3.2 Multivariable models ………………………………………………………………... 9

 

4. Discussion ………………………………………………………………………………… 11

 

        4.1 Limitations & Conclusions ...………………………………………………………. 14

 

5. References ……………………………………………………………………………….... 16

 

6. Tables ……………………………………………………………………………………... 19

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, Immunology
Keyword	heterosexual discordant Zambia acquisition sub-Saharan Africa HIV syphilis transmission serodiscordance
Committee Chair / Thesis Advisor	Wall, Kristin, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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