Factors associated with HIV co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases and AIDS in the municipality of São Paulo, Brazil, 2014

Luppi, Carla Gianna; Gomes, Solange Eduardo Chabu; Silva, Roberto José Carvalho da; Ueno, Amanda Miyako; Santos, Anna Maria Kamimura dos; Tayra, Ângela; Takahashi, Renata Ferreira

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 27 (1) • 2018 • https://doi.org/10.5123/S1679-49742018000100008 copy

Factors associated with HIV co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases and AIDS in the municipality of São Paulo, Brazil, 2014^* * Article developed within the Program of Work Education for Health in Health Surveillance (PET-Saúde/Vigilância), of the Ministry of Health.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to describe sociodemographic and behavioral characteristics and to identify factors associated with human immunodeficiency virus (HIV) co-infection in cases of acquired syphilis reported in a Reference Center for Sexually Transmitted Diseases (STD) and AIDS.

Methods:

cross-sectional study with secondary data from a Reference Center for STD and AIDS in the municipality of São Paulo, Brazil, in 2014; the Poisson regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (95%CI).

Results:

648 cases of acquired syphilis were reported, and 98% were male; 88% were men who have sex with men (MSM) and 57% had HIV co-infection; male sex (PR=1.95; 95%CI 1.05;3.61) and MSM (PR=1.87; 95%CI 1.38;2.53) were factors independently associated with HIV co-infection.

Conclusion:

there was a high prevalence of HIV co-infection in the service analyzed, disproportionately affecting MSM who were notified with acquired syphilis.

Keywords:
Epidemiological Surveillance; Syphilis; Sexually Transmitted Diseases; HIV Infections; Cross-Sectional Studies

Characteristics	STD/TCC^a		PLHA^b		Total
Characteristics	n	%	n	%	N	%
Sex
Female	11	3.0	3	1.0	14	2.2
Male	351	97.0	283	99.0	634	97.8
Age group (in years)
≤24	126	35.0	22	7.7	148	22.9
25-34	156	43.0	105	36.7	261	40.3
35-44	54	15.0	93	32..5	147	22.6
≥45	26	7.0	66	23.1	91	14.2
Education level
Elementary School	55	15.2	27	9.4	82	12.7
High School	121	33.4	102	35.7	223	34.4
Complete or incomplete Higher education	161	44.5	147	51.4	308	47.5
Unknown	25	6.9	10	3.5	35	5.4
Ethnicity/self-reported skin color
White	196	54.1	192	67.1	388	59.9
Black	38	10.6	26	9.1	64	9.9
Asian	4	1.1	7	2.5	11	1.7
Brown	88	24.3	53	18.5	141	21.8
Indigenous	3	0.8	4	1.4	7	1.0
Unknown	33	9.1	4	1.4	37	5.7
Total	362	100.0	286	100.0	648	100.0

Characteristics	STD/TCC^a		PLHA^b		Total
Characteristics	n	%	n	%	N	%
Clinical Classification
Primary	53	14.6	28	9.8	81	12.5
Secondary	115	31.8	80	28.0	195	30.1
Asymptomatic	194	53.6	175	61.2	369	56.9
Unknown	-	-	3	1.0	3	0.5
Result of non-treponemal serology
Title <1/32	33	9.1	28	9.8	61	9.4
Title ≥1/32	329	90.9	258	90.2	587	90.6
Serology status for human immunodeficiency virus (HIV) ^c
Non-reagent	279	77.1	2	0.7	281	43.5
Reagent	82	22.7	284	99.3	366	56.5
Gender identity
Transvestite	25	6.9	8	2.8	33	5.1
Transsexual woman	12	3.3	6	2.1	18	2.8
Transsexual man	2	0.6	-	-	2	0.3
Not applicable	310	85.6	250	87.4	560	86.4
Unknown	13	3.6	22	7.7	35	5.4
Multiple sexual partners in the prior year
Yes	257	71.0	136	47.6	393	60.6
No	75	20.7	61	21.3	136	21.0
Unknown	30	8.3	89	31.1	119	18.4
Exposure category
Heterosexual	53	14.7	16	5.6	69	10.6
MSM^d	306	84.5	265	92.7	571	88.1
Unknown	3	0.8	5	1.7	8	1.2
Use of injectable drugs in the prior year
Yes	5	1.4	5	1.7	10	1.5
No	281	77.6	200	69.9	481	74.2
Unknown	76	21.0	81	4.0	157	24.3
Use of non-injectable drugs
Yes	181	50.0	105	36.7	286	44.1
No	133	36.7	109	38.1	242	37.3
Unknown	48	13.3	72	25.2	120	6.0
Total	362	100.0	286	100.0	648	100.0

Characteristics	Infection by HIV (n)^a	Total (n)	Infection percentage by HIV (%)	Prevalence ratio	95%CI^b
Sex
Female	3	14	21.4	1.00
Male	363	633	57.3	2.68	1.30;5.50
Age group (in years)
≤24	49	148	33.1	1.00	-
25-34	142	261	54.4	1.64	1.27;2.12
35-44	107	147	72.8	2.19	1.71;2.82
≥45	68	91	74.7	2.26	1.74;2.92
Ethnicity/ self-referenced skin color ^c
White	239	388	61.6	1.00	-
Black	34	64	53.1	0.86	0.67;1.10
Asian	11	11	100	1.62	1.50;1.75
Brown	73	141	51.8	0.84	0.70;1.00
Indigenous	5	7	71.4	1.16	0.72;1.86
Education level (in years of schooling) ^d
0-7	22	56	39.3	1.00	-
≥8	333	556	59.9	1.52	1.09;2.12
Men who have sex with men (MSM) ^e
No	13	55	23.6	1.00	-
Yes	349	585	59.7	2.52	1.77;3.59
Multiple sex partners in the prior year ^f
No	75	136	55.1	1.00	-
Yes	188	392	48.0	0.87	0.72;1.04
Use of non-injectable drugs in the prior year ^g
No	136	242	56.2	1.00	-
Yes	148	285	51.9	0.92	0.78;1.08
Clinical classification ^h
Primary	36	80	45.0	1.00	-
Secondary	105	195	53.8	1.19	0.90;1.57
Asymptomatic	222	369	60.2	1.34	1.03;1.72
Outpatient clinic type
PLHAⁱ	284	286	99.3	1.00	-
STD/TCC^j	82	361	22.7	0.23	0.9; 0.26
Total	366	647	56.6	-	-

Characteristics	Model 1^a			Model 2^b		Model 3^c
Characteristics	Crude prevalence ratio	Adjusted prevalence ratio	95%CI^d	Adjusted prevalence ratio	95%CI^d	Adjusted prevalence ratio	95%CI^d
Sex
Female	1.00	1.00	-	1.00	-	1.00	-
Male	2.68	2.52	0.95;6.59	1.96	1.07;3.59	1.95	1.05;3.61
Age group (in years)
≤24	1.00	1.00	-	1.00	-
25-34	1.64	1.66	1.29;2.13	1.08	0.88;1.33
35-44	2.19	2.34	1.84;2.98	1,11	0.91;1.35
≥45	2.26	2.37	1.84;3.05	1,04	0.86;1.26
Education level (in years of schooling)
0-7	1.00	1.00	-	1.00	-	1.00	-
≥8	1.52	0.95	0.91;1.00	0.96	0.93;0.99	0.96	0.93;0.99
Men who have sex with men (MSM)
No	1.00	1.00	-	1.00	-	1.00	-
Yes	2.52	2.95	1.84;4.71	1.88	1.39;2.57	1.87	1.38;2.53
Outpatient clinic type
PLHA^e	1.00	-	-	1.00	-	1.00	-
STD/TCC^f	0.23	-	-	0.24	0.20;0.30	0.24	0.19;0.29

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Carla Gianna Luppi - Rua Santa Cruz, nº 81, São Paulo, SP, Brasil. CEP: 04121-000. E-mail: cgluppi@yahoo.com.br