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Society of Sexual Health Advisers

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Home » Syphilis predicts HIV incidence among men and transgender women who have sex with men in a pre-exposure prophylaxis trial.

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

June 22, 2014 By SSHA Leave a Comment

Background

Syphilis infection may potentiate transmission of HIV. We sought to determine the extent to which HIV acquisition was associated with syphilis infection within an HIV pre-exposure prophylaxis trial (iPrEx) and whether Emtricitabine/Tenofovir (FTC/TDF) modified that association.

Methods

The Pre-exposure Prophylaxis Initiative (iPrEx) study randomly assigned 2499  HIV-seronegative men and transgender women who have sex with men (MSM) to receive oral daily TDF coformulated with emtricitabine (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, there were 360 (14.4%) with positive RPR at screening;  333 (92.5%) had a positive confirmatory test, which did not differ between the arms (FTC/TDF vs placebo, p=0.81). 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 (FTC/TDF: 7.8 cases/per-year vs. placebo: 6.8, p=0.304). HIV incidence varied by incident syphilis (no syphilis: 2.8 vs incident syphilis: 8.0 cases per 100 person-years) reflecting a hazard ratio (HR) of 2.6, 95% confidence interval (CI) 1.6 to 4.4, p

Conclusions

In HIV-seronegative MSM, syphilis infection is associated with HIV acquisition in this pre-exposure prophylaxis (PrEP) trial; a syphilis diagnosis should prompt providers to offer PrEP unless otherwise contraindicated.

Filed Under: Latest SSHA News Tagged With: emtricitabine, FTC, hiv, iprex, national center for biotechnology information, ncbi, prep, rpr., syphilis, TDF, tenofovir

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About SSHA

The Society of Sexual Health Advisers (SSHA) is a UK national organisation with approximately 300 members out of an estimated 350 sexual health advisers in the country. It provides an opportunity for members to meet and work towards further professional development.

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