title: Viral Loads Among HIV-Infected Persons Diagnosed With Primary and Secondary Syphilis in 4 US Cities: New York City, Philadelphia, PA, Washington, DC, and Phoenix, AZ.
abstract: BACKGROUND
  Incident syphilis among HIV-infected persons indicates the ongoing behavioral risk for HIV transmission. Detectable viral loads (VLs) among coinfected cases may amplify this risk.
  
  
  METHODS
  Primary and secondary cases reported during 2009-2010 from 4 US sites were crossmatched with local HIV surveillance registries to identify syphilis case-persons infected with HIV before or shortly after the syphilis diagnosis. We examined HIV VL and CD4 results collected within 6 months before or after syphilis diagnosis for the coinfected cases identified. Independent correlates of detectable VLs (≥200 copies/mL) were determined.
  
  
  RESULTS
  We identified 1675 cases of incident primary or secondary syphilis among persons with HIV. Median age was 37 years; 99.5% were men, 41.1% were African American, 24.5% were Hispanics, and 79.9% of the HIV diagnoses were made at least 1 year before syphilis diagnosis. Among those coinfected, there were no VL results reported for 188 (11.2%); of the 1487 (88.8%) with reported VL results, 809 (54.4%) had a detectable VL (median, 25,101 copies/mL; range, 206-3,590,000 copies/mL). Detectable VLs independently correlated with syphilis diagnosed at younger age, at an sexually transmitted disease clinic, and closer in time to HIV diagnosis.
  
  
  CONCLUSIONS
  More than half of syphilis case-persons identified with HIV had a detectable VL collected within 6 months of the syphilis diagnosis. This suggests virologic and active behavioral risk for transmitting HIV.
authors.affiliation: *Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA; †Arizona Department of Health Services, STD Program, Phoenix, AZ; ‡Maricopa County Department of Public Health, STD Program, Phoenix, AZ; §New York City Department of Health and Mental Hygiene, Long Island City, NY; ‖Philadelphia Department of Public Health, Philadelphia, PA; and ¶HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Washington, DC.
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Taylor
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Newman
authors.forename: Julia A
authors.initials: JA
authors.lastname: Schillinger
authors.forename: Felicia M T
authors.initials: FM
authors.lastname: Lewis
authors.forename: Bruce
authors.initials: B
authors.lastname: Furness
authors.forename: Sarah
authors.initials: S
authors.lastname: Braunstein
authors.forename: Tom
authors.initials: T
authors.lastname: Mickey
authors.forename: Julia
authors.initials: J
authors.lastname: Skinner
authors.forename: Michael
authors.initials: M
authors.lastname: Eberhart
authors.forename: Jenevieve
authors.initials: J
authors.lastname: Opoku
authors.forename: Susan
authors.initials: S
authors.lastname: Blank
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Peterman
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013587:Syphilis / Q000150:complications* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult