Program Schedule

644
Rising Incidence of Syphilis Among Rural HIV+ Men Despite Systematic, Point of Care Prevention Counseling

Session: Oral Abstract Session: HIV Related Inflammation, Complications and Comorbidities
Friday, October 10, 2014: 11:15 AM
Room: The Pennsylvania Convention Center: 107-AB
Background: Syphilis incidence has been increasing in men with HIV infection despite the implementation of routine clinic-based HIV prevention efforts.  We observed an increase in syphilis diagnoses among our HIV+ cohort during the same time period that we introduced a “Preventions with Positives” initiative.  Patients’ risk profiles were closely examined to better understand the epidemiology of syphilis in our cohort of rural HIV-infected men in an effort to plan more effective prevention strategies.

Methods: We performed a retrospective cohort study to identify risk factors associated with incident syphilis diagnoses in a cohort of HIV+ men mostly living in rural south central Pennsylvania from 2008 to mid-2013.  During this same time period we introduced a succinct, formalized risk behavior screening protocol tied to transmission reduction education delivered at the point of care.  Patients’ demographic, clinical, psychosocial and risk behavioral characteristics were examined.  A multivariate logistic regression model was performed to identify factors associated with syphilis.

Results: Between 2003 and 2007 we diagnosed a total of 15 syphilis cases, all men.   Without significant changes in our population or syphilis screening practice, a total of 51 new syphilis infections were diagnosed among 702 HIV+ men during the study period (5 patients were diagnosed with 2 or more episodes).  The number of syphilis cases paradoxically increased from 5 cases in 2008 to 17 cases in 2012 in the face of our ongoing prevention counseling.  Younger age (<35 years) (adjusted odds ratio [aOR]=2.99), a higher educational attainment (aOR=4.30), and perception that partner may have sex with other people (aOR=2.85) were significantly associated with syphilis. Additionally, non-injection drug use was related to syphilis diagnosis in HIV+ men who have sex with men (aOR=2.61). 

Conclusion: Some HIV+ men, especially younger, well-educated men or those who perceived that their partners may have sex with other people, continue to have high-risk behaviors that may facilitate HIV transmission and increase their own risks of acquiring new STDs.  Routine clinic-based risk-reduction counseling may not have long-term effects in reducing high-risk behaviors.  New approaches are needed to prevent safer sex fatigue in HIV+ men.

Poonam Mathur, MD1, John Zurlo, MD2, Patsi Albright, CRNP, Ph.D2, Tonya Crook, MD2, Cynthia Whitener, MD2 and Ping Du, MD, PhD3, (1)Medicine, Hershey Medical Center, Hershey, PA, (2)Medicine/Infectious Diseases, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, (3)Medicine/Public Health Sciences, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA

Disclosures:

P. Mathur, None

J. Zurlo, None

P. Albright, None

T. Crook, None

C. Whitener, None

P. Du, None

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