WP 20 HIV Viral Loads Among Young HIV-Infected Men with Early Syphilis

Tuesday, June 10, 2014
International Ballroom
Melanie Taylor, MD, MPH, DIVISION OF STD PREVENTION, CENTERS FOR DISEASE CONTROL, Phoenix, AZ, WHITNEY LI, BS, OPHPR, CDC, Los Angeles, CA, Julia Skinner, MS, HIV Surveillance Division, Arizona Department of Health Services, Phoenix, AZ and Tom Mickey, BS, STD Program, Maricopa County Department of Public Health, Phoenix, AZ

Background: Increasing rates of syphilis have been reported among men who have sex with men (MSM), with high rates of HIV co-infection among these cases. HIV viral load data as a surrogate for HIV infectivity was evaluated among young men diagnosed with HIV and syphilis in Maricopa County, Arizona. 

Methods: Syphilis case report and HIV and STD surveillance data were abstracted to identify cases meeting the following criteria: (1) male, (2) 24 years of age or younger, (3) diagnosis of early syphilis (primary, secondary, or early latent) during 2009-2012, and (4) HIV-infected at the time of syphilis diagnosis.  HIV viral load and CD4 cell count data nearest to the time of syphilis diagnosis were abstracted.

Results: During 2009-2012, there were 56 HIV-infected, early syphilis cases meeting the age criteria. The median age was 22; 23 (41%) were Hispanic; 17 (30%) were White; and 14 (25%) were African American.  Of men with available information on gender of sexual partners (N=54, 96%), 53 (98%) reported MSM behavior.  Syphilis stages included: 5 (9%) with primary; 23 (41%) with secondary; and 28 (50%) with early latent syphilis.  Of the 56: only 4 (7%) patients had an undetectable viral load (< 100 c/mL) collected within a year of syphilis diagnosis; 32 (57%) had a detectable viral load collected within one year of syphilis diagnosis (median 21,000 c/mL, range 130 – 302,844 c/mL); and 20 (36%) had no reported viral load or a viral load collected greater than one year from syphilis diagnosis.  The median CD4 count was 375 cells/mm3 (N = 20, range 28 – 862 cells/mm3).

Conclusions: Among this group of young men, primarily MSM, co-infected with HIV and early syphilis, few had undetectable viral loads suggesting the potential for HIV transmission.