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

Authors :
Yeganeh N
Watts HD
Camarca M
Soares G
Joao E
Pilotto JH
Gray G
Theron G
Santos B
Fonseca R
Kreitchmann R
Pinto J
Mussi-Pinhata M
Ceriotto M
Machado DM
Grinzstejn B
Veloso VG
Morgado MG
Bryson Y
Mofenson LM
Nielsen-Saines K
Source :
The Pediatric infectious disease journal [Pediatr Infect Dis J] 2015 Mar; Vol. 34 (3), pp. e52-7.
Publication Year :
2015

Abstract

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.<br />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.<br />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 titersā‰„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.<br />Conclusion: 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.

Details

Language :
English
ISSN :
1532-0987
Volume :
34
Issue :
3
Database :
MEDLINE
Journal :
The Pediatric infectious disease journal
Publication Type :
Academic Journal
Accession number :
25742089
Full Text :
https://doi.org/10.1097/INF.0000000000000578