title: Risk factors associated with prevalent and incident syphilis among an HIV-infected cohort in Northeast China.
abstract: BACKGROUND
  Sexually transmitted infections (STIs) increase HIV infectivity through local inflammatory processes. Prevalent and incident STIs among people who live with HIV/AIDS (PLWHA) are indicators of high-risk sexual behaviors and imply potential spread of HIV. Little is known about the prevalence and incidence of concurrent syphilis and associated risk behaviors among PLWHA in China.
  
  
  METHODS
  A retrospective cohort study was conducted among PLWHA who attended the outpatient clinic of a designated AIDS treatment hospital in Shenyang, China, between March 2009 and May 2013. Physical examinations and syphilis serology were conducted at each visit. A questionnaire on demographic characteristics was also collected.
  
  
  RESULTS
  A total of 1010 PLWHA were enrolled, of whom 77.0% were men who have sex with men (MSM). The baseline syphilis prevalence among PLWHA was 19.8% (95% confidence interval [CI]:17.3-22.3%). During follow-up, 78.3% retained in the cohort, and contributed a median follow-up of 9.4 months (interquartile range: 5.9-18.7 months). Syphilis incidence among PLWHA was 18.7 (95% CI: 15.5-21.8) per 100 person years. Mulitvariate logistic analysis showed that receiving antiretroviral therapy (ART) (adjusted OR [aOR] = 0.48), older age (≥40 years vs. ≤24 years, aOR = 2.43), being MSM (aOR = 2.30) and having higher baseline HIV viral load (>100,000 copies/mL vs. ≤100,000 copies/mL, aOR = 1.56) were independent predictors for syphilis infection among PLWHA at enrollment (p < 0.05 for all). Mulivariate Cox regression found that receiving ART (adjusted hazard ratio [aHR] = 1.81), older age (≥40 years vs. ≤24 years, aHR: 5.17) and MSM status (aHR = 2.68) were independent risk factors for syphilis seroconversion (each p < 0.05).
  
  
  CONCLUSIONS
  Syphilis prevalence and incidence were high among PLWHA in Shenyang. A campaign focusing on detection and treatment of syphilis among PLWHA is urgently needed, especially one with a focus on MSM who are at a higher risk for syphilis.
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. qinghaihucn@gmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. qinghaihucn@gmail.com.
authors.forename: Qing-hai
authors.initials: QH
authors.lastname: Hu
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. xjjbeijing@gmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. xjjbeijing@gmail.com.
authors.forename: Jun-jie
authors.initials: JJ
authors.lastname: Xu
authors.affiliation: School of Public Health and Community Medicine, The University of New South Wales, Sydney, 2052, Australia. rolfe1234@gmail.com.
authors.forename: Hua-chun
authors.initials: HC
authors.lastname: Zou
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. lj_sycmu@163.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. lj_sycmu@163.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. zhangjing1985zj@hotmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. zhangjing1985zj@hotmail.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. ding_haibo@126.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. ding_haibo@126.com.
authors.forename: Hai-bo
authors.initials: HB
authors.lastname: Ding
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA. han-zhu.qian@vanderbilt.edu.
authors.forename: Han-Zhu
authors.initials: HZ
authors.lastname: Qian
authors.affiliation: English Department, University of Tennessee at Chattanooga, Chattanooga, TN, USA. gglsr@hotmail.com.
authors.forename: Si-ruo
authors.initials: SR
authors.lastname: Li
authors.affiliation: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA. yu.liu@vanderbilt.edu.
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. jiang_yongjun_jc@hotmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. jiang_yongjun_jc@hotmail.com.
authors.forename: Yong-jun
authors.initials: YJ
authors.lastname: Jiang
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. hongshang100@hotmail.com.|Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China. hongshang100@hotmail.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Shang
authors.affiliation: Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, 110001, P. R. China. wangnbj@163.com.|National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. wangnbj@163.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D060085:Coinfection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*