title: Results of a 25-year longitudinal analysis of the serologic incidence of syphilis in a cohort of HIV-infected patients with unrestricted access to care.
abstract: BACKGROUND
  The well-described biologic and epidemiologic associations of syphilis and HIV are particularly relevant to the military, as service members are young and at risk for sexually transmitted infections. We therefore used the results of serial serologic testing to determine the prevalence, incidence, and risk factors for incident syphilis in a cohort of HIV-infected Department of Defense beneficiaries.
  
  
  METHODS
  Participants with a positive nontreponemal test at HIV diagnosis that was confirmed on treponemal testing were categorized as prevalent cases, and participants with an initial negative nontreponemal test who subsequently developed a confirmed positive nontreponemal test were categorized as incident cases.
  
  
  RESULTS
  At HIV diagnosis, the prevalence of syphilis was 5.8% (n = 202). A total of 4239 participants contributed 27,192 person-years (PY) to the incidence analysis and 347 (8%) developed syphilis (rate, 1.3/100 PY; [1.1, 1.4]). Syphilis incidence was highest during the calendar years 2006 to 2009 (2.5/100 PY; [2.0, 2.9]). In multivariate analyses, younger age (per 10 year increase hazard ratio [HR], 0.8; [0.8-0.9]), male gender (HR, 5.6; [2.3-13.7]), non-European-American ethnicity (African-American HR, 3.2; [2.5-4.2]; Hispanic HR, 1.9; [1.2-3.0]), and history of hepatitis B (HR, 1.5; [1.2-1.9]) or gonorrhea (HR, 1.4; [1.1-1.8]) were associated with syphilis.
  
  
  CONCLUSIONS
  The significant burden of disease both at and after HIV diagnosis, observed in this cohort, suggests that the cost-effectiveness of extending syphilis screening to at-risk military members should be assessed. In addition, HIV-infected persons continue to acquire syphilis, emphasizing the continued importance of prevention for positive programs.
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Anuradha.ganesan@med.navy.mil
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.forename: Ann
authors.initials: A
authors.lastname: Fieberg
authors.forename: Brian K
authors.initials: BK
authors.lastname: Agan
authors.forename: Tahaniyat
authors.initials: T
authors.lastname: Lalani
authors.forename: Michael L
authors.initials: ML
authors.lastname: Landrum
authors.forename: Glenn
authors.initials: G
authors.lastname: Wortmann
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.forename: Alan R
authors.initials: AR
authors.lastname: Lifson
authors.forename: Grace
authors.initials: G
authors.lastname: Macalino
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000097:blood / Q000191:economics / Q000453:epidemiology*; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000097:blood / Q000191:economics / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult