The High Risk of an HIV Diagnosis Following a Diagnosis of Syphilis: A Population-level Analysis of New York City Men.

Background: Epidemiologic studies have shown that syphilis is associated with risk for human immunodeficiency virus (HIV) infection. We used population-level syphilis and HIV data to quantify HIV incidence among men following primary or secondary (P&S) syphilis diagnoses and identify the highest-risk subgroups for intensified prevention, such as pre-exposure prophylaxis with antiretroviral medications. Methods: Male cases reported to theNewYorkCityHIV/AIDS and Sexually TransmittedDisease (STD) surveillance registries were matched using a deterministic algorithm. We measured HIV incidence following P&S syphilis diagnosed between 2000 and June 2010 and identified risk factors for HIV infection using Cox proportional hazards models. Results: Of 2805 men with syphilis contributing 11 714 person-years of follow-up, 423 (15.1%) acquired HIV; annual incidencewas 3.61%(95%confidence interval [CI], 3.27%, 3.97%).HIV incidencewas high among: men who have sex with men (MSM) (5.56%, 95% CI, 5.02%-6.13%); males with secondary compared with primary syphilis (4.10% vs 2.64%, P < .0001); and males diagnosed with another bacterial STD after syphilis (7.89%, 95% CI, 6.62%-9.24%). Conclusions: HIV incidence amongmen diagnosed with syphilis is high; one in 20MSMwere diagnosed withHIV within a year. Our data have implications for syphilis and HIV screening and may be useful for further targeting HIVnegative populations for pre-exposure prophylaxis. [ABSTRACT FROM AUTHOR]