Article Text

Original research
Effect of syphilis infection on HIV acquisition: a systematic review and meta-analysis
  1. Meng Yin Wu1,
  2. Hui Zi Gong1,
  3. Kui Ru Hu2,
  4. He-yi Zheng1,
  5. Xia Wan2,
  6. Jun Li1
  1. 1 Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2 Epidemiology and Statistics, Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences & School of Basic Medicine at Peking Union Medical College, Beijing, China
  1. Correspondence to Dr Jun Li, Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; lijun35{at}hotmail.com

Abstract

Objectives Co-infection of syphilis and HIV remains hard to manage and its morbidity shows a rising tendency. Syphilis has been associated with increased risk of HIV acquisition in high-risk groups, especially in men who have sex with men (MSM). This systematic review and meta-analysis estimates the effect of syphilis infection on subsequent HIV acquisition, and assesses its difference between MSM and other high-risk populations.

Methods Five electronic databases were searched for literature published to 21 September 2019 without language restrictions. Longitudinal studies that enrolled key populations to compare the incidence of HIV with and without syphilis exposure were included. We used a random-effects model to estimate the effect of syphilis infection on HIV acquisition among high-risk populations, which include MSM, sex workers, serodiscordant couples, people who inject drugs and attendees of STD clinics.

Results A total of 17 cohorts and 5 case-control studies involving 65 232 participants were included. HIV incidence showed a two-time increase after syphilis exposure, compared with a control group (relative risk (RR) 2.67 (95% CI 2.05 to 3.47); p<0.05 for prevalence; RR 3.21 (95% CI 2.26 to 4.57); p=0.419 for incidence). No significant differences were observed between MSM and other high-risk groups in syphilis infection prevalence (RR 2.60 (95% CI 1.78 to 3.80); p<0.05 vs RR, 2.98 (95% CI 2.15 to 4.14); p<0.05; ratio of relative risk 0.76 (95% CI 0.49 to 1.17)).

Conclusions Syphilis infection increases the risk of HIV acquisition in high-risk populations. There is no evidence to suggest MSM are at greater risk than other high-risk populations. Prompt diagnosis, timely treatment, preventive interventions against syphilis infection would be a worthwhile investment for reducing HIV incidence. Strategies to combat stigma and discrimination targeted at MSM are pragmatically needed.

  • syphilis
  • HIV
  • homosexuality
  • meta-analysis

Data availability statement

Data are available on reasonable request.The data from participants were extracted from previous publications. All data relevant to this study are included in the article and supplementary information. Also, data are available from the first author or corresponding author (mengyin.wu@foxmail.com, lijun35@hotmail.com).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

Data are available on reasonable request.The data from participants were extracted from previous publications. All data relevant to this study are included in the article and supplementary information. Also, data are available from the first author or corresponding author (mengyin.wu@foxmail.com, lijun35@hotmail.com).

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Footnotes

  • XW and JL are joint senior authors.

  • Handling editor Laith J Abu-Raddad

  • Contributors MYW and JL had full access to all of the data in the study and takes responsibility for the integrity of the data. MYW and XW participated in study concept and design, interpreted results and supervision. All authors participated indata collect. MYW, XW and KRH did the statistical analysis. MYW and JL wrote the draft report. All authors revised the report and approved the final version before submission.

  • Funding This work is supported by Beijing Municipal Science and Technology Commission (No. Z191100006619011) and the Capital’s Funds for Health Improvement and Research (2020-2-4016).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.