WP 42 Syphilis Prevention Is HIV Prevention: Maximizing the Syphilis Interview

Wednesday, September 21, 2016
Galleria Exhibit Hall
Erika Samoff, PhD MPH1, Nicole Dzialowy, MSc1, Jason Maxwell, BS2, JoAnn Kuruc, BSN3 and Cynthia Gay, MD3, 1Communicable Disease Branch, North Carolina Division of Public Health, Raleigh, NC, 2North Carolina Department of Health and Human Services, North Carolina Division of Public Health, Raleigh, NC, 3Department of Medicine/Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC

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.