Syphilis predicts HIV incidence among men and transgender women who have sex with men in a preexposure prophylaxis trial.
Open accessAbstract
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.
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Similar to other STIs, multiple partners, anonymous partners, condomless sex, and substance use are all associated with HIV infection.
“Similar to other STIs, multiple partners, anonymous partners, condomless sex, and substance use are all associated with HIV infection (193–196).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [196]
The Results section reports an association between incident syphilis and HIV acquisition. The Discussion also reports an iPrEx secondary analysis identifying condomless receptive anal intercourse and more than five sex partners as HIV risk factors. Our copy does not establish associations for anonymous partners or substance use; a partner of unknown HIV status is not necessarily anonymous. (LLM, conf=0.88)
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- Authors
- Solomon, M. M., Mayer, K. H., Glidden, D. V., Liu, A. Y., McMahan, V. M., Guanira, J. V., Chariyalertsak, S., Fernandez, T., Grant, R. M., Bekker, L.-G., Buchbinder, S., Casapia, M., Chariyalertsak, S., Guanira, J., Kallas, E., Lama, J., Mayer, K., Montoya, O., Schechter, M., Veloso, V., & for the iPrEx Study Team
- Affiliations
- Gladstone Institutes (US)
- University of California, San Francisco (US)
- San Francisco Department of Public Health (US)
- Chiang Mai University (TH)
- Corresponding author
- Solomon, M. M.
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-06-13
- Volume
- 59
- Issue
- 7
- Pages
- 1020-1026
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC4166980
- OpenAlex
- W2114094089
- Cited by
- 159
- References
- 42
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 13 · 2023: 6 · 2022: 5 · 2021: 10 · 2020: 18 · 2019: 22 · 2018: 19 · 2017: 18 · 2016: 14 · 2015: 19 · 2014: 6
- FWCI
- 13.31
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Clinical Infectious Diseases (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Arca - Repositório Institucional da Fiocruz (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation
- Gilead Sciences
- Gladstone Institutes
- National Institutes of Health (5u01ai064002-07, UL1TR000004)
- University of California, San Francisco (UL1RR024131)
- National Institute of Allergy and Infectious Diseases (U01-AI064002, R01AI062333, RR024131, UO1 AI64002, AI64002, AI062333, T32AI007641)
- National Center for Research Resources (UL1RR024131)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Physiology › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- syphilis, HIV acquisition, HIV pre-exposure prophylaxis, tenofovir/emtricitabine, men who have sex with men, transgender women, HIV transmission
- MeSH terms
- Emtricitabine, Tenofovir, Adenine, Adult, Deoxycytidine, Female, Humans, Male, Middle Aged, Placebos, Syphilis, HIV Infections, Incidence, Prevalence, Treatment Outcome, Homosexuality, Male, Anti-HIV Agents, Young Adult, Organophosphonates, Transgender Persons, Pre-Exposure Prophylaxis
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