Factors associated with HIV/syphilis co-infection initiating of antiretroviral therapy

Simões, Luana Andrade; Mendes, Jullye Campos; Silveira, Micheline Rosa; Costa, André Moura Gomes da; Lula, Mariana Dias; Ceccato, Maria das Graças Braga

doi:10.11606/s1518-8787.2022056003904

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Sumário

Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056003904 copy

Factors associated with HIV/syphilis co-infection initiating of antiretroviral therapy

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To evaluate the prevalence and factors associated with HIV/syphilis co-infection in people initiating antiretroviral therapy in Belo Horizonte, capital of the state of Minas Gerais.

METHODS

A sectional section of a prospective cohort study was carried out with people living with HIV, treatment-naive, initiating antiretroviral therapy, older than 16 years, and in follow-up treatment at specialized HIV/Aids care services in Belo Horizonte. Sociodemographic, behavioral, clinical, laboratory and pharmacological treatment-related data were obtained through interviews, medical records, and information systems for logistical control of antiretroviral medications and laboratory tests. The dependent variable was the first episode of active syphilis, recorded by the physician in clinical records, within 12 months after beginning of the antiretroviral therapy. Factors associated with HIV/syphilis co-infection were assessed using binary multiple logistic regression.

RESULTS

Among the 459 individuals included, a prevalence of 19.5% (n = 90) of sexually transmitted infections (STI) was observed, with syphilis (n = 49) being the most frequent STI in these individuals. The prevalence of HIV/syphilis co-infection was 10.6% (n = 49), and the associated independent factors were alcohol use (OR = 2.30; 95%CI: 1.01–5.26), and having a diagnosis of other sexually transmitted infections (OR = 3.33; 95%CI: 1.24–8.95).

CONCLUSIONS

There was a high prevalence of HIV/syphilis co-infection in people living with HIV initiating antiretroviral therapy in Belo Horizonte. HIV/syphilis co-infection was associated with behavioral and clinical factors, such as alcohol use and diagnosis of other sexually transmitted infections. Prior knowledge about the factors associated with this co-infection may support the decisions of health professionals engaged in the care to people living with HIV, with regard to timely diagnosis, guidance, follow-up and adequate treatment, both for syphilis and HIV.

HIV Infections; Syphilis; Coinfection, epidemiology; Risk Factors; Antiretroviral Therapy, Highly Active; Cross-Sectional Studies

Characteristics	Total n = 459		HIV/ syphilis co-infection				p
	Total n = 459		Yes n = 49		No n = 410
	n	%	n	%	n	%
Sociodemographic
Sex							0.018^a
Male	374	81.5	46	93.9	328	80.0
Female	85	18.5	3	6.1	82	20.0
Age (years)							0.573
16–19	18	3.9	1	2.0	17	4.1
20–34	245	53.4	26	53.1	219	53.4
35–49	145	31.6	14	28.6	131	32.0
≥ 50	51	11.1	8	16.3	43	10.5
Color/ethnicity							0.874^a
Brown	222	48.4	21	42.9	201	49.0
White	108	23.5	13	26.5	95	23.2
Black	106	23.1	14	28.6	92	22.4
Yellow	15	3.3	1	2.0	14	3.4
Indigenous	3	0.7	0	0.0	3	0.7
Missing data	5	1.1	0	0.0	5	1.2
Marital status							0.271
Single/divorced/widowed	366	79.7	42	85.7	324	79.0
Married/commonwealth marriage	93	20.3	7	14.3	86	21.0
Children							0.297
Yes	162	35.3	14	28.6	148	36.1
No	297	64.7	35	71.4	262	63.9
Formal education (years)							0.043^a
≤ 9	117	25.5	11	22.4	106	25.9
10–12	178	38.8	12	24.5	166	40.5
≥ 13	163	35.5	26	53.1	137	33.4
Missing data	1	0.2	0	0.0	1	0.2
Job							0.694
Yes	269	58.6	30	61.2	239	58.3
No	190	41.4	19	38.8	171	41.7
Own income							0.087^a
Yes	373	81.3	41	83.7	332	81.0
No	85	18.5	7	14.3	78	19.0
Missing data	1	0.2	1	2.0	0	0.0
Economic class							0.306^a
High (A-B)	162	35.3	20	40.8	142	34.6
Intermediate (C)	212	46.2	23	46.9	189	46.1
Low (D-E)	73	15.9	4	8.2	69	16.8
Missing data	12	2.6	2	4.1	10	2.4
Private health plan							0.511
Yes	121	26.4	11	22.4	110	26.8
No	338	73.6	38	77.6	300	73.2
Place of residence							0.656^a
Belo Horizonte	404	88.0	44	89.8	360	87.8
Belo Horizonte Metropolitan Area	49	10.7	4	8.2	45	11.0
Other municipalities	6	1.3	1	2.0	5	1.2
Behavioral and life habits
Fixed sexual partner within 12 months after ART							0.619^a
Yes	218	47.5	22	44.9	196	47.8
No	187	40.7	23	46.9	164	40.0
Missing data	54	11.8	4	8.2	50	12.2
Use of alcohol in the month before the interview							0.435^a
Yes	294	64.1	36	73.5	258	62.9
No	162	35.3	13	26.5	149	36.3
Missing data	3	0.7	0	0.0	3	0.7
Current use of tobacco							0.600
Yes	126	27.5	15	30.6	111	27.1
No	333	72.5	34	69.4	299	72.9
Use of illicit drugs in life ever							0.493^a
Yes	221	48.1	27	55.1	194	47.3
No	236	51.4	22	44.9	214	52.2
Missing data	2	0.4	0	0.0	2	0.5
Condom use in the last month							0.156
Yes	248	54.0	31	63.3	217	52.9
No	117	25.5	13	26.5	104	25.4
Missing data	94	20.5	5	10.2	89	21.7
Condom use in the last sexual intercourse							0.383^a
Yes	343	74.7	41	83.7	302	73.7
No	98	21.4	7	14.3	91	22.2
Missing data	18	3.9	1	2.0	17	4.1
Source of HIV infection exposure category							0.025^a
Men (MSM)	234	51.0	34	69.4	200	48.8
Men (non MSM)/women	168	36.6	12	24.5	156	38.0
Missing data	57	12.4	3	6.1	54	13.2
Clinical
Clinical classification at the first visit							0.907^a
Aids conditions (C)	96	20.9	11	22.4	85	20.7
Asymptomatic (A)	291	63.4	30	61.2	261	63.7
Symptomatic (B)	67	14.6	8	16.3	59	14.4
Missing data	5	1.1	0	0.0	5	1.2
Clinical classification at the last visit							0.351^a
Aids conditions (C)	35	7.6	5	10.2	30	7.3
Asymptomatic (A)	371	80.8	42	85.7	329	80.2
Symptomatic (B)	16	3.5	0	0.0	16	3.9
Missing data	37	8.1	2	4.1	35	8.5
Comorbidities							0.951^a
Yes	172	37.5	18	36.7	154	37.6
No	279	60.8	31	63.3	248	60.5
Missing data	8	1.7	0	0.0	8	2.0
Other STIs (except syphilis)							0.021
Yes	41	8.9	9	18.4	32	7.8
No	418	91.1	40	81.6	378	92.2
Mucosal lesions							0.086^a
Yes	23	5.0	5	10.2	18	4.4
No	436	95.0	44	89.8	392	95.6
History of STI							0.204
Yes	134	29.2	16	32.7	118	28.8
No	124	27.0	9	18.4	115	28.0
Missing data	201	43.8	24	49.0	177	43.2
Laboratory
Viral load at start of ART (copies/ml)							0.812^a
≤ 100 thousand	305	66.4	31	63.3	274	66.8
> 100 thousand	114	24.8	14	28.6	100	24.4
Missing data	40	8.7	4	8.2	36	8.8
Viral load at start of ART							0.194^a
Undetectable	11	2.4	3	6.1	8	2.0
Detectable	408	88.9	42	85.7	366	89.3
Missing data	40	8.7	4	8.2	36	8.8
Viral load after 12 months of ART (copies/ml)							0.211^a
≤ 100 thousand	316	68.8	39	79.6	277	67.6
> 100 thousand	3	0.7	0	0.0	3	0.7
Missing data	140	30.5	10	20.4	130	31.7
Viral load after 12 months of ART							0.203
Undetectable	288	62.7	34	69.4	254	62.0
Detectable	31	6.8	5	10.2	26	6.3
Missing data	140	30.5	10	20.4	130	31.7
TCD4 lymphocytes at start of ART (cells/mm³)							0.274^a
< 200	120	26.1	12	24.5	108	26.3
200–500	165	35.9	13	26.5	152	37.1
> 500	134	29.2	20	40.8	114	27.8
Missing data	40	8.7	4	8.2	36	8.8
TCD4 lymphocytes after 12 months of ART (cells/mm³)							0.998
< 200	27	5.9	3	6.1	24	5.9
200–500	139	30.3	15	30.6	124	30.2
> 500	155	33.8	16	32.7	139	33.9
Missing data	138	30.1	15	30.6	123	30.0
Drug treatment
Mean time of HIV diagnosis (month)	15.3	SD = 32.1	8.5	SD = 13.4	16.1	SD = 33.5	0.004^b
Time of HIV diagnosis (month)							0.018^a
≤ 3	131	28.5	21	42.9	110	26.8
> 3	325	70.8	27	55.1	298	72.7
Missing data	3	0.7	1	2.0	2	0.5
Average time of ART treatment (days)	78.6	SD = 59.0	62.8	SD = 55.2	80.4	SD = 59.2	0.048^b
Therapeutic regimen in use							0.085^a
TLE	291	63.4	38	77.6	253	61.7
TLD	142	30.9	9	18.4	133	32.4
Other regimens	26	5.7	2	4.1	24	5.9
Non-adherence to ART in the last 15 days							0.339
Yes	68	14.8	9	18.4	59	14.4
No	362	78.9	35	71.4	327	79.8
Missing data	29	6.3	5	10.2	24	5.9

Characteristics	n (%)^a	OR (95%CI)	p
Sociodemographic
Sex
Male	374 (81.5)	3.83 (1.16–12.64)	0.027
Female	85 (18.5)	1.00
Age (years)	459 (100)	1.01 (0.98–1.03)	0.674
Color/ethnicity
Brown/black	328 (72.2)	0.96 (0.50–1.84)	0.892
White/yellow/indigenous	126 (27.8)	1.00
Marital status
Single/divorced/widowed	366 (79.7)	1.59 (0.69–3.67)	0.275
Married/commonwealth marriage	93 (20.3)	1.00
Children
Yes	162 (35.3)	1.00
No	297 (64.7)	1.41 (0.74–2.71)	0.299
Formal education (years)
≤ 9	117 (25.5)	0.83 (0.41–1.68)	0.599
≥ 10	341 (74.5)	1.00
Job
Yes	269 (58.6)	1.00
No	190 (41.4)	0.89 (0.48–1.63)	0.694
Own income
Yes	373 (81.4)	1.00
No	85 (18.6)	0.73 (0.31–1.68)	0.456
Economic class
High (A-B)	162 (36.2)	1.00
Intermediate-low (C-D-E)	285 (63.8)	0.74 (0.40–1.37)	0.343
Private health plan
Yes	121 (26.4)	1.00
No	338 (73.6)	1.27 (0.63–2.57)	0.511
Place of residence
Metropolitan region/other municipalities	55 (12.0)	1.00
Belo Horizonte	404 (88.0)	1.22 (0.46–3.23)	0.685
Behavioral and life habits
Fixed sexual partner within 12 months after ART
Yes	218 (47.5)	1.00
No	187 (40.7)	1.25 (0.67–2.32)	0.482
Use of alcohol in the month before the interview
Yes	294 (64.5)	1.60 (0.82–3.11)	0.167
No	162 (35.5)	1.00
Current use of tobacco
Yes	126 (27.5)	1.19 (0.62–2.27)	0.600
No	333 (72.5)	1.00
Use of illicit drugs in life ever
Yes	221 (48.4)	1.35 (0.75–2.46)	0.319
No	236 (51.6)	1.00
Condom use in the last month
Yes	248 (67.9)	1.00
No	117 (32.1)	0.88 (0.44–1.74)	0.704
Condom use in the last sexual intercourse
Yes	343 (77.8)	1.00
No	98 (22.2)	0.57 (0.25–1.31)	0.182
Source of HIV infection - exposure category
Men (MSM)	234 (51.0)	2.21 (1.11–4.41)	0.024
Men (non MSM)/women	168 (36.6)	1.00
Clinical
Clinical classification at the first visit
Aids conditions (C)	96 (21.1)	1.00
No Aids (A-B)	358 (78.9)	1.09 (0.54–2.22)	0.813
Clinical classification at the last visit
Aids conditions (C)	35 (8.3)	1.00
No Aids (A-B)	387 (91.7)	0.73 (0.27–1.98)	0.538
Comorbidities
Yes	172 (38.1)	0.94 (0.51–1.73)	0.830
No	279 (61.9)	1.00
Other STIs (except syphilis)
Yes	41 (8.9)	2.66 (1.19–5.96)	0.018
No	418 (91.1)	1.00
Mucosal lesions
Yes	23 (5.0)	2.48 (0.88–6.99)	0.087
No	436 (95.0)	1.00
Laboratory
Viral load at start of ART
Detectable	408 (88.9)	1.00
Undetectable	11 (2.4)	3.27 (0.84–12.79)	0.089
Viral load after 12 months of ART
Detectable	31 (6.8)	1.00
Undetectable	288 (62.7)	0.70 (0.25–1.93)	0.487
TCD4 lymphocytes at start of ART (cells/mm³)
< 200	120 (26.1)	1.00
200–500	165 (35.9)	0.77 (0.34–1.75)	0.533
> 500	134 (29.2)	1.58 (0.74–3.39)	0.240
TCD4 lymphocytes after 12 months of ART (cells/mm³)
< 200	27 (5.9)	1.00
200–500	139 (30.3)	0.97 (0.26–3.60)	0.961
> 500	155 (33.8)	0.92 (0.25–3.40)	0.902
Drug treatment
Time of HIV diagnosis (months)	456 (100.0)	0.99 (0.97–1.01)	0.138
Average time of antiretroviral treatment (days)	459 (100.0)	0.99 (0.99–1.00)	0.050
Therapeutic regimen in use
TLE	291 (63.4)	1.00
TLD	142 (30.9)	0.45 (0.21–0.96)	0.039
Other regimens	26 (5.7)	0.56 (0.13–2.44)	0.436
Self-report of non-adherence to ART in the last 15 days
Yes	68 (15.8)	1.43 (0.65–3.12)	0.375
No	362 (84.2)	1.00

Characteristics	OR (95%CI)	p
Sex
Male	3.58 (0.82–15.58)	0.089
Female	1.00
Use of alcohol in the month before the interview
Yes	2.30 (1.01–5.26)	0.049
No	1.00
Diagnosis of other STIs (except syphilis)
Yes	3.33 (1.24–8.95)	0.017
No	1.00
Average time of antiretroviral treatment (days)	0.99 (0.99–1.00)	0.066

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[1] Correspondence: Luana Andrade Simões Universidade Federal de Minas Gerais Av. Presidente Antônio Carlos, nº 6.627, sala 1.023-B2 31270-901 Belo Horizonte, MG, Brasil E-mail: lu.unife@gmail.com