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Background: In North Carolina, 45% of HIV-infected persons are virally suppressed. Half of the population diagnosed with syphilis also has HIV. Syphilis case follow-up can be an important link to HIV diagnosis, linkage to care and viral suppression. We assessed HIV outcomes following syphilis investigation.
Methods: North Carolina syphilis and HIV case and contact data for 2014 and 2015 were reviewed. Syphilis case records were reviewed to identify HIV cases diagnosed during syphilis contact interviews; acute HIV was defined as testing positive for HIV RNA but not HIV antibody using 4th generation HIV antigen/antibody testing, or testing positive with a negative result within the previous 45 days. We assessed the value of public health and clinician interaction following syphilis diagnosis among people co-infected with HIV (HIV diagnosed prior to or within 30 days of the syphilis diagnosis) by comparing the proportion virally suppressed (<200 copies per ml) prior to syphilis diagnosis and following the diagnosis (suppression detected in any viral load test in the year following diagnosis) using prevalence difference (PD) and 95% confidence intervals (CI).
Results: In 2015, 48% of the people diagnosed with syphilis in North Carolina also had HIV, and 38 new HIV cases, including 3 acute cases, were diagnosed during syphilis partner investigation. Among persons diagnosed with syphilis in 2014 who were previously-diagnosed with HIV, viral suppression increased from 47% before syphilis diagnosis to 58% after diagnosis (PD, 12%; 95% CI 5-14). Among people newly diagnosed with HIV immediately following syphilis diagnosis, 61% were virally suppressed following the diagnosis.
Conclusions: Given the high proportion of syphilis cases that are HIV co-infected, the syphilis diagnosis represents a prime opportunity to identify new and acute HIV infections and link them to care to limit further HIV transmissions.