Syphilis in HIV-infected mothers and infants: results from the NICHD/HPTN 040 study
Nava Yeganeh, Heather D Watts, Margaret Camarca, Gabriel Soares, Esau Joao, Jose Henrique Pilotto, Glenda Gray, Gerhard Theron, Breno Santos, Rosana Fonseca, Regis Kreitchmann, Jorge Pinto, Marisa Mussi-Pinhata, Mariana Ceriotto, Daisy Maria Machado, Beatriz Grinzstejn, Valdilea G Veloso, Mariza G Morgado, Yvonne Bryson, Lynne M Mofenson, Karin Nielsen-Saines, NICHD HPTN 040P1043 Study Team, Edgardo Szyld, Silvia Marzo, Flavia Faleiro Ferreira, Fabiana Kakehasi, Rita Lira, Carla Franceschini de Fraga Rita Lira, Debora Fernandes Coelho, Alberto Sanseverino, Luis Carlos Ribeiro, M Leticia Santos Cruz, Ezequias Martins, Jacquline Anita de Menezes, Luisa Andrea Torres Salgado, Ana Valeria Cordovil, Andréa Gouveia, Priscila Mazzucanti, Jorge Eurico Ribeiro, Marisa G Morgado, Geraldo Duarte, Adriana Aparecida Tiraboschi Barbaro, Carolina Sales Vieira, Regina Succi, Mark Cotton, Jeanne Louw, Elke Maritz, Sarita Lalsab, Shini Legoete, James Alasdair McIntyre, Mandisa Nyati, Allison Agwu, Jean Anderson, Joan Bess, Jonathan Ellen, Todd Noletto, Nancy Hutton, Mark Mirochnick, Carol Delany, Robert M Lawrence, Chas Griggs, Mobeen Rathore, Kathleen Thoma, Michelle Tucker, Audra Deveikis, Susan Marks, Linda Bettica, James M Oleske, Midnela Acevedo Flores, Elvia Pérez, Ruth Dickover, Bonnie Ank, Francisco Inacio Bastos, Ronaldo Ismerio Moreira, Marilia Santini de Oliveira, Monica Derrico, Valéria Ribeiro, Emmanuel Aluko, James Bethel, Yolanda Bertucci, Jannifer Bryant, Patty Chen, Barbara Driver, Ruby Duston, Adriana Ferreira, Priya Guyadeen, Sarah Howell, Marsha Johnson, Linda Kaufman, Naomi Leshabane, Lilya Meyerson, Rita Patel, Lubima Petrova, Georgine Pirce, Susan Raitt, Scott Watson, Yiling Xu, Eunice Yu, George Siberry, Jack Moye, Jennifer Read, Elizabeth Smith, Sheryl Zwerski, Nava Yeganeh, Heather D Watts, Margaret Camarca, Gabriel Soares, Esau Joao, Jose Henrique Pilotto, Glenda Gray, Gerhard Theron, Breno Santos, Rosana Fonseca, Regis Kreitchmann, Jorge Pinto, Marisa Mussi-Pinhata, Mariana Ceriotto, Daisy Maria Machado, Beatriz Grinzstejn, Valdilea G Veloso, Mariza G Morgado, Yvonne Bryson, Lynne M Mofenson, Karin Nielsen-Saines, NICHD HPTN 040P1043 Study Team, Edgardo Szyld, Silvia Marzo, Flavia Faleiro Ferreira, Fabiana Kakehasi, Rita Lira, Carla Franceschini de Fraga Rita Lira, Debora Fernandes Coelho, Alberto Sanseverino, Luis Carlos Ribeiro, M Leticia Santos Cruz, Ezequias Martins, Jacquline Anita de Menezes, Luisa Andrea Torres Salgado, Ana Valeria Cordovil, Andréa Gouveia, Priscila Mazzucanti, Jorge Eurico Ribeiro, Marisa G Morgado, Geraldo Duarte, Adriana Aparecida Tiraboschi Barbaro, Carolina Sales Vieira, Regina Succi, Mark Cotton, Jeanne Louw, Elke Maritz, Sarita Lalsab, Shini Legoete, James Alasdair McIntyre, Mandisa Nyati, Allison Agwu, Jean Anderson, Joan Bess, Jonathan Ellen, Todd Noletto, Nancy Hutton, Mark Mirochnick, Carol Delany, Robert M Lawrence, Chas Griggs, Mobeen Rathore, Kathleen Thoma, Michelle Tucker, Audra Deveikis, Susan Marks, Linda Bettica, James M Oleske, Midnela Acevedo Flores, Elvia Pérez, Ruth Dickover, Bonnie Ank, Francisco Inacio Bastos, Ronaldo Ismerio Moreira, Marilia Santini de Oliveira, Monica Derrico, Valéria Ribeiro, Emmanuel Aluko, James Bethel, Yolanda Bertucci, Jannifer Bryant, Patty Chen, Barbara Driver, Ruby Duston, Adriana Ferreira, Priya Guyadeen, Sarah Howell, Marsha Johnson, Linda Kaufman, Naomi Leshabane, Lilya Meyerson, Rita Patel, Lubima Petrova, Georgine Pirce, Susan Raitt, Scott Watson, Yiling Xu, Eunice Yu, George Siberry, Jack Moye, Jennifer Read, Elizabeth Smith, Sheryl Zwerski
Abstract
Background: Untreated syphilis during pregnancy is associated with spontaneous abortion, stillbirth, prematurity and infant mortality. Syphilis may facilitate HIV transmission, which is especially concerning in low- and middle-income countries where both diseases are common.
Methods: We performed an analysis of data available from NICHD/HPTN 040 (P1043), a study focused on the prevention of intrapartum HIV transmission to 1684 infants born to 1664 untreated HIV-infected women. This analysis evaluates risk factors and outcomes associated with a syphilis diagnosis in this cohort of HIV-infected women and their infants.
Results: Approximately, 10% of women (n=171) enrolled had serological evidence of syphilis without adequate treatment documented and 1.4% infants (n=24) were dually HIV and syphilis infected. Multivariate logistic analysis showed that compared with HIV-infected women, co-infected women were significantly more likely to self-identify as non-white (adjusted odds ratio [AOR] 2.5, 95% CI: 1.5-4.2), to consume alcohol during pregnancy (AOR 1.5, 95% CI: 1.1-2.1) and to transmit HIV to their infants (AOR 2.1, 95% CI: 1.3-3.4), with 88% of HIV infections being acquired in utero. As compared with HIV-infected or HIV-exposed infants, co-infected infants were significantly more likely to be born to mothers with venereal disease research laboratory titers≥1:16 (AOR 3, 95% CI: 1.1-8.2) and higher viral loads (AOR 1.5, 95% CI: 1.1-1.9). Of 6 newborns with symptomatic syphilis, 2 expired shortly after birth, and 2 were HIV-infected.
Conclusion: Syphilis continues to be a common co-infection in HIV-infected women and can facilitate in utero transmission of HIV to infants. Most infants are asymptomatic at birth, but those with symptoms have high mortality rates.
Trial registration: ClinicalTrials.gov NCT00099359.
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Source: PubMed