Opportunities for Syphilis Testing during Routine HIV-Monitoring Visits in Louisiana

Background:  In Louisiana, the incidence of primary and secondary syphilis diagnosis in persons living with HIV (PLWH) is approximately 15 times that of HIV-negative persons. Recent studies show the inclusion of syphilis testing during all HIV-monitoring visits, where CD4 T-cell count and viral load are monitored 2-4 times per year, may increase detection of syphilis cases and may be just as cost-effective as annual syphilis testing. The goal of this study was to explore the potential value of including syphilis testing during all HIV-monitoring visits for PLWH in Louisiana. To this end, HIV and STD surveillance data were used to characterize HIV-monitoring and syphilis testing patterns of PLWH with syphilis coinfection in Louisiana.

Methods:  Data from Louisiana’s STD and HIV surveillance databases were linked to determine PLWH who had a syphilis coinfection. The study population includes PLWH diagnosed with late latent or tertiary syphilis (LL/T) between January 1, 2010 and December 31, 2012 to ensure persons had at least one year of undiagnosed syphilis. Descriptive statistics were used to assess the frequency of syphilis diagnoses and HIV-monitoring visits that occurred concurrently and the frequency of HIV-monitoring visits occurring during the year prior to an LL/T syphilis diagnosis where LL/T syphilis infections remained undiagnosed (missed syphilis testing opportunities).

Results:  295 PLWH were included in the study. 22% were diagnosed with HIV and LL/T syphilis concurrently. Of those remaining, 78% were diagnosed with LL/T syphilis at an HIV-monitoring visit. There were 334 missed syphilis testing opportunities, which was an average of 2 missed opportunities per person. 61% had one or more missed syphilis testing opportunities (excluding concurrent diagnoses).

Conclusions:  Syphilis is relatively common among PLWH in Louisiana and there are numerous opportunities to diagnose syphilis at an earlier stage and prevent further syphilis transmission if testing occurs during all HIV-monitoring visits.