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Cited by 159HIV/AIDS Research and InterventionsSyphilis Diagnosis and TreatmentHIV, Drug Use, Sexual Risk

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Syphilis predicts HIV incidence among men and transgender women who have sex with men in a preexposure prophylaxis trial.

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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·2014·Clinical Infectious Diseases
DOI 10.1093/cid/ciu450PMC PMC4166980
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Abstract

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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Figure 1. Human immunodeficiency virus (HIV) incidence according to incident syphilis and treatment arm. Abbreviation: FTC/TDF, emtricitabine/tenofovir.
Figure 1. Human immunodeficiency virus (HIV) incidence according to incident syphilis and treatment arm. Abbreviation: FTC/TDF, emtricitabine/tenofovir.CC BY-NC-ND · PubMed Central

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Research works printed but not linked: 4

  1. 2012, Science Translational Medicine, 4, 151ra25
  2. 2010, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control, 59, 1
  3. 2012, MMWR. Morbidity and mortality weekly report, 61, 586
  4. 2011, MMWR. Morbidity and mortality weekly report, 60, 65

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Metadata

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
DOI
10.1093/cid/ciu450
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
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 › Infectious Diseases › 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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