Syphilis in HIV-infected mothers and infants: results from the NICHD/HPTN 040 study.
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.


CONCLUSIONS
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.
From the *David Geffen UCLA School of Medicine, Los Angeles, CA; †Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; ‡Westat, Rockville, MD; §Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil; ¶Hospital Geral de Nova Iguaçu, Nova Iguaçu and Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, (Fiocruz), Rio de Janeiro, Brazil; ‖Perinatal HIV Research Unit, University of Witwatersrand/Chris Hani Baragwanath Hospital, Johannesburg, South Africa; **Stellenbosch University/Tygerberg Hospital, Cape Town, South Africa; ††Hospital Conceicao, Porto Alegre, RS, Brazil; ‡‡Hospital Femina, Porto Alegre, RS, Brazil; §§Irmandade da Santa Casa de Misericordia de Porto Alegre, RS, Brazil; ¶¶Federal University of Minas Gerais, Belo Horizonte, MG, Brazil; ‖‖Universidade de Sao Paulo, Ribeirao Preto, SP, Brazil; ***Foundation for Maternal and Infant Health (FUNDASAMIN), Buenos Aires, Argentina; †††Escola Paulista de Medicine-Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil; and ‡‡‡Laboratório de Pesquisa Clínica em DST e AIDS - Instituto de Pesquisa Clínica Evandro Chagas - Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
Nava
N
Yeganeh
Heather D
HD
Watts
Margaret
M
Camarca
Gabriel
G
Soares
Esau
E
Joao
Jose Henrique
JH
Pilotto
Glenda
G
Gray
Gerhard
G
Theron
Breno
B
Santos
Rosana
R
Fonseca
Regis
R
Kreitchmann
Jorge
J
Pinto
Marisa
M
Mussi-Pinhata
Mariana
M
Ceriotto
Daisy Maria
DM
Machado
Beatriz
B
Grinzstejn
Beatriz
B
Grinsztejn
Valdilea G
VG
Veloso
Mariza G
MG
Morgado
Yvonne
Y
Bryson
Lynne M
LM
Mofenson
Karin
K
Nielsen-Saines
D000328:Adult; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012307:Risk Factors; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology*; D013590:Syphilis, Congenital / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult