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Background: Early syphilis infection indicates ongoing risk behavior in persons living with HIV (PLHIV). We examined early syphilis co-infection among PLHIV and HIV viral suppression in co-infected cases in Alameda County, California.
Methods: We matched reported cases of early syphilis in 2014 and 2015 to HIV surveillance data. To capture syphilis infections acquired after HIV diagnosis, only the first primary, secondary, and early latent syphilis cases occurring at least 90, 180, and 365 days after HIV diagnosis, respectively, were included. We examined recent HIV care status and virologic status for co-infected cases in which HIV diagnosis was at least one year prior to syphilis and assessed differences using chi-square tests.
Results: We identified 125 total cases of early syphilis among 4,760 male PLHIV, of which 56.8% were early latent, 31.2% secondary, and 12.0% primary. No co-infections occurred in females. The proportion co-infected was highest among: Asians and Pacific Islanders (5.1%) and Latinos (2.9%), those aged 20-29 (4.9%) and 30-39 (3.9%), and MSM (3.0%). Of the 122 PLHIV with an early syphilis diagnosis, only 3 were diagnosed with HIV in the prior year. Among the remaining 119, 113 (95.0%) had at least one visit and 91 (76.5%) had 2 or more visits at least 90 days apart in the year prior to their syphilis diagnosis. Seventy-two (60.5%) were virally suppressed. Of the 25 (21.0%) with unsuppressed viral load, 13 (52.0%) were interviewed, identifying 64 sex partners.
Conclusions: Co-infection with early syphilis among PLHIV was limited to males and found to differ by race, with the highest burden in Asians and Pacific Islanders. Co-infected persons with uncontrolled HIV infection have a high number of sex partners. Most co-infected persons were engaged in care suggesting an opportunity for patient education. HIV surveillance data can augment the delivery of tailored prevention interventions to PLHIV with early syphilis infection.