956. Characteristics of HIV-Syphilis Co-Infection in the Inner City
Session: Poster Abstract Session: Sexually Transmitted Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Sexually Transmitted Diseases (STD) rates have increased nationally among self-identified men who have sex with men (MSM). In 2011, 73% of Detroit male syphilis cases occurred among MSM: 71% were HIV positive. This study aimed to characterize the syphilis epidemic in HIV-infected patients presenting for care at Henry Ford Hospital in Detroit.

Methods: We conducted a retrospective review of Electronic Medical Records of patients 18 years or older, presenting with HIV-Syphilis co-infection at Henry Ford Hospital HIV clinic from 2007 to 2012. Data collected included demographics, syphilis presentation and recurrence, syphilis therapy, antiretroviral therapy, HIV-1 RNA viral load (VL), CD4 cell counts and treatment outcomes. Clinical response to therapy was defined as a ≥ 4 fold decrease of RPR at ≥ 3 months post therapy. Descriptive, parametric, non-parametric and logistic regression analyses were performed for all variables collected with Hochberg- corrected p-values reported where applicable.

Results: During the study period we identified 134 episodes of syphilis among 93 HIV-infected individuals. Patient characteristics at diagnosis of syphilis were as follows: mean age 38 years, 98% male, 74 % MSM and 78% African American (AA). In 29% patients more than one episode of syphilis was reported. Syphilis was considered latent in 64% and secondary in 22%. Mean CD4+ T cell count (cells/mm3) at diagnosis of syphilis, was 403 ±287: no differences were seen between primary (299 ±197) vs secondary (472 ±281, p=0.225) or between primary vs latent (413±295, p=0.253); differences were seen between latent (413 ± 295) vs tertiary (126 ± 112, p=0.026), and secondary vs tertiary syphilis (126 ±112,p=0.019). Similarly, VL (Log10copies/mL) was 4.69 ±5.11, with higher viremia in tertiary than in latent or secondary syphilis (5.4 ±5.4, p=0.009 & 0.049). Clinical response at 1 year was seen in 81% of those with an available RPR. There was no significant association of response with baseline variables.

Conclusion: In this study response to treatment was not associated with stage of syphilis, CD4+ count, or VL. MSM and AA accounted for the most cases. Nearly one third of patients had more than one episode of syphilis. A more concerted effort must be made to reduce high risk behavior particularly among black MSM.

Zahrae Sandouk, MD, Claudia Taramona, MD, Meredith Mahan, Norman Markowitz, MD, John Mckinnon, MD and Indira Brar, MD, Henry Ford Hospital, Detroit, MI

Disclosures:

Z. Sandouk, None

C. Taramona, None

M. Mahan, None

N. Markowitz, None

J. Mckinnon, None

I. Brar, None

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